Question:
What is the best way to manage early breakdown of episiotomy or tear repairs?
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Answer:
No systematic reviews on the management of wound dehiscence following episiotomy or perineal tear repairs were found. However, a protocol1 (Evidence level IV) for a review comparing secondary suturing and non-suturing provides pertinent background information about some of the risks associated with expectant management. The reviewers:
“envisage that re-suturing within the first two weeks following childbirth may result in a reduction in the perineal pain during the healing process up to six months post delivery; a reduction in dyspareunia; continuation of exclusive breastfeeding up to six months; and increased satisfaction with the aesthetic results of the peineal wound.”
The reviewers cite a number of existing studies which have investigated the management of episiotomy and tear dehiscence2,3,4,5. These studies indicate that early re-suture compares favourably with expectant management.
Ramin and Gilstrap6 provide details of a preoperative protocol for repair of episiotomy dehiscence and outline a secondary repair technique and postoperative care.
References:
1. Dudley LM, Kettle C, Ismail KMK. Secondary suturing compared to non-suturing for broken down perineal wounds following childbirth. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008977. DOI: 10.1002/14651858.CD008977 (http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD008977/frame.html)
2. Uygur D, Yesildaglar N, Kis S, Sipahi T. Early repair of episiotomy dehiscence. Australian and New Zealand Journal of Obstetrics and Gynaecology 2004; 44: 244-246. (Evidence level IIb)
3. Ramin SM, Ramus RM, Little BB, Gilstrap LC. Early repair of episiotomy dehiscence associated with infection. American Journal of Obstetrics and Gynecology 1992; 167: 1104-7. (Evidence level IIb)
4. Monberg J, Hammen S. Ruptured episiotomia resutured primarily. Acta Obstetricia et Gynecologia Scandinavica 1987; 66: 163-164. (Evidence level IIb)
5. Hankins GD, Hauth JC, Gilstrap LC, Hammond TL, Yeomans ER, Snyder RR. Early repair of episiotomy dehiscence. Obstetrics & Gynecology 1990; 75: 48-51. (Evidence level IIb)
6. Ramin SM, Gilstrap LC. Episiotomy and early repair of dehiscence. Clinical Obstetrics and Gynecology 1994; 37: 816-823.
Search date: 26 July 2011
Evidence levels
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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