The Ipswich childbirth study: one year follow up of alternative methods used in perineal repair

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 chronic 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 felling 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.