A comparison of chromic catgut, polyglactin 910, and Vicryil rapide sutures for episiotomy repair: a randomized clinical trial

A comparison of chromic catgut, polyglactin 910, and Vicryil rapide sutures for episiotomy repair: a randomized clinical trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A comparison of chromic catgut, polyglactin 910, and Vicryil rapide sutures for episiotomy repair: a randomized clinical trial Shole Shahgheibi, Farnaz Zandvakili, Mohammad Aziz Rasouli, Mobin Naqshbandi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1659930/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Episiotomy is one of the common surgical procedures in maternity wards. A large number of women who undergo episiotomy suffer from short-term postpartum complications, which are associated with a type of applied suture. Chromic catgut, polyglactin 910 (Coated Vicryl) and Vicryil rapide are the most common suture materials for the perineal repair. The aim of this study is to compare three suture materials on perineal pain, infection, and inflammation at the site of perineal repair of episiotomy. Methods: This randomized clinical trial was conducted on 114 patients referred to the labor ward of Besat Hospital, Sanandaj City, Iran in 2017-2018. Random allocation was conducted using envelopes containing a number from one to three for the three suture materials. Each envelope was opened by the gynecology resident and each group was treated by a specific suture material. The severity of perineal pain, infection, incidence rate of inflammation, and residual materials were evaluated at the 48 th hours, 7 th day, and 42 nd day and in the case of pain during sexual intercourse at the 6 th week after episiotomy. Results: The severity of perineal pain was significantly different between the three groups at 48 th hour, 7 th day, and 42 nd day after episiotomy (P<0.001). Moreover, 15.4% of the patients (n=6) who used Vicryil rapide suture reported no pain (P<0.001). Moreover, the severity of the moderate and severe pains at the 7 th day and 42 nd day were significantly lower in Vicryil rapide group in comparison with the chromic catgut and polyglactin 910 groups. The inflammation at the site of perineum repair was also significantly lower in the Vicryil rapide group in comparison with other two other groups at the 48 th hour and 7 th day after episiotomy (P<0.001). Furthermore, the pain severity during sexual intercourse was significantly lower in the Vicryil rapide group (P<0.001). Conclusions: According to the results, using Vicryil rapide suture for episiotomy repair was associated with earlier pain and inflammation reduction at the site of perineum repair. Trial registration: IRCT20141208020249N5 ( http://en.irct.ir/trial/34194 ) Date trial registration: 02 February 2019 (The trial was retrospectively registered) Suture Episiotomy Severity of pain Clinical Trial Study Iran Figures Figure 1 Background Episiotomy is one of the common surgical procedures in maternity wards and it is performed during the second stage of labor. Episiotomy is performed when 4cm of caput diameter is visible during a contraction and the repair of the perineum is postponed until delivery of the placenta. There are two main types of episiotomy: midline and mediolateral that are different in terms of incision angle of perineum ( 1 – 3 ). The frequency of episiotomy use has declined in the developed countries. ( 1 , 4 ). The application rate of episiotomy differs globally depending on the extent to which it is limited or commonly used. In 2012, the rate of episiotomy use in vaginal delivery was 8% in Netherlands, 13% in the UK, and about 12% in the United States ( 5 , 6 ). The rate of episiotomy use is high in developing countries, with 46% and 54.9% in two countries of the west of Africa and about 99% in countries of the east of Europe ( 6 ). The rate of mediolateral episiotomy was reported 97.3% among nulliparous women in Tehran province (Iran) ( 7 ). A large number of women who undergo episiotomy suffer from short-term postpartum complications such as loss of blood, perineal pain, edema, infection, hematoma, and wound dehiscence. In addition, more than 20% of these individuals experience long-term postpartum complications including incision wound infection and painful sexual intercourse ( 3 , 4 , 8 , 9 ). Asian ethnicity has been shown to be a risk factor for severe perineal trauma in some countries; however, there is still uncertainties as to whether Asian ethnicity is an independent risk factor, or if other factors combine with Asian ethnicity to increase the likelihood of severe perineal trauma ( 10 ). Factors such as type of the applied suture material, wound healing method, and surgical skills of the surgeon are associated with the rates of episiotomy complications ( 9 , 11 ). Chromic catgut and polyglactin 910 are the most common suture materials for the perineal repair. Chromic catgut is treated by chromium salts to delay the absorption time and decrease the inflammatory response in the tissue ( 12 , 13 ). According to previous studies, chromic gut contains collagen and it is broken down by proteolytic enzymes; thus, it stimulates the inflammatory response in the tissue ( 14 ). In contrast, synthetic suture materials such as Vicryil rapide create less inflammatory response, less postpartum pain, and relatively rapid wound healing compared with chromic gut ( 6 , 14 ). Some researchers believe that there is no difference in terms of wound dehiscence between different types of suture materials. Other complications such as pain, irritating sutures, and wound infections were less prevalent in subjects treated by synthetic suture materials ( 15 ). Reduced pain level and risk of wound dehiscence are associated with the use of Vicryil rapide suture after episiotomy ( 16 , 17 ). Although, with polyglactin 910, the removal of residual materials to alleviate pain and have a pain-free intercourse is needed in some occasions, Vicryil rapide sutures can be used as an alternative to reduce the related complications ( 9 , 18 ). There is no general consensus among researchers about the superiority of suture materials. Hence, further interventional researches are required to evaluate and compare the impact of new suture materials with classical ones and identify the most effective suture materials for perineal repair ( 19 , 20 ). This study was conducted to compare the impact of 3 suture materials on perineal pain, inflammation, infection, and sexual intercourse after episiotomy. Methods This study is reported according to the CONSORT guidelines for the presentation of clinical trials. This randomized, controlled, three-arm parallel-group study was performed at the in Besat Hospital of Sanandaj City, Kurdistan province (Iran). Randomization codes (single block of 120 patients) were generated by epidemiologist. Enrolment was done directly after informed consent was obtained from the patients. Study IDs were assigned chronologically. In order to conceal allocation, epidemiologist was informed and added the study ID in chronological order in the randomization list. On their next visit, patients received a sealed, opaque envelope informing them of their allocated treatment. In this study, three types of suture materials including chromic catgut (n = 38), polyglactin 910 (n = 37), and Vicryil rapide (n = 39) were compared in terms of the repair of episiotomy. The