Objective To assess the long term implications of four alternative approach
es to postpartum perineal repair.
Design A stratified randomised controlled trial using a 2x2 factorial desig
n.
Setting Original recruitment at the Maternity Unit at Ipswich Hospital NHS
Trust, a district general hospital, between 1992 and 1994. Sample Seven hun
dred and ninety three women who had participated in the Ipswich Childbirth
Study - a trial among women who had required repair of episiotomy or first
or second degree tears - at least one year previously.
Methods Self-completed postal follow up at Least one year after recruitment
to trial comparing 1. two-stage repair leaving the skin unsutured with sta
ndard three-stage repair, and 2. polyglactin 910 with chronic catgut as sut
ure material for the repair.
Main outcome measures Failure. to resume pain-free intercourse; persistent
perineal pain; perineum feeling different; resuturing; time to resume pain-
free intercourse: and dyspareunia.
Results Fewer women allocated two-stage repair reported that the perineum f
elt different (30% versus 40%; RR 0.75; 95% CI 0.61 to 0.91; 2P < 0.01); ot
herwise there were no clear differences between the two methods, Women allo
cated polyglactin 910 were less likely to have dyspareunia (8% versus 13%;
RR 0.59, 95% CI 0,39 to 0.91; 2P = 0.02) and less likely to fail to resume
pain-free intercourse (8% versus 14%; RR 0.57, 95% CI 0.38 to 0.87; 2P < 0.
01).
Conclusion Two-stage repair of perineal trauma leaving the skin unsutured a
ppears to reduce the likelihood of the perineum felling different from befo
re delivery. in addition to less pain and dyspareunia initially; there were
no apparent disadvantages. Polyglactin 910 reduces dyspareunia long term,
indicating that the short term benefits of this material over chromic catgu
t persist.