Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention

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Title Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention
Author Elharmeel, Suzan MA; Chaudhary, Yasmin; Tan, Stephanie; Scheermeyer, Elly; Hanafy, Ashraf; Driel, Mieke L van
Journal Name Cochrane Database of Systematic Reviews
Year Published 2011
Place of publication United Kingdom
Publisher John Wiley & Sons Ltd.
Abstract Background Perineal tears commonly occur during childbirth. They are sutured most of the time. Surgical repair can be associated with adverse outcomes, such as pain, discomfort and interference with normal activities during puerperium and possibly breastfeeding. Surgical repair also has an impact on clinical workload and human and financial resources. Objectives To assess the evidence for surgical versus non-surgical management of first- and second-degree perineal tears sustained during childbirth. Search strategy We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 May 2011), CENTRAL (The Cochrane Library 2011, Issue 2 of 4) and MEDLINE (Jan 1966 to 2 May 2011). We also searched the reference lists of reviews, guidelines and other publications and contacted authors of identified eligible trials. Selection criteria Randomised controlled trials (RCTs) investigating the effect on clinical outcomes of suturing versus non-suturing techniques to repair first- and second-degree perineal tears sustained during childbirth. Data collection and analysis Two review authors independently assessed trials for inclusion and assessed trial quality. Three review authors independently extracted data. Main results We included two RCTs (involving 154 women) with a low risk of bias. It was not possible to pool the available studies. The two studies do not consistently report outcomes defined in the review. However, no significant differences were observed between the two groups (surgical versus non-surgical repair) in incidence of pain and wound complications, self-evaluated measures of pain at hospital discharge and postpartum and re-initiation of sexual activity. Differences in the use of analgesia varied between the studies, being high in the sutured group in one study. The other trial showed differences in wound closure and poor wound approximation in the non-suturing group, but noted incidentally also that more women were breastfeeding in this group. Authors' conclusions There is limited evidence available from RCTs to guide the choice between surgical or non-surgical repair of first- or second-degree perineal tears sustained during childbirth. Two studies find no difference between the two types of management with regard to clinical outcomes up to eight weeks postpartum. Therefore, at present there is insufficient evidence to suggest that one method is superior to the other with regard to healing and recovery in the early or late postnatal periods. Until further evidence becomes available, clinicians' decisions whether to suture or not can be based on their clinical judgement and the women's preference after informing them about the lack of long-term outcomes and the possible chance of a slower wound healing process, but possible better overall feeling of well being if left un-sutured.
Peer Reviewed Yes
Published Yes
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Copyright Statement Copyright 2011 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2011, Issue. 8. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.
Volume 2011
Issue Number 8
Page from 1
Page to 21
ISSN 1469-493X
Date Accessioned 2012-02-02
Language en_US
Faculty Griffith Health Faculty
Subject Medical and Health Sciences
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1x

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