participants were selected between January 2017 and December 2018. All patients aged over 18 years with sustained hemodynamic situation; midline or mediolateral episiotomies were used in the study. The exclusion criteria were having diabetes mellitus, chronic diseases, collagen vascular diseases, Body Mass Index (BMI) > 35, undergoing corticosteroid, prolonged labor, and premature rupture of membranes (PROM). After the deliveries, if suture material would be needed for episiotomies, a suture material would be selected by choosing one the three envelopes (containing a number from one to three representing the three suture type materials), and the repairs would be done by the gynecology residents using the selected suture material. All participants were informed about the purpose and process of the study, and written informed consent for participation in the study was obtained from the participants. The approval for this study was obtained from the Ethics Committee of Kurdistan University of Medical Science (IR.MUK.REC.1396.188). Random allocation was conducted using the envelopes (Fig. 1 ). The sample size was estimated following Malekpoor et al. with α = 0.05, a power of 0.9, SD1 = SD2 = 4.1, mean pain severity in interrupted method = 5.3, and mean of pain severity in continuous method with an estimated pain reduction of 20% = 4.24, and also the average pain severity ( 21 ). Pain severity, infection, inflammation at the site of perineum repair, and residual materials were evaluated at the 48th hour, 7th day, and 42nd day after delivery and in case of pain during sexual intercourse after the 6th week. Initial evaluation of the patients, as well as treatment and follow-up to evaluate clinical status, severity of pain, inflammation at the site of perineum repair, suture dehiscence, infection, residual materials and pain during sexual intercourse were performed by trained nurses who were blinded to the treatment allocation. Both the practitioners (obstetricians and midwives) and the labor nurses were unaware of the suture choice before this point. The study nurses asking the questions were blinded to the suture material used. After postpartum visit, subjects were asked a similar series of questions by their doctor or midwife who also inspected each patient’s perineum for evidence of residual suture material and wound dehiscence. The pain severity was evaluated on the Visual Analog Scale (VAS). Based on the distribution of pain VAS scores, pain intensities were categorized into no pain (0–4 mm), low pain (5–44 mm), moderate pain (45–74 mm), and severe pain (75– 100 mm) ( 22 ). Mefenamic acid was prescribed to all patients (every eight hours) for up to seven days after episiotomy. Episiotomy healing was assessed using the REEDA scale (Redness, Oedema, Ecchymosis, Discharge, Approximation) at three different moments in the postpartum period. The REEDA scale assesses the inflammatory process and tissue healing in the perineal trauma, through the evaluation of five items of healing: redness (hyperaemia), oedema, ecchymosis, discharge, and approximation of the wound edges (coaptation) ( 23 ). Statistical analyses were performed using the chi-square test, the Kruskal-Wallis test, and ANOVA ( P < 0.05). All statistical analyses were performed using Stata 14.0 (StataCorp, College Station, TX). Results In order to compare the three types of suture materials including chromic catgut (n = 38), polyglactin 910 (n = 37), and Vicryil rapide (n = 39) as to the repair of episiotomy, three groups were formed through random allocation. The mean ± standard deviation ( SD ) for age and gestational age of the participants were 27.02 ± 5.85 and 39 ± 3.55 years respectively, with no significant difference between the three treatment groups in this regard (P > 0.05). Gravida 1 had the highest frequency among all three groups. All the delivery cases were “natural birth” (as delivering a baby without the aid of any kind of medication) and episiotomy was done as mediolateral. The frequency of live, aborted, and Ectopic pregnancy (EP), and Molar Pregnancy (Mol) in the groups are presented in Table 1 . Table 1 Demographic characteristics of the participants Variable Chromic catgut N = 38 Polyglactin 910 N = 37 Vicryil rapide N = 39 P Age (Mean ± SD) 6.01 ± 27.4 5.51 ± 25.6 5.91 ± 28 0.198 Age of gestational 1.04 ± 39.4 1.65 ± 38.1 1.26 ± 39.4 0.589 N (%) N (%) N (%) Gravid 1 22 (58) 25 (67.6) 25 (64.1) 0.901 2 10 (26.2) 8 (21.6) 10 (25.6) 3 6 (15.8) 4 (10.8) 4 (10.3) Para 0 26 (68.4) 27 (73) 28 (71.8) 0.867 1 12 (28.9) 9 (24.3) 11 (28.2) 2 1 (2.6) 1 (2.7) - Live No 25 (65.8) 27 (73) 28 (71.8) 0.817 0 12 (31.6) 9 (24.3) 11 (28.2) 1 1 (2.6) 1 (2.7) - Abortion No 31 (81.6) 34 (91.9) 33 (84.6) 0.386 1 6 (15.8) 1 (2.7) 5 (12.8) 2 1 (2.6) 2 (5.4) 1 (2.6) Ectopic Pregnancy No - - - - Yes 38 (100) 37 (100) 39 (100) Molar Pregnancy No - - - - Yes 38 (100) 37 (100) 39 (100) SD: Standard Deviation, N: Number Pain severity was significantly different at the 48th hour, 7th day, and 42nd day after the repair of episiotomy (P < 0.001). In addition, six patients (15.4%) who were treated by Vicryl rapide suture experienced no pain at the 48th hour (P < 0.001). The severity of moderate and severe pain at the 7th day and 42nd day were significantly lower in Vicryil rapide group in comparison with chromic catgut and polyglactin 910 groups (P < 0.001). In addition, the inflammation at the site of perineum repair was also significantly different, as it was lower in Vicryil rapide group 21 (53.8%) and higher in the chromic gut group 37 (97.4%) and 25 (65.8%) at the 48th hour and 7th day after repair of episiotomy respectively (P < 0.001). However, inflammation at the site of perineum repair showed no significant difference between the three groups at the 42nd day (P = 0.546). Furthermore, the severity of pain during sexual intercourse at the 6th week was significantly lower in Vicryil rapide group (P < 0.001). As such, 22 (58%) and 14 (37.8%) patients in chromic catgut and polyglactin 910 groups respectively displayed moderate pain during intercourse at the 6th week after the repair of episiotomy (Table 2 ). Table 2 Comparison of pain intensity, inflammation at the site of perineal repair, infection, dehiscence suture and residual materials between three study groups. Variables Chromic catgut Polyglactin 910 Vicryil Rapide P Pain at 48 hours No - - 6 (15.4) < 0.001 Low 1 (2.6) 17 (45.9) 19 (47.8) Moderate 22 (57.9) 18 (48.6) 13 (33.3) Severe 15 (39.5) 2 (5.4) 1 (2.6) Pain at 7 days No 1 (2.6) 2 (5.4) 20 (51.3) < 0.001 Low 20 (52.6) 28 (75.8) 18 (46.2) Moderate 12 (31.6) 7 (18.9) 1 (2.6) Severe 5 (13.2) - - Pain at 42 days No 11 (28.9) 21 (56.8) 30 (76.9) < 0.001 Low 25 (65.8) 15 (40.5) 9 (23.1) Moderate 2 (5.3) 1 (2.7) - Severe - - - Inflammation at 48 hours Yes 37 (97.4) 25 (67.6) 21 (53.8) < 0.001 No 1 (2.6) 12 (32.4) 18 (46.2) Inflammation at 7 days Yes 25 (65.8) 14 (37.8) 1 (2.6) < 0.001 No 13 (34.2) 23 (62.2) 38 (97.4) Inflammation at 42 days Yes 1 (2.6) 1 (2.7) - 0.546 No 37 (97.4) 36 (97.3) 39 (100) Infection at 48 hours Yes - - - - No 38 (100) 37 (100) 39 (100) Infection at 7 days Yes 2 (5.3) 1 (2.7) - No 36 (94.7) 36 (97.3) 39 (100) 0.170 Infection at 42 days Yes - - - No 38 (100) 37 (100) 39 (100) - Sutures Dehiscence at 48 hours Yes - - - - No 38 (100) 37 (100) 39 (100) Sutures Dehiscence at 7 days Yes 3 (7.9) 4 (10.8) - - No 35 (92.1) 23 (89.2) 39 (100) Sutures Dehiscence at 