Should all second-degree perineal tears be sutured? A Comprehensive Literature Review

Abstract

Aim The aim of this study is to provide a critical summary of the literature in relation to the non-suturing of second-degree perineal tears. The review specifically addresses the question ‘Should all second-degree tears be sutured?’ Background In the UK, approximately 85% of women sustain some degree of perineal trauma following a vaginal birth. 60-70% of these women will be sutured (Sleep et al 1984, Albers et al 1999). During the 1990s the practice of not suturing second-degree tears started to gain popularity among midwives, without robust evidence to support it. Despite the publication of subsequent research, there is still little agreement on the benefits/disadvantages of not suturing tears. Methods A comprehensive literature review was undertaken. A number of electronic databases (including zetoc for grey literature) were searched for the period 1986 to the present and two midwifery journals were hand-searched for the period 2008 to the present. Strict inclusion criteria were set. Data was analysed using the Critical Appraisal Skills Programme (CASP) tool and transcribed to a data extraction grid. Study outcomes and recommendations were coded. Common codes were grouped together into five themes. Findings Outcomes for long-term wound healing, rates of infection, pain levels, urinary incontinence and sexual function were similar for sutured and non-sutured tears Women view perinenal suturing from a social and psychological perspective as well as a physical one. Problems with the research process were apparent in nearly all the included studies. Conclusion & Recommendations A number of outcomes in relation to sutured and non-sutured tears have been examined. The evidence suggests that some outcomes are similar for the two treatments. However, these conclusions are made in the absence of high-quality empirical evidence (level 1+ see appendix 2). This study highlights the need for a large-scale randomized controlled trial to establish unequivocal evidence in relation to the practice of non-suturing. This research should be supported with qualitative studies examining women’s views in relation to suturing.

Date of Award	1 Sept 2010
Original language	English
Awarding Institution	University of Brighton
Supervisor	Peggy Stevens (Supervisor)