Perineal suture practices. Are they up to date with the evidence based medicine data: A local experience into a university maternity?

OBJECTIVES

To investigate the prevalence of perineal suture techniques then to identify the factors influencing suturing technique choices.

METHODS

Prospective, observational, monocentric study over 20 weeks in a university hospital. A personal questionnaire was completed by medical practitioners performing perineal sutures: years of experience, training attendance, suturing techniques usually used for degrees 1 and 2 tears/episiotomies. For each delivery with perineal tear/episiotomy, the professional answered on the type of suture performed and the reasons for choosing this technique. We distinguished discontinuous sutures (several stitches/continuous locking stitch) from continuous sutures (single thread, single continuous locking stitch). We evaluated the prevalence of the techniques used in our center as well as the factors associated with the choice of technique, then we described the characteristics of the professionals who responded to the survey and their suturing habits.

RESULTS

Among the 401 perineal sutures, 45.4% of them were continuous (n = 182), discontinuous sutures were more performed. Discontinuous sutures were more common in 1st and 2nd degree tears. Residents/obstetricians performed significantly more continuous sutures than midwives. Whatever the type of suture technique used (continuous or discontinuous), professionals sutured in the way they felt most suitable to the degree of tearing/episiotomy. Fifty-one percent of midwives are trained in continuous technique, compared with 81% of residents/obstetricians. Midwives required training in 70% of cases and 64% of residents.

CONCLUSIONS

It appears necessary to disseminate continuous suture techniques and to promote their training in order to improve our practices.