42 days Yes - - - - No (100) 37 39 (100) Residual materials at 48 hours Yes 38 (100) 1 (2.7) - - No - 36 (97.3) 39 (100) Residual materials at 7 days Yes 38 (100) 1 (2.7) - 0.118 No - 36 (97.3) 39 (100) Residual materials at 42 days Yes 38 (100) (7.2) 1 - - No - 36 (97.3) 39 (100) Pain during sexual intercourse No - - 6 (15.4) < 0.001 Low 16 (42) 23 (63.2) 27 (69.2) Moderate 22 (58) 14 (37.8) 6 (15.4) There was no significant difference in the rate of infection, suture dehiscence, and residual materials at the 48th hour, 7th day, and 42nd day after delivery between the three groups (P > 0.05) (Table 2 ). Episiotomy repair procedure was repeated in only one subject in all three study groups, and all sutures began to absorb at the 2nd week after the repair of episiotomy. Suture spitting was observed in seven cases at 7th days, incision infection was reported in three cases, and repair episiotomy was repeated only in one subject (Table 2 ). Discussion Pain severity was significantly different at the 48th hour, 7th day, and 42nd day after repair of episiotomy between chromic catgut, polyglactin 910, and Vicryil rapide groups. The severity of perineal pain was significantly lower in patients treated by Vicryil rapide suture. Additionally, inflammation at the site of perineum repair at the 48th hours and 7th day was lower in Vicryil rapide group. Bharathi et al. stated that pain level was lower in episiotomy repair by Vicryil rapide than that by chromic catgut ( 18 ). The Perumal study also revealed that pain severity at the 48th hour and 7th day after repair of episiotomy was significantly lower with Vicyil rapide than with chromic catgut ( 13 ). In a study conducted by Abdullah et al. episiotomy by Vicryil rapide suture was associated with reduced pain level and faster wound healing ( 24 ). A small Danish randomized control trial (RCT) showed that there was no significant difference between perineum pain in short-term and long-term. However, the subjects in Vicryl rapide group reported a decrease in the pain when they walked at the 14th day ( 25 ). Ulster compared polyglactin 910 and Vircyl rapide in two groups and found a significant difference between pain and infections at the 6th and 12th weeks so that the both were lower in Vicryl rapide ( 26 ). According to the meta-analysis, polyglactin 910 was associated with less short-term pain compared to traditional gut sutures; however, it increased the rates of removal. Further researches with alternative suture materials are needed ( 27 ). The results of a meta-analysis study on eight clinical trials showed that synthetic suture materials reduced episiotomy pain for a short period of time. This is consistent with the findings of the present study ( 17 ). The wide range of episiotomy pain measured in different studies may be due to different suture materials and different measurement methods for pain intensity. However, the majority of previous studies indicated that Vicryil rapide for episiotomy repair reduced the severity of pain ( 6 , 18 ). Furthermore, the pain severity particularly decreased at the 42nd days after delivery. Synthetic absorbable suture Vicryil rapide was superior to naturally absorbable chromic catgut and polyglactin 910 with respect to inflammation at the site of perineum repair at various positions and at the 48th hour and 7th day after episiotomy. This finding is consistent with Perumal and Talbot et al. ( 13 , 28 ). However, inflammation at the site of perineum repair was not significant at 42 days, and some of the subjects displayed inflammation at the 42nd days, which is consistent with previous studies ( 12 , 18 ). The significant reduction of inflammation at the site of perineum repair at this stage is mainly due to the fact that most of the episiotomy wounds were healed six weeks after delivery ( 28 ). The rates of infection, suture dehiscence, and residual materials at the 48th hours, 7th days, and 42nd days after the repair of episiotomy were not significantly different between the three groups, which is also supported by Joseph study ( 29 ). The results of other studies showed no residual suture material in either group at the end of the 6th week. Joseph et al. showed that the remaining of suture in Vicryl rapide was completely absorbed while suture residual were observed in 18% of polyglactin 910 and 18% of chromic catgut groups ( 29 ). Mackrodt reported that 12% of polyglactin 910 group needed removal of the residual of suture ( 30 ). A Danish randomized control trial (RCT) found no difference between the groups regarding episiotomy dehiscence ( 25 ). In addition, a limited number of subjects displayed incision infection, spitting sutures, and residual materials at the 48th hours and 42nd days after delivery. An RCT study revealed that suture dehiscence was higher in patients treated by chromic catgut suture ( 31 ). The magnificent reduction in the rates of infection, suture dehiscence, and residual materials at this stage is mainly due to the fact that most of the episiotomy wounds were healed six weeks after delivery. Feeling pain during sexual intercourse was lower in patients treated by Vicryil rapide, which is consistent with the findings of the McElhinny study who compared the impact of Vicryl versus Vicryl rapide. However, at the sixth week, a significant difference in dyspareunia scores between the two groups was noted. The Vicryl rapide group experienced considerably less pain than the Vicryl group ( 26 ). Kettle, et al. investigated 1542 female patients, and found that pain during sexual intercourse was not significantly different three months after the delivery between patients treated by polyglactin 910 and standard suture materials. The inconsistency of these results with our study can be attributed to the fact that pain measurement was not performed at the 6th week after delivery ( 31 ). The short follow up for patients low sample size in all three study groups was one of the limitations of the current study. On the other hand, we believe that our findings were not biased. Hence, we suggest further research with larger sample size and longer follow-up. Conclusion According to the results of this study, the use of Vicryil rapide suture for episiotomy repair was associated with earlier pain and inflammation alleviation at the site of perineum repair. Thus, Vicryil rapide suture should be chosen as the first-line suture material for episiotomy. Abbreviations BMI Body Mass Index PROM Premature Rupture of Membranes VAS Visual Analog Scale ANOVA Analysis of Variance SD Standard Deviation EP Ectopic Pregnancy MOL Molar Pregnancy Declarations Acknowledgments This article is based on Dr. Chnour Limouei's thesis on obstetrics. The authors would like to thank all patients and their family for help us to perform this study. The authors also, thank collaboration the Clinical Research Development Center of Kowsar hospitals, Sanandaj, Iran Funding This study was funded by Vice Chancellor for Research and Technology of Kurdistan University of Medical Sciences, Sanandaj, Iran. The funding body played no role in the design of the study, collection, analysis, or interpretation of data or in writing the manuscript. Availability of data and materials The datasets used and/or analyzed during the current study can be made available by the corresponding author on reasonable request. Authors’ contributions SS and CL conceived and designed the study. SS, FZ, CL and MAR analyzed and interpreted the data, and drafted the manuscript. SS, FZ, MAR, CL and MN were involved in the composition of the study tool, supervision of the research process and critical revision and review of the manuscript. All the authors read and approved the final manuscript. Ethics approval and consent to participate The approval for this study was obtained from the Ethics Committee of Kurdistan University of Medical Science (IR.MUK.REC.1396.188). Written informed consent for participation in the study was obtained from participants. Consent for publication Not applicable. Competing Interests The authors have no conflicts of interest to declare. References Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics 24th edition McGraw-Hill Education. Medical, editor: Mcgraw-hill; 2014. El-Din AS, Kamal MM, Amin MA. Comparison between two incision angles of mediolateral episiotomy in primiparous women: a randomized controlled trial. Journal of Obstetrics and Gynaecology Research. 