Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention

Suzan M. A. Elharmeel, Yasmin Chaudhary, Stephanie Tan, Elly Scheermeyer, Ashraf Hanafy, Mieke L. Van Driel

Research output: Contribution to journalArticleResearchpeer-review

19 Citations (Scopus)

Abstract

Background

Perineal tears commonly occur during childbirth. They are sutured most of the time. Surgical repair can be associated with adverse outcomes, such as pain, discomfort and interference with normal activities during puerperium and possibly breastfeeding. Surgical repair also has an impact on clinical workload and human and financial resources.

Objectives

To assess the evidence for surgical versus non-surgical management of first-and second-degree perineal tears sustained during childbirth.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 May 2011), CENTRAL (The Cochrane Library 2011, Issue 2 of 4) and MEDLINE (Jan 1966 to 2May 2011). We also searched the reference lists of reviews, guidelines and other publications and contacted authors of identified eligible trials.

Selection criteria

Randomised controlled trials (RCTs) investigating the effect on clinical outcomes of suturing versus non-suturing techniques to repair first-and second-degree perineal tears sustained during childbirth.

Data collection and analysis

Two review authors independently assessed trials for inclusion and assessed trial quality. Three review authors independently extracted data.

Main results

We included two RCTs (involving 154 women) with a low risk of bias. It was not possible to pool the available studies. The two studies do not consistently report outcomes defined in the review. However, no significant differences were observed between the two groups (surgical versus non-surgical repair) in incidence of pain and wound complications, self-evaluated measures of pain at hospital discharge and postpartum and re-initiation of sexual activity. Differences in the use of analgesia varied between the studies, being high in the sutured group in one study. The other trial showed differences in wound closure and poor wound approximation in the non-suturing group, but noted incidentally also that more women were breastfeeding in this group.

Authors' conclusions

There is limited evidence available from RCTs to guide the choice between surgical or non-surgical repair of first-or second-degree perineal tears sustained during childbirth. Two studies find no difference between the two types of management with regard to clinical outcomes up to eight weeks postpartum. Therefore, at present there is insufficient evidence to suggest that one method is superior to the other with regard to healing and recovery in the early or late postnatal periods. Until further evidence becomes available, clinicians' decisions whether to suture or not can be based on their clinical judgement and the women's preference after informing them about the lack of long-term outcomes and the possible chance of a slower wound healing process, but possible better overall feeling of well being if left un-sutured.

Original languageEnglish
Article number008534
Number of pages20
JournalCochrane Database of Systematic Reviews
Volume2011
Issue number8
DOIs
Publication statusPublished - 2011
Externally publishedYes

Cite this

Elharmeel, S. M. A., Chaudhary, Y., Tan, S., Scheermeyer, E., Hanafy, A., & Van Driel, M. L. (2011). Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. Cochrane Database of Systematic Reviews, 2011(8), [008534]. https://doi.org/10.1002/14651858.CD008534.pub2
Elharmeel, Suzan M. A. ; Chaudhary, Yasmin ; Tan, Stephanie ; Scheermeyer, Elly ; Hanafy, Ashraf ; Van Driel, Mieke L. / Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. In: Cochrane Database of Systematic Reviews. 2011 ; Vol. 2011, No. 8.
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title = "Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention",
abstract = "BackgroundPerineal tears commonly occur during childbirth. They are sutured most of the time. Surgical repair can be associated with adverse outcomes, such as pain, discomfort and interference with normal activities during puerperium and possibly breastfeeding. Surgical repair also has an impact on clinical workload and human and financial resources.ObjectivesTo assess the evidence for surgical versus non-surgical management of first-and second-degree perineal tears sustained during childbirth.Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 May 2011), CENTRAL (The Cochrane Library 2011, Issue 2 of 4) and MEDLINE (Jan 1966 to 2May 2011). We also searched the reference lists of reviews, guidelines and other publications and contacted authors of identified eligible trials.Selection criteriaRandomised controlled trials (RCTs) investigating the effect on clinical outcomes of suturing versus non-suturing techniques to repair first-and second-degree perineal tears sustained during childbirth.Data collection and analysisTwo review authors independently assessed trials for inclusion and assessed trial quality. Three review authors independently extracted data.Main resultsWe included two RCTs (involving 154 women) with a low risk of bias. It was not possible to pool the available studies. The two studies do not consistently report outcomes defined in the review. However, no significant differences were observed between the two groups (surgical versus non-surgical repair) in incidence of pain and wound complications, self-evaluated measures of pain at hospital discharge and postpartum and re-initiation of sexual activity. Differences in the use of analgesia varied between the studies, being high in the sutured group in one study. The other trial showed differences in wound closure and poor wound approximation in the non-suturing group, but noted incidentally also that more women were breastfeeding in this group.Authors' conclusionsThere is limited evidence available from RCTs to guide the choice between surgical or non-surgical repair of first-or second-degree perineal tears sustained during childbirth. Two studies find no difference between the two types of management with regard to clinical outcomes up to eight weeks postpartum. Therefore, at present there is insufficient evidence to suggest that one method is superior to the other with regard to healing and recovery in the early or late postnatal periods. Until further evidence becomes available, clinicians' decisions whether to suture or not can be based on their clinical judgement and the women's preference after informing them about the lack of long-term outcomes and the possible chance of a slower wound healing process, but possible better overall feeling of well being if left un-sutured.",
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Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. / Elharmeel, Suzan M. A.; Chaudhary, Yasmin; Tan, Stephanie; Scheermeyer, Elly; Hanafy, Ashraf; Van Driel, Mieke L.

