eISSN: 2377-4304

Obstetrics & Gynecology International Journal

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Received: January 01, 1970 | Published: ,

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Abstract

Introduction: Episiotomy is an incision in perineal area in second stage of labour.

Aim of the work: To detect the effect of interrupted method of skin suturing versus Subcuticular method of episiotomy closure on post delivery echymosis, redness and edema.

Patients and methods: All patients were delivered by normal vaginal delivery and a medio lateral episiotomy was made and then closure of the episiotomy was done using either a subcuticular or interrupted technique according to the group using Vicryl 3-0.

Results: There was no significant difference between the postpartum edema after 7 days in the interrupted group when compared to the continous group with a P value 0.416.

Conclusion: There was no significant difference between the interrupted method of closing episiotomy and subcuticular way on postoperative inflammation.

Introduction

Episiotomy is an incision that is made in perineum at second stage of delivery. There are Long term sequels of episiotomy repair. A considerable number of women experience perineal pain and up to 20 percent have long term sequels e.g., dyspareunia.¹

The best method for repairing episiotomy is the method that is not time consuming and lesser materials and causes lesser pain in the immediate and long term periods. And so helps to start sexual relation early with a lesser pain and has a lower chance for resuturing.²

There was a traditional technique that was used for episiotomy repair with applying 3 layers closure technique.³

Although there are many ways to repair episiotomy, Now two widely used techniques of closure are applied; subcutaneous continuous and interrupted techniques.⁴

Patients and methods

This was a prospective multi centric randomized study that was made in Aljazeerah hospital, Kasr alainy hospital and Helwan university hospitals, Egypt in the period from June 2017 till July 2018.

166 pregnant women were recruited to participate in this study, The Allocation and Randomization; a computer generated randomization table was used for allocation in each study arm implementing a closed envelope system opened by operating room nurse during the time of randomization. The randomization allocation was 1:1. The two groups were randomly selected, 83 in each group. 6 cases dropped out from follow up and did not come to the hospital to follow post delivery, so they were excluded from the study and 160 cases continue the study.

All patients were delivered by normal vaginal delivery and a medio lateral episiotomy was made and then closure of the episiotomy was done using either a subcuticular or interrupted technique according to the group.

In the regular follow up of patients, they were examined to assess echymosis, redness and edema at the episiotomy site 7 days post delivery.

Inclusion criteria, a primigravida pregnant 38 weeks or more with no medical disorders with pregnancy with cephalic presentation, BMI below 25.

Exclusion criteria include preterm delivery, any medical disorders with pregnancy, twin pregnancy, fetuses with malpresentation, previous cesarean section (Figure 1).

Figure 1 Consort flow diagram.

Statistical methods and sample size calculation

Data were coded and entered using the statistical package SPSS version 25. Data was summarized using mean and standard deviation for quantitative variables and frequencies (number of cases) and relative frequencies (percentages) for categorical variables. Comparisons between groups were done using unpaired t test (Chan, 2003).⁵ For comparing categorical data, Chi square (c²) test was performed. Exact test was used instead when the expected frequency is less than 5 (Chan, 2003).⁶ P-values less than 0.05 were considered as statistically significant.^5,6

Sample size was calculation was done using the comparison between subcuticular skin suturing and interrupted suturing on postpartum inflammation of episiotomy as reported in a previous publication made by Alkhafaji ZHH,⁷ the proportion of wound infection in subcuticular skin suturing is 2% while the proportion of wound infection in interrupted suturing is 14.5%, accordingly, we calculated that the minimum proper sample size needed to be 150 patients to be able to reject the null hypothesis with 80% power (β= 0.2) and 95 % significance level (α=0.05 ).sample size was increased to allow for drop out, the total sample size was 200 patients.⁷

Results

The present study was a prospective multi centric randomized study that was made in Aljazeerah hospital, Kasr alainy hospital and Helwan university hospitals, Egypt in the period from June 2017 till July 2018.Among 166 pregnant women that were recruited to participate in this study, the mean value of number of sutures was 7.34 +/- .67 and the mean value of length of delivery was 12.04 +/- 3.11 as mentioned in Table 1.