2014;40(7):1877–82. Kalis V, Laine K, De Leeuw J, Ismail K, Tincello D. Classification of episiotomy: towards a standardisation of terminology. BJOG: an international journal of obstetrics & gynaecology. 2012;119(5):522–6. Fraser D, Cooper M. MA, Myles' Textbook for Midwives. London: Churchill Livington; 2003. Friedman AM, Ananth CV, Prendergast E, D'alton ME, Wright JD. Evaluation of third-degree and fourth-degree laceration rates as quality indicators. Obstetrics & Gynecology. 2015;125(4):927–37. Kettle C, Dowswell T, Ismail KM. Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database of Systematic Reviews. 2010(6). Vakili F, Mirmohammadaliei M, Montazeri A, Farokhi M, Minaee MB. Impact of hypericum perforatum ointment on perineal pain intensity following episiotomy: a randomized placebo-controlled trial. Journal of caring sciences. 2018;7(4):205. Abdolahpour P, Babaei M, Gasemi Y. Causes of maternal mortality in pregnant women in urban and rural areas of Ilam. Iran J Health Syst Res. 2011;7(6):1278–87. Bharathi A, Reddy DD, Kote GS. A prospective randomized comparative study of vicryl rapide versus chromic catgut for episiotomy repair. Journal of clinical and diagnostic research: JCDR. 2013;7(2):326. Wheeler J, Davis D, Fry M, Brodie P, Homer CS. Is Asian ethnicity an independent risk factor for severe perineal trauma in childbirth? A systematic review of the literature. Women and Birth. 2012;25(3):107–13. Kindberg S, Stehouwer M, Hvidman L, Henriksen TB. Postpartum perineal repair performed by midwives: a randomised trial comparing two suture techniques leaving the skin unsutured. BJOG: An International Journal of Obstetrics & Gynaecology. 2008;115(4):472–9. Bose E, Samant M, Lal P, Mishra S, Ghosh A. Comparison of impact of polyglactin 910 (Vicryl rapide) and chromic catgut sutures on perineal pain following episiotomy wound repair in eastern Indian patients. Journal of the Scientific Society. 2013;40(2):95. Perumal D, Selvaraju D. Comparative study of episiotomy repair: Absorbable synthetic versus chromic catgut suture material. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017;6(6):2186–90. Sohail S, Abbas T, Ata S. Comparison between synthetic vicryl & chromic catgut on perineal repair. Medical Channel. 2009;15(2):48–50. McKinney ES, James SR, Murray SS, Nelson K, Ashwill J. Maternal-Child Nursing-E-Book: Elsevier Health Sciences; 2017. Jallad K, Steele SE, Barber MD. Breakdown of Perineal Laceration Repair After Vaginal Delivery: A Case-Control Study. Female pelvic medicine & reconstructive surgery. 2016;22(4):276–9. Kettle C, Dowswell T, Ismail KM. Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears. The Cochrane Library. 2012(11). Leroux N, Bujold E. Impact of chromic catgut versus polyglactin 910 versus fast-absorbing polyglactin 910 sutures for perineal repair: a randomized, controlled trial. American journal of obstetrics and gynecology. 2006;194(6):1585–90; discussion 90. Johnson A, Thakar R, Sultan AH. Obstetric perineal wound infection: is there underreporting? British Journal of Nursing. 2012;21(Sup5):S28-S35. Ziaie T, Porhidary M, Nazifkar H, Kazemnejad E. Comparison of Wound Repair Outcomes of Chromic Catgut versus Vicryl Sutures for Episiotomy Repair: A clinical trial. Advances in Nursing & Midwifery. 2016;26(92):1–5. Malekpoor P, Sehati Shafaei F, Del Azar A, Ghojazadeh M. Effect of Turmeric solution on pain relief after episiotomy in primiparus women. Nursing and Midwifery. Journal of Tabriz University of Medical Sciences. 2009;16:4–11. Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. The Journal of pain. 2003;4(7):407–14. Alvarenga MB, Francisco AA, Oliveira SMJVd, Silva FMBd, Shimoda GT, Damiani LP. Episiotomy healing assessment: redness, oedema, ecchymosis, discharge, approximation (REEDA) scale reliability. Revista latino-americana de enfermagem. 2015;23(1):162–8. Abdullah M, Noreen A, Iqbal M, Sohail R. Comparison between chromic catgut and vicryl rapide for analgesia requirement in episiotomy repair in primigravidas. Annals of King Edward Medical University. 2015;21(3):193-. Gemynthe A, Langhoff-Roos J, Sahl S, Knudsen J. New VICRYL* formulation: an improved method of perineal repair? British Journal of Midwifery. 1996;4(5):230–4. McElhinney B, Glenn D, Dornan G, Harper M. Episiotomy repair: Vicryl versus Vicryl rapide. The Ulster medical journal. 2000;69(1):27. Kettle C, Johanson R. Absorbable synthetic versus catgut suture material for perineal repair. Cochrane database of systematic reviews. 1996;2(1): CD000006. doi: 10.1002/14651858.CD000006 . Talbot AW, Meadows AE, Tyers AG, Shah-Desai S. Use of 7/0 Vicryl (coated polyglactin 910) and 7/0 Vicryl-rapide (irradiated polyglactin 910) in skin closure in ophthalmic plastic surgery. Orbit (Amsterdam, Netherlands). 2002;21(1):1–8. Joseph K, Shantha B, Prakash S. Comparative study of episiotomy repair: Absorbable synthetic versus chromic catgut suture material. Journal of Obestetrics and Gynecology of India. 2008;58(6):495–9. Mackrodt C, Gordon B, Fern E, Ayers S, Truesdale A, Grant A. The Ipswich Childbirth Study: 2. A randomised comparison of polyglactin 910 with chromic catgut for postpartum perineal repair. BJOG: An International Journal of Obstetrics & Gynaecology. 1998;105(4):441–5. Kettle C, Hills RK, Jones P, Darby L, Gray R, Johanson R. Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial. The Lancet. 2002;359(9325):2217–23. