Clinical and Aesthetic Review of Episiotomy Wound Closure Methods.

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Published: Oct 21, 2023
DOI: https://doi.org/10.47191/ijmscrs/v3-i10-50
Keywords:
episiotomy, perineal tear, wound closure, continuous sutures, interrupted sutures, scar, post-partum pain, suture materials, aesthetic outcome.

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Ahmad Fawzy
Department of Plastic Surgery, University of Jenderal Soedirman – Margono Soekarjo County Hospital, Indonesia
Indah Fauziah
Obstetric and Gynecology Department, Kramat 128 Hospital, Indonesia
Ismiralda Oke Putranti
Department of Dermatology and Venereology, University of Jenderal Soedirman – Wijayakusuma Army Hospital, Indonesia

Abstract

An episiotomy is a surgical incision in the perineum to facilitate the baby's head during delivery. Physicians or midwives may use this procedure if he/she finds out the tissue around the vaginal opening begins tearing or does not seem to be stretching enough to allow the baby to be delivered. With an increasing trend for hospital births and for physicians to get involved in the normal uncomplicated birth process, there was rise in the number of episiotomies. After the baby is delivered through the extended vaginal opening, the area is applied with local anesthetic agent and incision is repaired with sutures. Our study reviewed the development in the past twenty years regarding episiotomy wound closure methods, and discovered that continuous sutures for episiotomy or perineal repair have clinical advantages in term of faster and better wound healing, more favorable scarring, shorter post-procedural pain, more rapid resumption of sexual activity, lower incidence of urinary incontinence, compared to interrupted sutures. They were also beneficial in term of less consumption of suture materials. In determining suture materials, clinicians should strongly consider the tear severity, tissue characteristics, as well as the desired aesthetic outcome.

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How to Cite
Ahmad Fawzy, Indah Fauziah, & Ismiralda Oke Putranti. (2023). Clinical and Aesthetic Review of Episiotomy Wound Closure Methods. International Journal of Medical Science and Clinical Research Studies, 3(10), 2368–2376. https://doi.org/10.47191/ijmscrs/v3-i10-50
Issue
Vol. 3 No. 10 (2023): Volume 03 Issue 10 October 2023
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Articles
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This work is licensed under a Creative Commons Attribution 4.0 International License.

References

I. Barjon K, Mahdy H. Episiotomy. [Updated 2022 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546675/

II. Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD000081. DOI: 10.1002/14651858.CD000081.pub2. Update in: Cochrane Database Syst Rev. 2017 Feb 08;2:CD000081.

III. Goh R, Goh D, Ellepola H. Perineal tears - A review. Aust J Gen Pract. 2018 Jan-Feb;47(1-2):35-38. DOI: 10.31128/AFP-09-17-4333.

IV. Priddis H, Dahlen HG, Schmied V, Sneddon A, Kettle C, Brown C, Thornton C. Risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma in a first birth in New South Wales between 2000-2008: a population based data linkage study. BMC Pregnancy Childbirth. 2013 Apr 08;13:89.

V. Klein MC, Gauthier RJ, Jorgensen SH, Robbins JM, Kaczorowski J, Johnson B, Corriveau M, Westreich R, Waghorn K, Gelfand MM, et al. Does episiotomy prevent perineal trauma and pelvic floor relaxation? Online J Curr Clin Trials. 1992 Jul 1;Doc No 10:[6019 words; 65 paragraphs]. DOI: 10.1097/00006254-199404000-00008.

VI. de Tayrac R, Panel L, Masson G, Mares P. Episiotomie et prévention des lésions pelvi-périnéales [Episiotomy and prevention of perineal and pelvic floor injuries]. J Gynecol Obstet Biol Reprod (Paris). 2006 Feb;35(1 Suppl):1S24-1S31. French.

VII. Kalis V, Laine K, de Leeuw JW, Ismail KM, Tincello DG. Classification of episiotomy: towards a standardisation of terminology. BJOG. 2012 Apr;119(5):522-6.

