Episiotomy Repair in Poor Resource Settings, is It Justifiable to Recommend the Fast Absorbing Polyglactin 910 Suture (Vicryl Rapide) as the Suture of Choice? – A Randomized Controlled Trial

Background: Episiotomy is a deliberate incision on the perineum during childbirth, with the intent to expedite delivery and to prevent perineal tear. It is often complicated with perineal pain, wound dehiscence and vulva hematoma. Some of the risk factors associated with these complications include poor surgical technique, sepsis and the type of suture material used. Chromic catgut suture has been abandoned in developed countries, but it is still used frequently in poor resource settings, especially in West Africa.

Objective: The objective of this study is to determine whether the use of fast-absorbing polyglactin 910 suture (vicryl rapide) to repair episiotomy would result in less postpartum morbidity, when compared to chromic catgut suture. The morbidity parameters include perineal pain, wound dehiscence, wound resuturing, vulva hematoma and dyspareunia.

Methods and Materials: This is a parallel randomized controlled trial of 400 booked parturients who delivered and had episiotomy repair in the labour ward, department of obstetrics and gynaecology, Niger Delta University Teaching Hospital, Southern Nigeria. The subjects were allocated into two groups via a double-blind randomization method. In 200 of the women, the episiotomies were repaired with fast-absorbing polyglactin 910 suture, while chromic catgut suture was used in the other 200 subjects as control. All the episiotomies were mediolateral, and only size 0 sutures were used.

A patient’s information sheet (the research protocol) was filled for each patient by the researcher or the doctor on labour ward call, this commences about 6 – 12 hours after an episiotomy repair to avoid the effect of the local anesthetic drug on pain perception and to accommodate patients who wish to rest. Relevant information concerning immediate complications such as: Perineal pain, difficulty in micturition and vulva hematoma was obtained. Patients were re-evaluated at 7 days postpartum for perineal pain, wound healing, wound dehiscence and need for secondary wound suturing. The final evaluation was at 6 weeks postpartum for complete wound healing, perineal pain and dyspareunia. Data was analyzed using SPSS version 22 and EPI Info version 7.

Results: There was no significant difference in immediate postoperative complication (within 24 hours) between the test and control groups. Episiotomy repair with polyglactin 910 suture resulted in more satisfactory wound healing at 7 days postpartum than chromic catgut suture. P = 0.001, X2 = 10.05. Odds ratio = 0.57[CI, 0.40 – 0.80]. Repair with chromic catgut suture resulted in more perineal pain P = 0.006, more wound breakdown P = 0.02, Odds ratio = 1.62[CI, 1.09 – 2.44] and were twice more likely to have wound resuturing than polyglactin 910, Odd ratio = 2.24 [1.12, 4.49], P = 0.01. At 6 weeks postpartum, there was no significant difference in wound healing, perineal pain and dyspareunia between the test and control groups.

Conclusion: Episiotomy repair with polyglactin 910 mitigates postpartum morbidity via reduced perineal pain, more satisfactory wound healing, and less need for secondary wound suturing when compared with chromic catgut suture. It is hereby recommended as the suture of choice for episiotomy repair in West Africa, because of the high rate of puerperal sepsis, perineal wound infections and wound dehiscence in this region.