Continuous and interrupted suturing techniques for .[Intervention Review] Continuous and interrupted

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Transcript of Continuous and interrupted suturing techniques for .[Intervention Review] Continuous and interrupted

  • Continuous and interrupted suturing techniques for repair of

    episiotomy or second-degree tears (Review)

    Kettle C, Dowswell T, Ismail KMK

    This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library

    2012, Issue 11

    http://www.thecochranelibrary.com

    Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears (Review)

    Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

    http://www.thecochranelibrary.com

  • T A B L E O F C O N T E N T S

    1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    2BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    3OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    3METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    7RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    13DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    14AUTHORS CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    14ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    14REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    16CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    41DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    Analysis 1.1. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 1

    Short-term pain - up to day 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

    Analysis 1.2. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 2

    Analgesia - up to day 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

    Analysis 1.3. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 3

    Dyspareunia - up to 3 months postpartum. . . . . . . . . . . . . . . . . . . . . . . . 45

    Analysis 1.4. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 4

    Re-suturing - up to 3 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

    Analysis 1.5. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 5

    Long-term pain - up to 3 months postpartum. . . . . . . . . . . . . . . . . . . . . . . 47

    Analysis 1.6. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 6

    Failure to resume pain-free intercourse - 3 months postpartum. . . . . . . . . . . . . . . . . 48

    Analysis 1.7. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 7

    Removal of suture material - up to 3 months postpartum. . . . . . . . . . . . . . . . . . . 49

    Analysis 1.8. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 8

    Suture material use (used 2 or more packets of suturing material). . . . . . . . . . . . . . . . . 50

    Analysis 1.9. Comparison 1 Continuous versus interrupted sutures for repair of all layers or perineal skin only, Outcome 9

    Time taken to carry out the repair (minutes). . . . . . . . . . . . . . . . . . . . . . . . 51

    Analysis 2.1. Comparison 2 Subgroup analysis: continuous versus interrupted (all layers or skin only)), Outcome 1 Short-

    term pain - up to day 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

    Analysis 2.2. Comparison 2 Subgroup analysis: continuous versus interrupted (all layers or skin only)), Outcome 2

    Analgesia - up to day 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

    Analysis 2.3. Comparison 2 Subgroup analysis: continuous versus interrupted (all layers or skin only)), Outcome 3

    Dyspareunia - up to 3 months postpartum. . . . . . . . . . . . . . . . . . . . . . . . 54

    Analysis 3.1. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 1 Short-term pain: number

    of women with perineal pain (up to 48 hours). . . . . . . . . . . . . . . . . . . . . . . 55

    Analysis 3.2. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 2 Short-term pain up to

    14 days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

    Analysis 3.3. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 3 Analgesia use up to 10

    days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

    Analysis 3.4. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 4 Dyspareunia up to 3

    months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

    Analysis 3.5. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 5 Long-term pain (up to 3

    months). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

    Analysis 3.6. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 6 Failure to resume pain-

    free intercourse up to 3 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

    Analysis 3.7. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 7 Wound gaping (< 0.5

    cm) up to 10 days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

    iContinuous and interrupted suturing techniques for repair of episiotomy or second-degree tears (Review)

    Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

  • Analysis 3.8. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 8 Wound re-sutured up to

    3 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

    Analysis 3.9. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 9 Removal of suture

    material up to 3 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

    Analysis 3.10. Comparison 3 Three-stage versus two-stage (skin not sutured) approach, Outcome 10 Time (in minutes)

    taken to carry out the repair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

    Analysis 4.1. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 1 Short-term pain

    (up to day 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

    Analysis 4.2. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 2 Short-term pain (at

    12 hours after the repair). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

    Analysis 4.3. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 3 Analgesia use up to

    10 days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

    Analysis 4.4. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 4 Dyspareunia up to

    3 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

    Analysis 4.5. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 5 Re-suturing up to 3

    months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

    Analysis 4.6. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 6 Superficial skin

    gaping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

    Analysis 4.7. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 7 Removal of suture

    material - up to 3 months postpartum. . . . . . . . . . . . . . . . . . . . . . . . . . 67

    Analysis 4.8. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 8 Time (minutes)

    taken to carry out the repair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

    Analysis 4.9. Comparison 4 Other techniques using continuous versus interrupted sutures, Outcome 9 Satisfied with

    repair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

    68WHATS NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    68HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    69CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    69DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    69SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    70DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . .

    70INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    iiContinuous and interrupted suturing techniques for repair of episiotomy or second-degree tears (Review)

    Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

  • [Intervention Review]

    Continuous and interrupted suturing techniques for repair ofepisiotomy or second-degree tears

    Christine Kettle1, Therese Dowswell2, Khaled MK Ismail3

    1Staffordshire University, Beaconside, UK. 2Cochrane Pregnancy and Childbirth Group, Department of Wome