Early secondary perineal repair: a pilot study with 2nd degree tears and episiotomies

Background: A new approach to postpartum care for women was adapted in our hospital in Denmark in 2013. All women are now offered routine check-up of perineal wounds. Midwives perform the examination 48 – 72 hours after vaginal birth in a Postnatal Clinic. If the wounds show signs insufficient primary repair or suture break down, an early secondary repair is offered.

Objective: The aim of this study is to evaluate a policy of early secondary repair of insufficiently sutured perineal lacerations of 1^st or 2^nd degree and episiotomies.

Methods: All women who have sustained 1^st or 2^nd degree perineal lacerations or episiotomies are in our study group. More than 6000 women of mixed parity have visited the Postnatal Clinic from 01.02.2013 – 31.05.2015. We thus have a 2-year consecutive data collection.

Midwives at the Postnatal Clinic perform an objective evaluation of healing in more than 90% of the women.

Primary outcomes are:

• Insufficient primary repair,

• Stitches breaking down,

• Infection,

• Postpartum perineal pain.

A group of three specialised midwives were responsible for the assessment of insufficiently healed wounds, of performing the secondary repairs and assessing the results at follow-up 7 – 10 days postoperatively.

Results: We have conducted more than 70 early secondary perineal repairs to the labia, 1^st and 2^nd degree perineal lacerations within the first week post partum. Urogynaecologists act as consultants to the clinic and challenging cases are discussed at regular inter-professional meetings.

Cases of good and poor wound healing is documented by photos which enables us to give feedback to the clinicians involved in the primary repair following vaginal birth.

Conclusion: The initiative of evaluating perineal wound healing has led to the development of a guideline on early secondary repair performed by midwives.

Data analysis is in progress and will be presented at the conferences.