In: Cochrane Database of Systematic Reviews, Vol. 2011, No. 8, 008534, 2011.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention

AU - Elharmeel, Suzan M. A.

AU - Chaudhary, Yasmin

AU - Tan, Stephanie

AU - Scheermeyer, Elly

AU - Hanafy, Ashraf

AU - Van Driel, Mieke L.

PY - 2011

Y1 - 2011

N2 - BackgroundPerineal tears commonly occur during childbirth. They are sutured most of the time. Surgical repair can be associated with adverse outcomes, such as pain, discomfort and interference with normal activities during puerperium and possibly breastfeeding. Surgical repair also has an impact on clinical workload and human and financial resources.ObjectivesTo assess the evidence for surgical versus non-surgical management of first-and second-degree perineal tears sustained during childbirth.Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 May 2011), CENTRAL (The Cochrane Library 2011, Issue 2 of 4) and MEDLINE (Jan 1966 to 2May 2011). We also searched the reference lists of reviews, guidelines and other publications and contacted authors of identified eligible trials.Selection criteriaRandomised controlled trials (RCTs) investigating the effect on clinical outcomes of suturing versus non-suturing techniques to repair first-and second-degree perineal tears sustained during childbirth.Data collection and analysisTwo review authors independently assessed trials for inclusion and assessed trial quality. Three review authors independently extracted data.Main resultsWe included two RCTs (involving 154 women) with a low risk of bias. It was not possible to pool the available studies. The two studies do not consistently report outcomes defined in the review. However, no significant differences were observed between the two groups (surgical versus non-surgical repair) in incidence of pain and wound complications, self-evaluated measures of pain at hospital discharge and postpartum and re-initiation of sexual activity. Differences in the use of analgesia varied between the studies, being high in the sutured group in one study. The other trial showed differences in wound closure and poor wound approximation in the non-suturing group, but noted incidentally also that more women were breastfeeding in this group.Authors' conclusionsThere is limited evidence available from RCTs to guide the choice between surgical or non-surgical repair of first-or second-degree perineal tears sustained during childbirth. Two studies find no difference between the two types of management with regard to clinical outcomes up to eight weeks postpartum. Therefore, at present there is insufficient evidence to suggest that one method is superior to the other with regard to healing and recovery in the early or late postnatal periods. Until further evidence becomes available, clinicians' decisions whether to suture or not can be based on their clinical judgement and the women's preference after informing them about the lack of long-term outcomes and the possible chance of a slower wound healing process, but possible better overall feeling of well being if left un-sutured.

AB - BackgroundPerineal tears commonly occur during childbirth. They are sutured most of the time. Surgical repair can be associated with adverse outcomes, such as pain, discomfort and interference with normal activities during puerperium and possibly breastfeeding. Surgical repair also has an impact on clinical workload and human and financial resources.ObjectivesTo assess the evidence for surgical versus non-surgical management of first-and second-degree perineal tears sustained during childbirth.Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 May 2011), CENTRAL (The Cochrane Library 2011, Issue 2 of 4) and MEDLINE (Jan 1966 to 2May 2011). We also searched the reference lists of reviews, guidelines and other publications and contacted authors of identified eligible trials.Selection criteriaRandomised controlled trials (RCTs) investigating the effect on clinical outcomes of suturing versus non-suturing techniques to repair first-and second-degree perineal tears sustained during childbirth.Data collection and analysisTwo review authors independently assessed trials for inclusion and assessed trial quality. Three review authors independently extracted data.Main resultsWe included two RCTs (involving 154 women) with a low risk of bias. It was not possible to pool the available studies. The two studies do not consistently report outcomes defined in the review. However, no significant differences were observed between the two groups (surgical versus non-surgical repair) in incidence of pain and wound complications, self-evaluated measures of pain at hospital discharge and postpartum and re-initiation of sexual activity. Differences in the use of analgesia varied between the studies, being high in the sutured group in one study. The other trial showed differences in wound closure and poor wound approximation in the non-suturing group, but noted incidentally also that more women were breastfeeding in this group.Authors' conclusionsThere is limited evidence available from RCTs to guide the choice between surgical or non-surgical repair of first-or second-degree perineal tears sustained during childbirth. Two studies find no difference between the two types of management with regard to clinical outcomes up to eight weeks postpartum. Therefore, at present there is insufficient evidence to suggest that one method is superior to the other with regard to healing and recovery in the early or late postnatal periods. Until further evidence becomes available, clinicians' decisions whether to suture or not can be based on their clinical judgement and the women's preference after informing them about the lack of long-term outcomes and the possible chance of a slower wound healing process, but possible better overall feeling of well being if left un-sutured.

U2 - 10.1002/14651858.CD008534.pub2

DO - 10.1002/14651858.CD008534.pub2

M3 - Article

VL - 2011

JO - Cochrane database of systematic reviews (Online)

JF - Cochrane database of systematic reviews (Online)

SN - 1469-493X

IS - 8

M1 - 008534

ER -