VIII. Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to mothers III - pregnancy and birth: report of the Third National U.S. Survey of Women´s Childbearing Experiences [Internet] New York: Childbirth Connection; 2013. pp. 28–33. https://correio.usp.br/service/home/~/Declercq_2013%20Listening%20to%20MothersSM%20III%20Nadir.pdf?auth=co&loc=pt_BR&id=26463&part=2S

IX. Kettle C, Hills RK, Ismail KM. Continuous versus interrupted sutures for repair of episiotomy or second degree tears. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000947. DOI: 10.1002/14651858.CD000947.pub2.

X. Kettle C, Dowswell T, Ismail KM. Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears. Cochrane Database Syst Rev. 2012 Nov 14;11(11):CD000947. DOI: 10.1002/14651858.CD000947.pub3.

XI. Kamel A, Khaled M. Episiotomy and obstetric perineal wound dehiscence: beyond soreness. J Obstet Gynaecol. 2014 Apr;34(3):215-7. DOI: 10.3109/01443615.2013.866080. Epub 2014 Jan 31.

XII. Dudley L, Kettle C, Ismail K. Prevalence, pathophysiology and current management of dehisced perineal wounds following childbirth. Br J Midwifery. 2013;21(3):160–171.

XIII. Salmanov AG, Voitok TG, Maidannyk IV, Vdovychenko SY, Chorna OО, Marushchenko YL, et al. Episiotomy infections in the puerperium and antimicrobial resistance of responsible pathogens in Ukraine. Wiad Lek. 2020;73(11):2325-2331.

XIV. Sultan AH, Thakar R, Ismail KM, Kalis V, Laine K, Räisänen SH, et al. The role of mediolateral episiotomy during operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:192-196.

XV. Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017 Feb 08;2:CD000081.

XVI. Marty N, Verspyck E. [Perineal tears and episiotomy: Surgical procedure - CNGOF perineal prevention and protection in obstetrics guidelines]. Gynecol Obstet Fertil Senol. 2018 Dec;46(12):948-967.

XVII. Shmueli A, Gabbay Benziv R, Hiersch L, Ashwal E, Aviram R, Yogev Y, et al. Episiotomy - risk factors and outcomes. J Matern Fetal Neonatal Med. 2017 Feb;30(3):251-256.

XVIII. Almeida SFS, Riesco MLG. Randomized controlled clinical trial on two perineal trauma suture techniques in normal delivery. Rev. Latino-Am. Enfermagem. 2008;16(2):272–279.

XIX. Way S. Episiotomy and body image. Mod Midwife. 1996 Sep;6(9):18-9.

XX. Ketcham KR, Pastorek JG 2nd, Letellier RL. Episiotomy repair: chromic versus polyglycolic acid suture. South Med J. 1994 Apr;87(4):514-7. DOI: 10.1097/00007611-199404000-00018.

XXI. Gillanders SL, Anderson S, Mellon L, Heskin L. A systematic review and meta-analysis: Do absorbable or non-absorbable suture materials differ in aesthetic outcomes in patients requiring primary closure of facial wounds? J Plast Reconstr Aesthet Surg. 2018 Dec;71(12):1682-1692. DOI: 10.1016/j.bjps.2018.08.027.

XXII. Nikolov A, Dimitrov A, Raicheva R. Tekhnika s prod'lzhitelen shev za v'zstanoviavane na epiziotomii [A technique of continuous sutures for reconstruction of episiotomies]. Akush Ginekol (Sofiia). 2001;40(4):7-11. Bulgarian.

XXIII. Harn HI, Ogawa R, Hsu CK, Hughes MW, Tang MJ, Chuong CM. The tension biology of wound healing. Exp Dermatol. 2019 Apr;28(4):464-471. DOI: 10.1111/exd.13460. Epub 2017 Dec 20. PMID: 29105155.

XXIV. Son D, Harijan A. Overview of surgical scar prevention and management. J Korean Med Sci. 2014 Jun;29(6):751-7. DOI: 10.3346/jkms.2014.29.6.751. Epub 2014 May 30. PMID: 24932073; PMCID: PMC4055805.

XXV. Berginc-Sormaz G. Dehiscencija epiziotomije [Dehiscence in episiotomies]. Jugosl Ginekol Opstet. 1979;19(1-2):107-12. Croatian. PMID: 550014.