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1659930","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":106328866,"identity":"73b56b77-2b38-4c11-af1d-c23c45208d3a","order_by":0,"name":"Shole Shahgheibi","email":"","orcid":"","institution":"Kurdistan University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shole","middleName":"","lastName":"Shahgheibi","suffix":""},{"id":106328867,"identity":"059abac7-5146-4826-8913-00a4afbe764b","order_by":1,"name":"Farnaz Zandvakili","email":"","orcid":"","institution":"Kurdistan University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Farnaz","middleName":"","lastName":"Zandvakili","suffix":""},{"id":106328868,"identity":"22f909dd-4d40-4f25-9644-9f63c8320094","order_by":2,"name":"Mohammad Aziz Rasouli","email":"","orcid":"","institution":"Kurdistan University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Aziz","lastName":"Rasouli","suffix":""},{"id":106328869,"identity":"274f4dee-9320-4709-a18b-2e8a13984ad4","order_by":3,"name":"Mobin Naqshbandi","email":"","orcid":"","institution":"Iran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mobin","middleName":"","lastName":"Naqshbandi","suffix":""},{"id":106328870,"identity":"319593a7-9cb6-433d-9dcc-04ee7cdf8c4e","order_by":4,"name":"Chnour Limouei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArUlEQVRIiWNgGAWjYBACAwYeMC3HAGUQr8WYdC2JDcRrYT977MHHtnvpG46fPfjgA4OdnG4DIS08eemGM9uKczecyUs2nMGQbGx2gJAWCR4zad62hNwNB3LMpHkYDiRuI1ZLusH5NyRqSTC4QbQtPDlmkjPOJRjOvPHG2HCGARF+sW8/YybxoSxBnu98juGDDxV2cgS1wIECWKUBscpBQL6BFNWjYBSMglEwogAAjEk70EIZCw8AAAAASUVORK5CYII=","orcid":"","institution":"Kurdistan University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Chnour","middleName":"","lastName":"Limouei","suffix":""}],"badges":[],"createdAt":"2022-05-16 04:59:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1659930/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1659930/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":21630579,"identity":"3cc5571a-fe9f-4106-8b24-c3d5dc604628","added_by":"auto","created_at":"2022-05-18 18:28:45","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":158589,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of compared three types of suture materials including chromic catgut, polyglactin 910, and Vicryil rapide for repair of episiotomy\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1659930/v1/74024272b5faab109150dd20.jpg"},{"id":22434044,"identity":"e21ada6c-125f-4533-8f28-3802294be971","added_by":"auto","created_at":"2022-06-09 00:59:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":344934,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1659930/v1/70e0febb-b832-4d25-8130-4c6884f3022a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A comparison of chromic catgut, polyglactin 910, and Vicryil rapide sutures for episiotomy repair: a randomized clinical trial","fulltext":[{"header":"Background","content":"\u003cp\u003eEpisiotomy is one of the common surgical procedures in maternity wards and it is performed during the second stage of labor. Episiotomy is performed when 4cm of caput diameter is visible during a contraction and the repair of the perineum is postponed until delivery of the placenta. There are two main types of episiotomy: midline and mediolateral that are different in terms of incision angle of perineum (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The frequency of episiotomy use has declined in the developed countries. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe application rate of episiotomy differs globally depending on the extent to which it is limited or commonly used. In 2012, the rate of episiotomy use in vaginal delivery was 8% in Netherlands, 13% in the UK, and about 12% in the United States (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The rate of episiotomy use is high in developing countries, with 46% and 54.9% in two countries of the west of Africa and about 99% in countries of the east of Europe (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The rate of mediolateral episiotomy was reported 97.3% among nulliparous women in Tehran province (Iran) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA large number of women who undergo episiotomy suffer from short-term postpartum complications such as loss of blood, perineal pain, edema, infection, hematoma, and wound dehiscence. In addition, more than 20% of these individuals experience long-term postpartum complications including incision wound infection and painful sexual intercourse (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAsian ethnicity has been shown to be a risk factor for severe perineal trauma in some countries; however, there is still uncertainties as to whether Asian ethnicity is an independent risk factor, or if other factors combine with Asian ethnicity to increase the likelihood of severe perineal trauma (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFactors such as type of the applied suture material, wound healing method, and surgical skills of the surgeon are associated with the rates of episiotomy complications (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChromic catgut and polyglactin 910 are the most common suture materials for the perineal repair. Chromic catgut is treated by chromium salts to delay the absorption time and decrease the inflammatory response in the tissue (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). According to previous studies, chromic gut contains collagen and it is broken down by proteolytic enzymes; thus, it stimulates the inflammatory response in the tissue (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In contrast, synthetic suture materials such as Vicryil rapide create less inflammatory response, less postpartum pain, and relatively rapid wound healing compared with chromic gut (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Some researchers believe that there is no difference in terms of wound dehiscence between different types of suture materials. Other complications such as pain, irritating sutures, and wound infections were less prevalent in subjects treated by synthetic suture materials (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Reduced pain level and risk of wound dehiscence are associated with the use of Vicryil rapide suture after episiotomy (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Although, with polyglactin 910, the removal of residual materials to alleviate pain and have a pain-free intercourse is needed in some occasions, Vicryil rapide sutures can be used as an alternative to reduce the related complications (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is no general consensus among researchers about the superiority of suture materials. Hence, further interventional researches are required to evaluate and compare the impact of new suture materials with classical ones and identify the most effective suture materials for perineal repair (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This study was conducted to compare the impact of 3 suture materials on perineal pain, inflammation, infection, and sexual intercourse after episiotomy.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This study is reported according to the CONSORT guidelines for the presentation of clinical trials. This randomized, controlled, three-arm parallel-group study was performed at the in Besat Hospital of Sanandaj City, Kurdistan province (Iran). Randomization codes (single block of 120 patients) were generated by epidemiologist. Enrolment was done directly after informed consent was obtained from the patients. Study IDs were assigned chronologically. In order to conceal allocation, epidemiologist was informed and added the study ID in chronological order in the randomization list. On their next visit, patients received a sealed, opaque envelope informing them of their allocated treatment.\u003c/p\u003e \u003cp\u003eIn this study, three types of suture materials including chromic catgut (n\u0026thinsp;=\u0026thinsp;38), polyglactin 910 (n\u0026thinsp;=\u0026thinsp;37), and Vicryil rapide (n\u0026thinsp;=\u0026thinsp;39) were compared in terms of the repair of episiotomy. The participants were selected between January 2017 and December 2018. All patients aged over 18 years with sustained hemodynamic situation; midline or mediolateral episiotomies were used in the study. The exclusion criteria were having diabetes mellitus, chronic diseases, collagen vascular diseases, Body Mass Index (BMI)\u0026thinsp;\u0026gt;\u0026thinsp;35, undergoing corticosteroid, prolonged labor, and premature rupture of membranes (PROM).