Publication:

A comparative study of three layered interrupted suturing versus continuous subcuticular suturing in episiotomy closure

Background Episiotomy is a surgically planned incision on the perineum and posterior vaginal wall during the second stage of labour. There are various types of episiotomy like midline, mediolateral, lateral and J-shaped. There are various maternal and fetal benefits of episiotomy like reduction in perineal injuries, preservation of pelvic floor muscle function and cranial protection etc. There are various ways of suturing of episiotomy like three layered interrupted suturing, single knot type, three layered subcuticuler and continuous subcuticular technique. Perineal pain is the most common complaint after episiotomy. Objective of the study was to compare between the two episiotomy suturing techniques, one is traditional three layered interrupted technique and the other is continuous subcuticular technique.

Methods It is prospective comparative interventional study conducted in department of obstetrics and gynaecology at Sardar Vallabh Bhai Patel (SVBP) Hospital, Meerut from January 2020 to July 2021. In this study, 100 primigravida who delivered vaginally with the aid of episiotomy in the hospital were included. The episiotomy of 50 patients were sutured by three layered interrupted technique (control) and 50 patients episiotomy were sutured by continuous subcuticular technique (cases). Both groups were compared in view of duration of surgery in minutes, amount of suture material used, and post-operative pain within 12 hours and within 48 hours of delivery and delayed complication if any.

Results The duration of surgery was significantly lower in the continuous subcuticular technique (9.94±1.17 min) p value <0.0001 as compared to three layered interrupted technique (13.04±1.38 min). The amount of suture material used is less in continuous group (81.18±5.61 cm) as compared to control group (85.22±5.40 cm) p value <0.0004. There was no need of extra use of local analgesia (p<0.0061) and patient had less post-operative pain at 12 hrs and 48 hrs of delivery in continuous subcuticular group (p<0.0001). There was not any delayed complication seen in continuous group.

Conclusions From my study it is concluded that continuous subcuticular episiotomy suturing technique is better than three layered traditional technique as it require less time, less suture material, less local analgesia and associated with less pain experience and complication.