Divya, Selvaraju (2013) Comparative study of Episiotomy Repair: Absorbable Synthetic Versus Chromic Catgut Suture material. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Perineal trauma is the most commonly encountered surgery in the day-today practice of an obstetrician. It can be either a spontaneous tear or a surgical (episiotomy) enlargement of the pelvic soft tissue outlet during the last phase of second stage of labor or delivery. The first surgical opening of the perineum in order to prevent severe perineal tear was suggested by Ould, in 1741. However, the first publication in a medical journal about episiotomy was only in 1810. Prevalence of the episiotomy varies around the world depending on whether it is used as a routine or a restricted procedure. Rates vary from 8% in the Netherlands, 13% in England to 25% in USA. The rates are still higher in developing countries, like ours, since the use of restricted episiotomy is not being practiced widely in primigravidas. Although the Cochrane Database Review has now recommended the practice of restrictive episiotomy, routine use of it still continues in most of our maternity units. Prevalence rate of 54.9% and 99% have been reported in West African countries and East European countries respectively. Perineal trauma affects the physical, mental and social well-being of the mother in her peurperium. A large proportion of women suffer short term perineal pain and up to 20% have long term problems like dyspareunia. Other complications involve removal of retained suture material, wound dehiscence and re-suturing. AIM OF THIS STUDY: To compare absorbable synthetic sutures with chromic catgut sutures for episiotomy repair with respect to pain, analgesic requirement, wound dehiscense, removal of residual suture material, long term pain & superficial dyspareunia. PRIMARY OBJECTIVE: Whether the synthetic absorbable suture material is better than the natural absorbable suture material in relieving the postpartum morbidity associated with episiotomy or perineal laceration repair. PRIMARY OUTCOME : Early short term pain ( up to 48 hrs) • Late short term pain ( up to 7 days) • Use of Analgesia. SECONDARY OUTCOME: • Long term pain • Nature of wound healing • Need for re-suturing • Removal of unabsorbed suture material INCLUSION CRITERIA: • All patients with an elective episiotomy • Second degree perineal laceration EXCLUSION CRITERIA : Episiotomy incisions extended by instrumental deliveries • Severe anemia • Diabetes mellitus • On drugs like steroids & immunosuppressant • Epidural labor analgesia • Women whose membranes had ruptured for >24hrs • Patients with foul smelling vaginal discharge. MATERIALS AND METHODS: The study was conducted in Institute of Social Obstetrics and Govt. Kasturba Gandhi Hospital, Triplicane, Chennai-5. This is a prospective, comparative study involving two groups of patients selected randomly as per the inclusion criteria. Each group will have 100 women. A) Polyglactin 910 (Fast-absorbing) – group I, B) Chromic catgut – group II. All women in the reproductive age group, attending the Government Kasturba Gandhi Hospital, who had a normal vaginal delivery, requiring an episiotomy or had a second degree perineal tear, were eligible to enter the trail. Enrolment took place immediately after delivery, after taking their consent. All episiotomies were repaired using the same technique: single continuous sub-cuticular perineal sutures, by the post-graduates. Mothers were interviewed at 48hrs, 7days, 15days, 6 and 12 wks regarding perineal pain perception, analgesic requirement and dysparuenia. Local examination was done for nature of healing. RESULTS AND ANALYSIS: This study commenced with 100 women in each group who underwent episiotomy or perineal laceration repair. None of the patients in our study had epidural analgesia for pain relief in labor. In our study, all the perineal repairs were performed under local anesthesia by the post graduates in the labor ward. Descriptive statistics were utilized and all results are presented in terms of percentages. Categorical data were compared using Chi Square Test or Fischer’s Exact Test if appropriate. Statistical significance was p<0.05. SUMMARY: In this study, the use of a rapidly absorbing form of synthetic absorbable suture material, in the repair of episiotomy or perineal laceration in 100 patients during the study period February 2012 to July 2012, were simultaneously compared with the traditional natural absorbable suture material, at ISO KGH Hospital for Women and Children, Triplicane, Chennai. • The mean age group of the studied women was 21.77 years. The distribution of the women in the age group 21-25 was relatively higher. • Among the studied women, 77.5% were Primi gravida. • With the use of rapidly absorbing polyglactin 910, there was a significant reduction (p=0.000) in the short term pain, 19 compared to 80 in the control group. • When the analgesic requirement was compared on the 7th day, there was significant reduction in the (0%) study group, as compared to the control group (80%). • Analgesic requirement at day 15 was compared and there was significant reduction in the study group (0%), compared to the control group (17%). • With regard to wound dehiscence and the need for resuturing, there was statistically significant difference in the control group (15%), compared to the study group (0%). • There was no statistical significance between the two groups in terms of dyspareunia (12.4% vs. 10.7%). CONCLUSION: Fast-absorbing form of Polyglactin seems to be effective in reducing some of the morbidity associated with perineal repair following childbirth. • There was significant reduction in the short term pain. • There was significant reduction in the need for analgesia • The incidence of wound dehiscence was markedly reduced and hence the need for resuturing. • There was no need for suture removal. Our study shows the distinct advantage of polyglactin (rapidly absorbable) over chromic catgut, as far as subjective pain perception, analgesic requirement, wound dehiscence and re-suturing are concerned. Hence rapidly absorbable form of polyglactin may be considered in place of traditional chromic catgut for perineal repair in all government maternity units.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparative study ; episiotomy repair ; absorbable synthetic ; chromic catgut suture material. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 07:34 |
| Last Modified: | 13 Dec 2017 03:15 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4057 |
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