Frohlich Julie, Kettle Christine
St Thomas' Hospital, London, UK.
BMJ Clin Evid. 2015 Mar 10;2015:1401.
More than 85% of women having a vaginal birth suffer some perineal trauma. Spontaneous tears requiring suturing are estimated to occur in at least one third of women in the UK and US. Perineal trauma can lead to long-term physical and psychological problems.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of different methods and materials for primary repair of first- and second-degree tears and episiotomies? What are the effects of different methods and materials for primary repair of obstetric anal sphincter injuries (third- and fourth-degree tears)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 33 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: conventional suturing; different methods and materials for primary repair of obstetric anal sphincter injuries; non-suturing of muscle and skin (or perineal skin alone); and sutures (absorbable synthetic sutures, catgut sutures, continuous sutures, interrupted sutures).
超过85%经阴道分娩的女性会遭受某种会阴创伤。据估计，在英国和美国，至少三分之一的女性会发生需要缝合的自然撕裂伤。会阴创伤可导致长期的身体和心理问题。
我们进行了一项系统评价，旨在回答以下临床问题：不同方法和材料对一度和二度撕裂伤及会阴切开术进行一期修复的效果如何？不同方法和材料对产科肛门括约肌损伤（三度和四度撕裂伤）进行一期修复的效果如何？我们检索了：截至2013年11月的医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、考克兰图书馆及其他重要数据库（临床证据综述会定期更新，请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及医疗产品监管局（MHRA）等相关组织的危害警示。
我们发现33项研究符合我们的纳入标准。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们提供了以下干预措施的有效性和安全性相关信息：传统缝合；产科肛门括约肌损伤一期修复的不同方法和材料；肌肉和皮肤不缝合（或仅会阴皮肤不缝合）；以及缝线（可吸收合成缝线、肠线、连续缝线、间断缝线）。