XXVI. Graczyk S, Limanowski M, Wyduba M. Zeszycie nacietego krocza--porównanie dwóch technik w aspekcie klinicznym i kosmetycznym [Suture of the episiotomy wound--comparison of two techniques from clinical and aesthetic aspects]. Ginekol Pol. 1998 Jan;69(1):6-11. Polish. PMID: 9553315.

XXVII. Morano S, Mistrangelo E, Pastorino D, Lijoi D, Costantini S, Ragni N. A randomized comparison of suturing techniques for episiotomy and laceration repair after spontaneous vaginal birth. J Minim Invasive Gynecol. 2006 Sep-Oct;13(5):457-62. DOI: 10.1016/j.jmig.2006.06.006. PMID: 16962532.

XXVIII. Valenzuela P, Saiz Puente MS, Valero JL, Azorín R, Ortega R, Guijarro R. Continuous versus interrupted sutures for repair of episiotomy or second-degree perineal tears: a randomised controlled trial. BJOG. 2009 Feb;116(3):436-41. DOI: 10.1111/j.1471-0528.2008.02056.x.

XXIX. Kokanalı D, Ugur M, Kuntay Kokanalı M, Karayalcın R, Tonguc E. Continuous versus interrupted episiotomy repair with monofilament or multifilament absorbed suture materials: a randomised controlled trial. Arch Gynecol Obstet. 2011 Aug;284(2):275-80. DOI: 10.1007/s00404-010-1620-0.

XXX. Aslam R, Khan SA, ul Amir Z, Amir F. Interrupted versus continuous sutures for repair of episiotomy or 2nd degree perineal tears. J Ayub Med Coll Abbottabad. 2015 Jul-Sep;27(3):680-3.

XXXI. Martínez-Galiano JM, Arredondo-López B, Molina-Garcia L, Cámara-Jurado AM, Cocera-Ruiz E, Rodríguez-Delgado M. Continuous versus discontinuous suture in perineal injuries produced during delivery in primiparous women: a randomized controlled trial. BMC Pregnancy Childbirth. 2019 Dec 16;19(1):499. DOI: 10.1186/s12884-019-2655-2.

XXXII. Aydın Besen M, Rathfisch G. The effect of suture techniques used in repair of episiotomy and perineal tear on perineal pain and dyspareunia. Health Care Women Int. 2020 Jan;41(1):22-37. DOI: 10.1080/07399332.2019.1663194.

XXXIII. Sanson C, Papin S, Pierre F, Gachon B. Perineal suture practices. Are they up to date with the evidence based medicine data: A local experience into a university maternity? J Gynecol Obstet Hum Reprod. 2020 May;49(5):101634. DOI: 10.1016/j.jogoh.2019.101634.

XXXIV. Grant A. The choice of suture materials and techniques for repair of perineal trauma: an overview of the evidence from controlled trials. Br J Obstet Gynaecol. 1989 Nov;96(11):1281-9. DOI: 10.1111/j.1471-0528.1989.tb03225.x. PMID: 2558706.

XXXV. Kettle C, Dowswell T, Ismail KM. Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database Syst Rev. 2010 Jun 16;2010(6):CD000006. DOI: 10.1002/14651858.CD000006.pub2.

XXXVI. Livingstone E, Simpson D, Naismith WC. A comparison between catgut and polyglycolic acid sutures in episiotomy repair. J Obstet Gynaecol Br Commonw. 1974 Mar;81(3):245-7. DOI: 10.1111/j.1471-0528.1974.tb00453.x.

XXXVII. Bänninger U, Bührig H, Schreiner WE. Vergleichende Studie über die Verwendung von Polyglykolsäure (Dexon) und Chromcatgut als Nahtmaterial bei der Episiotomienaht [A comparison between chromic catgut and polyglycolic acid sutures in episiotomy repair (author's transl)]. Geburtshilfe Frauenheilkd. 1978 Jan;38(1):30-3. German.

XXXVIII. Nikolov A, Dimitrov A, Iliev D, Krŭsteva K. [Repair of episiotomies with synthetic suture material]. Akush Ginekol (Sofiia). 2006;45(7):12-5. Bulgarian.

XXXIX. Dencker A, Lundgren I, Sporrong T. Suturing after childbirth--a randomised controlled study testing a new monofilament material. BJOG. 2006 Jan;113(1):114-6. DOI: 10.1111/j.1471-0528.2005.00803.x.