الفهرس 
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Abstract
The aim of this study to compare the continuous versus interrupted sutures as regard the
time taken in the repair, perineal pain (at 48 h, 10 days and three months) postpartum, the need
for analgesia up to 48 hours after delivery, amount of blood loss during the repair measured by
counting surgical gauze used, drapes around the patient, and amount of blood in the suction
container if present, length of threads used by centimeters, wound dehiscence and infection and the
need for suture removal and the need for resuturing. To test this hypothesis, we conducted a
double-blind randomized controlled clinical trial in healthy, low-risk laboring women requiring
surgical repair for episiotomies.
In the second stage of labor, 170 pregnant women received a mediolateral episiotomy in Ain Shams
University, Maternity Hospital were chosen to participate in the study after obtaining a written
consent. They were randomly allocated into two groups A and B; randomization was done using
closed enveloped method.
Group A: was repaired by interrupted suturing technique and include (85) pregnant women.
Group B: was repaired by continuous suturing technique
and include (85) pregnant women.
The exclusion criteria include:
Instrumental vaginal delivery.
Previous perineal surgery.
Preexisting medical condition that might adversely affect healing, as Diabetes Mellitus.
Induction of labor.
Complicated episiotomy.
Perineal laceration involving anal sphincter (third or fourth).
Primipara refuses to be enrolled in the study.
The choice of the suture technique was concealed from the patient, resident physicians who
managed the delivery and physicians who followed up the patients and evaluated them in the return
visit.
All the participants were subjected to:
Full history for each patient, general, abdominal and vaginal examination.
Routine laboratory investigations (CBC, urine analysis, etc.)
Abdominal ultrasound.
Management of second stage of labor
The second stage of labor was managed without instrumentation except for episiotomy which was
done when indicated.
The standard analgesia for perineal repair was infiltration analgesia in the wound area using five:
twenty ml lignocaine ten mg/ml.
Episiotomy when indicated was done mediolateral at the time of head crowning.
During delivery of the head, modified Ritgen’s maneuver technique was used including: guarding the
perineum, slow delivery of the head, maintaining head flexion.
Delivery of the shoulders, the anterior shoulder first then the posterior one, by lateral flexion
of the body.
After delivery, packing of the vagina was done using gauze soaked with betadine after exploration
of the vagina.
Repair of episiotomy:
It was done according to the type of the group:
Group A was closed using the interrupted suture (IT) which involves placing three layers of
sutures: a continuous ”locking” stitch to close the vaginal
epithelium, commencing above the apex of the
wound and finishing at the level of the fourchette; three or four interrupted sutures to
reapproximate the deep and superficial muscles; and interrupted transcutaneous technique to close
the skin.
Group B was closed using the continuous knotless suturing technique (CKT) which involves placing
the first stitch above the apex of vaginal trauma to secure any bleeding points that might not be
visible. Vaginal trauma, perineal muscles (deep and superficial), and skin are reapproximated with
a loose, continuous, non- locking technique. The skin sutures are placed closely fairly deeply in
the subcutaneous tissue, reversing back and finishing with a terminal knot placed in the vagina
beyond the hymeneal reminants.
For each participant:
The time needed for suturing was recorded, length of threads used by centimeters needed for repair
and amount of blood loss during the repair measured by counting surgical gauze used, drapes around
the patient and amount of blood in the suction container if present.At 48 hours, ten days and three months after delivery,
each patient was Followed up for perineal pain measured by visual analogue scale (V A S), The need
for analgesia up to 48 hours after delivery, wound dehiscence and infection, The need for suture
removal.
Regarding the Maternal outcomes:
There was no statistically significant difference could be detected between continuous and
interrupted groups as regard participant’s age, weight, BMI, wound dehiscence, infection, wound
resuturing, suture removal, and pain after ten days and three months after delivery.
The results showed that there was highly statistically significant difference could be detected
between continuous and interrupted groups as regard time of wound suturing that the interrupted
group had more time of wound suturing compared to the continuous group.
The results showed that there was highly statistically significant difference could be detected
between continuous and interrupted groups as regard perineal pain at 48 hours and at ten days
measured by VAS scales that continuous group had a lower VAS scores compared to interrupted group,
but there is no significant difference after three months.
The results showed that there was highly statistically significant difference could be detected
between continuous and interrupted groups as regard length of threads used by centimeters that it
was higher in interrupted group compared to continuous group.
The results showed that there was highly statistically significant difference could be detected
between continuous and interrupted groups as regard the need for analgesia up to 48 hours after
delivery that a larger numbers of the interrupted group needed analgesia compared to continuous
group.
The results showed that there was highly statistically significant difference could be detected
between continuous and interrupted groups as regard the amount of blood loss during the repair
measured by counting surgical gauze used and drapes around the patient that it was higher in
interrupted group compared to continuous group.