Perinealcare – evidence-based suture technique in first- and second-degree perineal tears
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Arcada University of Applied Sciences, Helsinki, Finland
Publication date: 2023-10-24
Corresponding author
Mariette Pontán   

Arcada University of Applied Sciences, Helsinki, Finland
Eur J Midwifery 2023;7(Supplement 1):A91
During a vaginal delivery up to 85% of those giving birth get a perineal tear. Tears affect both physical, psychological and social well-being for the woman. A first-degree tear leads to slight discomfort. A second-degree tear can lead to prolonged pain, affect body image, breastfeeding and family life, as well as lead to sexual dysfunctions. The aim with the master thesis was to make visible how the diagnosis of the perineal tears and the suture technique itself can affect the womans sexual and reproductive health postpartum and for the rest of life.

Material and Methods:
The method for the master thesis was scoping review. Scientific articles were found in Cinahl, PubMed, Cochrane Library. Also, Google Scholar, guidelines, educational programs and books were used in the manual search to find scientific articles. The data-analysis was done as inductive content analysis.

The result includes several steps of the perineal care, preparation, identification, choice of material, suture technique and documentation. Midwives and obstetricians should have evidence-based knowledge of perineal anatomy and physiology, how the perineal tear should be repaired, as well as how the perineal tear and the suture affect the woman's life. Professionals should explain to the woman why the assessment and suturing is performed. Assessment and detection of perineal tears are strongly associated with a correct diagnosis. Anesthesia must be given before assessment and it should be sufficient throughout the repair. Rectal examination should be part of the systematic assessment and after each suturing. The suture material also affects the result; in the superficial layer use quickly absorbable sutures when needed; in the second-degree tears an absorbable suture and the suturing must be done in three layers, (vagina - perineal muscles – skin). The continuous suture is recommended over single sutures, as they have a beneficial effect on the perceived pain, the use of pain relief, as well as on the woman’s sexual and reproductive health postpartum. Information to the woman and documentation are an important part of perineal care.

Every midwife and obstetrician need to have evidence-based knowledge about perineal anatomy and physiology, about perineal care and its importance, to ensure for every woman to have optimal sexual and reproductive health after a vaginal delivery. Diagnosis of perineal tear and proper assessment, including a rectal examination, must be performed after every vaginal delivery. Suturing technique should be chosen based on evidence and documented; a second-degree tear should be sutured in three layers with absorbable suture. The woman must receive information about the tear, reparation and self-care.

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