\u003c/p\u003e \u003cp\u003eAfter the deliveries, if suture material would be needed for episiotomies, a suture material would be selected by choosing one the three envelopes (containing a number from one to three representing the three suture type materials), and the repairs would be done by the gynecology residents using the selected suture material. All participants were informed about the purpose and process of the study, and written informed consent for participation in the study was obtained from the participants. The approval for this study was obtained from the Ethics Committee of Kurdistan University of Medical Science (IR.MUK.REC.1396.188). Random allocation was conducted using the envelopes (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe sample size was estimated following Malekpoor et al. with α\u0026thinsp;=\u0026thinsp;0.05, a power of 0.9, SD1\u0026thinsp;=\u0026thinsp;SD2\u0026thinsp;=\u0026thinsp;4.1, mean pain severity in interrupted method\u0026thinsp;=\u0026thinsp;5.3, and mean of pain severity in continuous method with an estimated pain reduction of 20% = 4.24, and also the average pain severity (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePain severity, infection, inflammation at the site of perineum repair, and residual materials were evaluated at the 48th hour, 7th day, and 42nd day after delivery and in case of pain during sexual intercourse after the 6th week.\u003c/p\u003e \u003cp\u003eInitial evaluation of the patients, as well as treatment and follow-up to evaluate clinical status, severity of pain, inflammation at the site of perineum repair, suture dehiscence, infection, residual materials and pain during sexual intercourse were performed by trained nurses who were blinded to the treatment allocation. Both the practitioners (obstetricians and midwives) and the labor nurses were unaware of the suture choice before this point. The study nurses asking the questions were blinded to the suture material used. After postpartum visit, subjects were asked a similar series of questions by their doctor or midwife who also inspected each patient\u0026rsquo;s perineum for evidence of residual suture material and wound dehiscence. The pain severity was evaluated on the Visual Analog Scale (VAS). Based on the distribution of pain VAS scores, pain intensities were categorized into no pain (0\u0026ndash;4 mm), low pain (5\u0026ndash;44 mm), moderate pain (45\u0026ndash;74 mm), and severe pain (75\u0026ndash; 100 mm) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Mefenamic acid was prescribed to all patients (every eight hours) for up to seven days after episiotomy. Episiotomy healing was assessed using the REEDA scale (Redness, Oedema, Ecchymosis, Discharge, Approximation) at three different moments in the postpartum period. The REEDA scale assesses the inflammatory process and tissue healing in the perineal trauma, through the evaluation of five items of healing: redness (hyperaemia), oedema, ecchymosis, discharge, and approximation of the wound edges (coaptation) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStatistical analyses were performed using the chi-square test, the Kruskal-Wallis test, and ANOVA (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). All statistical analyses were performed using Stata 14.0 (StataCorp, College Station, TX).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn order to compare the three types of suture materials including chromic catgut (n\u0026thinsp;=\u0026thinsp;38), polyglactin 910 (n\u0026thinsp;=\u0026thinsp;37), and Vicryil rapide (n\u0026thinsp;=\u0026thinsp;39) as to the repair of episiotomy, three groups were formed through random allocation. The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u003cem\u003eSD\u003c/em\u003e) for age and gestational age of the participants were 27.02\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85 and 39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.55 years respectively, with no significant difference between the three treatment groups in this regard (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Gravida 1 had the highest frequency among all three groups. All the delivery cases were \u0026ldquo;natural birth\u0026rdquo; (as delivering a baby without the aid of any kind of medication) and episiotomy was done as mediolateral.\u003c/p\u003e \u003cp\u003eThe frequency of live, aborted, and Ectopic pregnancy (EP), and Molar Pregnancy (Mol) in the groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChromic catgut\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePolyglactin 910\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;37\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVicryil rapide\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;39\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.01\u0026thinsp;\u0026plusmn;\u0026thinsp;27.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.51\u0026thinsp;\u0026plusmn;\u0026thinsp;25.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.91\u0026thinsp;\u0026plusmn;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of gestational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.65\u0026thinsp;\u0026plusmn;\u0026thinsp;38.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.26\u0026thinsp;\u0026plusmn;\u0026thinsp;39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (64.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (71.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (71.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (84.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEctopic Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMolar Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSD: Standard Deviation, N: Number\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePain severity was significantly different at the 48th hour, 7th day, and 42nd day after the repair of episiotomy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, six patients (15.4%) who were treated by Vicryl rapide suture experienced no pain at the 48th hour (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The severity of moderate and severe pain at the 7th day and 42nd day were significantly lower in Vicryil rapide group in comparison with chromic catgut and polyglactin 910 groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, the inflammation at the site of perineum repair was also significantly different, as it was lower in Vicryil rapide group 21 (53.8%) and higher in the chromic gut group 37 (97.4%) and 25 (65.8%) at the 48th hour and 7th day after repair of episiotomy respectively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). However, inflammation at the site of perineum repair showed no significant difference between the three groups at the 42nd day (P\u0026thinsp;=\u0026thinsp;0.546). Furthermore, the severity of pain during sexual intercourse at the 6th week was significantly lower in Vicryil rapide group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). As such, 22 (58%) and 14 (37.8%) patients in chromic catgut and polyglactin 910 groups respectively displayed moderate pain during intercourse at the 6th week after the repair of episiotomy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of pain intensity, inflammation at the site of perineal repair, infection, dehiscence suture and residual materials between three study groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChromic catgut\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePolyglactin 910\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVicryil Rapide\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain at 48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain at 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (51.