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Criado em : 02 Aug 2014
Alterado em : 02 Aug 2014

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The Ipswich childbirth study: one year follow up of alternative methods used in perineal repair - BJOG: An International Journal of Obstetrics & Gynaecology - Vol. 108, 1 - ISBN: 1471-0528 - p.34-40

Autores :

Grant, Adrian; Gordon, Beverley; Mackrodat, Carolyn; Fern, Elizabeth; Truesdale, Ann; Ayers, Sarah

Ano de publicação :

2001

URL(s) :

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-…
https://doi.org/10.1111/j.1471-0528.2001.00016.x

Résumé (français)  :

Abstract (English)  :

Objective To assess the long term implications of four alternative approaches to postpartum perineal repair. Design A stratified randomised controlled trial using a 2x2 factorial design. Setting Original recruitment at the Maternity Unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994. Sample Seven hundred 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 standard three-stage repair, and 2. polyglactin 910 with chromic catgut as suture 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 felt different (30% versus 40%; RR 0.75; 95% CI 0.61 to 0.91; 2P<0.01); otherwise there were no clear differences between the two methods. Women allocated 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 appears to reduce the likelihood of the perineum feeling different from before 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 catgut persist.

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Import 02/08/2014 — 02 Aug 2014