BACKGROUND: Some birth trauma lacerations after vaginal delivery benefit from suture repair because of size or association with ongoing bleeding. Other lacerations are trivial and can be left to heal without intervention. This study was done to compare the outcomes of suture repair of minor lacerations with the outcomes following spontaneous healing.
POPULATION STUDIED: A total of 80 women delivered by midwives in a large university hospital in Sweden were enrolled. The total number of eligible patients who did not participate was not stated. Inclusion criteria required lacerations of the labia minora, vagina, or perineum that did not bleed, fell well together, and were less than 2 cm deep or 2 cm long. Whether some lacerations were too small for inclusion in the study was not stated.
STUDY DESIGN AND VALIDITY: Using sealed opaque envelopes to conceal allocation assignment, eligible subjects were randomized to either a spontaneous healing or suture group. Patients were enrolled between the time of delivery and time of repair. Suturing was performed with polyglycolic acid under topical or pudendal block anesthesia. Healing was evaluated at 2 to 3 days and at 8 weeks by clinical examination, and at 6 months by questionnaire. Two patients in the suture group were withdrawn from analysis because a nonstudy suture material was used. Study groups were comparable in age, labor characteristics, birth weights, labor analgesia used, oxytocin use, and birth positions. Only one woman was delivered in the lithotomy position. Outcomes assessment blinding was not possible, because the observer could easily tell whether suturing had been performed. Power was calculated to achieve a 95% confidence of detecting a 20% difference in effect between the 2 groups.
OUTCOMES MEASURED: Primary outcome measures were healing by visual inspection, discomfort, and return to sexual intercourse. Secondary outcome measures were duration of breastfeeding and patient perceived effect of the laceration on breastfeeding.
RESULTS: There were a total of 87 lacerations in the 40 patients in the nonsutured group and 74 lacerations in the 38 patients in the sutured group. At 2 to 3 days, 11 of 87 lacerations in the nonsutured group had minor problems in healing compared with 4 of 74 lacerations in the sutured group (nonsignificant difference). At 8 weeks, 8 of 87 lacerations in the nonsutured group had minor problems in healing compared with 8 of 74 lacerations in the sutured group (nonsignificant difference). More women in the sutured group reported using analgesic drugs for perineal pain. There were no differences in return to intercourse or duration of breastfeeding. Five patients in the sutured group had sutures removed because of annoyance. Sixteen percent of the women in the sutured group perceived that breastfeeding was affected by the laceration, while none of the women in the nonintervention group perceived an effect (P=.04; number needed to harm=6.3).
Suturing minor nonbleeding postpartum lacerations (<2 cm long and <2 cm deep) does not improve healing rates or decrease perineal discomfort. Clinicians not in the habit of suturing small lacerations need not begin doing so. Those who suture all lacerations can safely leave minor lacerations untouched. Appropriate repair of larger lacerations was not addressed by this study.