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain at 42 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInflammation at 48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (97.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (67.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (32.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInflammation at 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (65.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (97.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInflammation at 42 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (97.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfection at 48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfection at 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (94.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eInfection at 42 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSutures Dehiscence at 48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSutures Dehiscence at 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (89.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSutures Dehiscence at 42 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(100) 37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidual materials at 48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidual materials at 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidual materials at 42 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(7.2) 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePain during sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (63.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was no significant difference in the rate of infection, suture dehiscence, and residual materials at the 48th hour, 7th day, and 42nd day after delivery between the three groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Episiotomy repair procedure was repeated in only one subject in all three study groups, and all sutures began to absorb at the 2nd week after the repair of episiotomy. Suture spitting was observed in seven cases at 7th days, incision infection was reported in three cases, and repair episiotomy was repeated only in one subject (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePain severity was significantly different at the 48th hour, 7th day, and 42nd day after repair of episiotomy between chromic catgut, polyglactin 910, and Vicryil rapide groups. The severity of perineal pain was significantly lower in patients treated by Vicryil rapide suture. Additionally, inflammation at the site of perineum repair at the 48th hours and 7th day was lower in Vicryil rapide group.\u003c/p\u003e \u003cp\u003eBharathi et al. stated that pain level was lower in episiotomy repair by Vicryil rapide than that by chromic catgut (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The Perumal study also revealed that pain severity at the 48th hour and 7th day after repair of episiotomy was significantly lower with Vicyil rapide than with chromic catgut (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In a study conducted by Abdullah et al. episiotomy by Vicryil rapide suture was associated with reduced pain level and faster wound healing (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA small Danish randomized control trial (RCT) showed that there was no significant difference between perineum pain in short-term and long-term. However, the subjects in Vicryl rapide group reported a decrease in the pain when they walked at the 14th day (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Ulster compared polyglactin 910 and Vircyl rapide in two groups and found a significant difference between pain and infections at the 6th and 12th weeks so that the both were lower in Vicryl rapide (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the meta-analysis, polyglactin 910 was associated with less short-term pain compared to traditional gut sutures; however, it increased the rates of removal. Further researches with alternative suture materials are needed (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results of a meta-analysis study on eight clinical trials showed that synthetic suture materials reduced episiotomy pain for a short period of time. This is consistent with the findings of the present study (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The wide range of episiotomy pain measured in different studies may be due to different suture materials and different measurement methods for pain intensity. However, the majority of previous studies indicated that Vicryil rapide for episiotomy repair reduced the severity of pain (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Furthermore, the pain severity particularly decreased at the 42nd days after delivery.\u003c/p\u003e \u003cp\u003eSynthetic absorbable suture Vicryil rapide was superior to naturally absorbable chromic catgut and polyglactin 910 with respect to inflammation at the site of perineum repair at various positions and at the 48th hour and 7th day after episiotomy. This finding is consistent with Perumal and Talbot et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, inflammation at the site of perineum repair was not significant at 42 days, and some of the subjects displayed inflammation at the 42nd days, which is consistent with previous studies (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The significant reduction of inflammation at the site of perineum repair at this stage is mainly due to the fact that most of the episiotomy wounds were healed six weeks after delivery (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe rates of infection, suture dehiscence, and residual materials at the 48th hours, 7th days, and 42nd days after the repair of episiotomy were not significantly different between the three groups, which is also supported by Joseph study (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The results of other studies showed no residual suture material in either group at the end of the 6th week. Joseph et al. showed that the remaining of suture in Vicryl rapide was completely absorbed while suture residual were observed in 18% of polyglactin 910 and 18% of chromic catgut groups (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Mackrodt reported that 12% of polyglactin 910 group needed removal of the residual of suture (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). A Danish randomized control trial (RCT) found no difference between the groups regarding episiotomy dehiscence (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In addition, a limited number of subjects displayed incision infection, spitting sutures, and residual materials at the 48th hours and 42nd days after delivery. An RCT study revealed that suture dehiscence was higher in patients treated by chromic catgut suture (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The magnificent reduction in the rates of infection, suture dehiscence, and residual materials at this stage is mainly due to the fact that most of the episiotomy wounds were healed six weeks after delivery.