There were no statistically significant difference between patients of both groups regarding age, BMI, number of sutures, blood loss and length of delivery as demonstrated in Table 2.

The total number of cases that had redness , edema and echymosis was 10 , 15 and 14 cases respectively as shown in Table 3.

The comparative analysis of subcuticular group versus interrupted group as regard post delivery complications is illustrated in Table 4.

	Mean	Standard deviation
Age	28.3	5.25
BMI	21.79	1.8
Length of delivery (hours)	12.04	3.11
Blood loss (CC)	560.63	147.02
Number of sutures	7.34	0.67

Table 1 shows Description of data

		Count	%
Gravidity & parity	multigravida	54	33.80%
Gravidity & parity	primigravida	106	66.20%
Technique of closure	Continous (subcuticular)	80	50.00%
Technique of closure	interrupted	80	50.00%
Redness	yes	10	6.20%
Redness	No	150	93.80%
Edema	yes	15	9.40%
Edema	no	145	90.60%
Echymosis	yes	14	8.80%
Echymosis	no	146	91.20%

Table 2 Shows analysis of cases regarding gravidity, technique of skin closure and presence of complications

		Technique of closure				P value
		Continous (subcuticular)		Interrupted
		Count	%	Count	%
Gravidity & parity	multigravida	28	35.00%	26	32.50%	0.738
Gravidity & parity	primigravida	52	65.00%	54	67.50%	0.738
Redness	yes	6	7.50%	4	5.00%	0.514
Redness	No	74	92.50%	76	95.00%	0.514
Edema	yes	9	11.20%	6	7.50%	0.416
Edema	no	71	88.80%	74	92.50%	0.416
Echymosis	yes	8	10.00%	6	7.50%	0.576
	no	72	90.00%	74	92.50%	0.576

Table 3 Comparison between the 2 groups regarding presence of redness, edema and echymosis

	Technique of closure				P value
	Continous (subcuticular)		Interrupted
	Mean	Standard Deviation	Mean	Standard Deviation
Age	29.08	5.57	27.53	4.83	0.062
BMI	21.62	1.77	21.96	1.83	0.237
Length of delivery (hours)	11.73	3.35	12.35	2.82	0.204
blood loss (CC)	566.25	155.65	555	138.62	0.63
number of sutures	7.4	0.59	7.27	0.75	0.241

Table 4 Shows the mean and standard deviation and P value between 2 groups

Discussion

In the present study, the number of sutures has no statistical significance with a P value 0.241, indicating that there was no difference in presence of redness, echymosis or edema postoperatively with different suture number.

In agreement with our study, South mead perineal suture research found that there was no change between the subcuticular and interrupted sutures results.⁸

In the present study, there was no significant difference between the postpartum edema after 7 days in the interrupted group when compared to the continous group with a P value 0.416.

RCOG 2004 guideline also given level A gradation to the use of continuous subcuticular technique for perineal skin closure and a loose, continuous non locking suturing technique to appose vaginal tissue and perineal muscle as it is associated with less short term pain compared with the interrupted method.⁹

In the present study, there was no significant difference between the postpartum redness after 7 days in the interrupted group when compared to the continous group with a P value 0.514.

In Pakistan, a previous research compared the methods of closure in interrupted and continous closure ways of episiotomy on the 6th and on the 10th day and after delivery. Similar to our results, they did not find a significant difference in the rate of healing of wound.¹⁰

In a previous study made concluded that wound gaping was recorded in 5 women sutured with CC, whereas, none of the women sutured with VR showed gaping of their episiotomy wound.¹¹

Also in the current study, there was no statistical significance between the interrupted method and subcuticular method regarding presence of echymosis 7 days post delivery with a P value 0.576.

Conclusion

Our study revealed that there is no statistically significant difference between the interrupted method of closing episiotomy and subcuticular way on postoperative inflammation.