Gordon B, Mackrodt C, Fern E, Truesdale A, Ayers S, Grant A
Ipswich Hospital NHS Trust, UK.
Br J Obstet Gynaecol. 1998 Apr;105(4):435-40. doi: 10.1111/j.1471-0528.1998.tb10130.x.
To evaluate a policy of two stage postpartum perineal repair leaving the skin unsutured.
A stratified randomised controlled trial using a 2 x 2 factorial design.
The maternity unit at Ipswich Hospital NHS Trust, a district general hospital, between 1992 and 1994.
1780 women requiring surgical repair of episiotomy or first or second degree tear following a spontaneous or simple instrumental delivery.
A policy of two-stage perineal repair leaving skin unsutured was compared with a policy of three stage repair including skin closure with interrupted or subcuticular sutures. Both groups were assessed by a research midwife, blind to the allocation, completing questionnaires at 24 to 48 hours and 10 days postpartum, and by self-completed questionnaires at three months after birth.
Completed questionnaires were returned for 99% of women at both 24 to 48 hours and ten days and by 93% of women three months postpartum. No differences were detected in perineal pain at 24 to 48 hours (62% vs 64%; RR 0.96, 95% CI 0.90-1.03; 2P = 0.3) and 10 days (25% vs 28%; RR 0.90, 95% CI 0.77-1.06; 2P = 0.2). Significantly fewer women allocated to two-stage repair reported tight stitches at ten days (14% vs 18%; RR 0.77, 95% CI 0.62-0.96, 2P = 0.02); similar numbers of repairs were judged to be breaking down (five compared with seven women). At three months postpartum fewer women allocated to the two-stage repair reported perineal pain and more had resumed pain-free intercourse. Amongst women who had resumed intercourse there was a significant difference in dyspareunia (15% vs 19%; RR 0.80, 95% CI 0.65-0.99; 2P = 0.04). Significantly fewer women in the two-stage repair group (7% vs 12%; RR 0.61, 95% CI 0.45-0.83; 2P = < 0.01) reported removal of suture material. Four women in the two-stage repair group had required resuturing, compared with nine allocated to the three-stage repair.
Two-stage repair of perineal trauma leaving the skin unsutured appears to reduce pain and dyspareunia three months postpartum. There are no apparent disadvantages, in particular no evidence of an increased risk of breakdown of the repair and resuturing.
评估产后会阴分两阶段修复且不缝合皮肤的策略。
采用2×2析因设计的分层随机对照试验。
1992年至1994年间，在伊普斯威奇医院国民保健服务信托基金的产科病房，一家地区综合医院。
1780名在自然分娩或简单器械助产产后需要进行会阴切开术或一、二度撕裂修补术的女性。
将不缝合皮肤的两阶段会阴修复策略与包括用间断或皮下缝线缝合皮肤的三阶段修复策略进行比较。两组均由一名研究助产士进行评估，该助产士对分组情况不知情，在产后24至48小时和10天完成问卷调查，并在产后三个月通过自行填写问卷进行评估。
在产后24至48小时和10天，99%的女性返回了完整问卷，产后三个月93%的女性返回了问卷。产后24至48小时（62%对64%；相对危险度0.96，95%可信区间0.90 - 1.03；P = 0.3）和10天（25%对28%；相对危险度0.90，95%可信区间0.77 - 1.06；P = 0.2）时，两组在会阴疼痛方面未检测到差异。分配到两阶段修复的女性在10天时报告缝线紧绷的人数显著较少（14%对18%；相对危险度0.77，95%可信区间0.62 - 0.96，P = 0.02）；判定修复失败的人数相近（分别为5名和7名女性）。产后三个月，分配到两阶段修复的女性报告会阴疼痛的人数较少，更多女性恢复了无痛性交。在恢复性交的女性中，性交困难存在显著差异（15%对19%；相对危险度0.80，95%可信区间0.65 - 0.99；P = 0.04）。两阶段修复组报告拆除缝线材料的女性显著较少（7%对12%；相对危险度0.61，95%可信区间0.45 - 0.83；P < 0.01）。两阶段修复组有4名女性需要再次缝合，而分配到三阶段修复组的有9名。
产后会阴创伤分两阶段修复且不缝合皮肤似乎可减轻产后三个月的疼痛和性交困难。没有明显的缺点，特别是没有证据表明修复失败和再次缝合的风险增加。