\u003c/p\u003e \u003cp\u003eFeeling pain during sexual intercourse was lower in patients treated by Vicryil rapide, which is consistent with the findings of the McElhinny study who compared the impact of Vicryl versus Vicryl rapide. However, at the sixth week, a significant difference in dyspareunia scores between the two groups was noted. The Vicryl rapide group experienced considerably less pain than the Vicryl group (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Kettle, et al. investigated 1542 female patients, and found that pain during sexual intercourse was not significantly different three months after the delivery between patients treated by polyglactin 910 and standard suture materials. The inconsistency of these results with our study can be attributed to the fact that pain measurement was not performed at the 6th week after delivery (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe short follow up for patients low sample size in all three study groups was one of the limitations of the current study. On the other hand, we believe that our findings were not biased. Hence, we suggest further research with larger sample size and longer follow-up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccording to the results of this study, the use of Vicryil rapide suture for episiotomy repair was associated with earlier pain and inflammation alleviation at the site of perineum repair. Thus, Vicryil rapide suture should be chosen as the first-line suture material for episiotomy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e BMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePROM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePremature Rupture of Membranes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual Analog Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANOVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalysis of Variance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEctopic Pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMOL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMolar Pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003eThis article is based on Dr. Chnour Limouei\u0026apos;s thesis on obstetrics. The authors would like to thank all patients and their family for help us to perform this study. The authors also, thank collaboration the Clinical Research Development Center of Kowsar hospitals, Sanandaj, Iran\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThis study was funded by Vice Chancellor for Research and Technology of Kurdistan University of Medical Sciences, Sanandaj, Iran. The funding body played no role in the design of the study, collection, analysis, or interpretation of data or in writing the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed during the current study can be made available by the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e SS and CL conceived and designed the study. SS, FZ, CL and MAR analyzed and interpreted the data, and drafted the manuscript. SS, FZ, MAR, CL and MN were involved in the composition of the study tool, supervision of the research process and critical revision and review of the manuscript. All the authors read and approved the final manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003eThe approval for this study was obtained from the Ethics Committee of Kurdistan University of Medical Science (IR.MUK.REC.1396.188). Written informed consent for participation in the study was obtained from participants.\u003cstrong\u003e\u0026nbsp;Consent for publication\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e The authors have no conflicts of interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams Obstetrics 24th edition McGraw-Hill Education. Medical, editor: Mcgraw-hill; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Din AS, Kamal MM, Amin MA. Comparison between two incision angles of mediolateral episiotomy in primiparous women: a randomized controlled trial. Journal of Obstetrics and Gynaecology Research. 2014;40(7):1877\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalis V, Laine K, De Leeuw J, Ismail K, Tincello D. Classification of episiotomy: towards a standardisation of terminology. BJOG: an international journal of obstetrics \u0026amp; gynaecology. 2012;119(5):522\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFraser D, Cooper M. MA, Myles' Textbook for Midwives. London: Churchill Livington; 2003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFriedman AM, Ananth CV, Prendergast E, D'alton ME, Wright JD. Evaluation of third-degree and fourth-degree laceration rates as quality indicators. Obstetrics \u0026amp; Gynecology. 2015;125(4):927\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKettle C, Dowswell T, Ismail KM. Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database of Systematic Reviews. 2010(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVakili F, Mirmohammadaliei M, Montazeri A, Farokhi M, Minaee MB. Impact of hypericum perforatum ointment on perineal pain intensity following episiotomy: a randomized placebo-controlled trial. Journal of caring sciences. 2018;7(4):205.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdolahpour P, Babaei M, Gasemi Y. Causes of maternal mortality in pregnant women in urban and rural areas of Ilam. Iran J Health Syst Res. 2011;7(6):1278\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBharathi A, Reddy DD, Kote GS. A prospective randomized comparative study of vicryl rapide versus chromic catgut for episiotomy repair. Journal of clinical and diagnostic research: JCDR. 2013;7(2):326.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWheeler J, Davis D, Fry M, Brodie P, Homer CS. Is Asian ethnicity an independent risk factor for severe perineal trauma in childbirth? A systematic review of the literature. Women and Birth. 2012;25(3):107\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKindberg S, Stehouwer M, Hvidman L, Henriksen TB. Postpartum perineal repair performed by midwives: a randomised trial comparing two suture techniques leaving the skin unsutured. BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology. 2008;115(4):472\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBose E, Samant M, Lal P, Mishra S, Ghosh A. Comparison of impact of polyglactin 910 (Vicryl rapide) and chromic catgut sutures on perineal pain following episiotomy wound repair in eastern Indian patients. Journal of the Scientific Society. 2013;40(2):95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerumal D, Selvaraju D. Comparative study of episiotomy repair: Absorbable synthetic versus chromic catgut suture material. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017;6(6):2186\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSohail S, Abbas T, Ata S. Comparison between synthetic vicryl \u0026amp; chromic catgut on perineal repair. Medical Channel. 2009;15(2):48\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKinney ES, James SR, Murray SS, Nelson K, Ashwill J. Maternal-Child Nursing-E-Book: Elsevier Health Sciences; 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJallad K, Steele SE, Barber MD. Breakdown of Perineal Laceration Repair After Vaginal Delivery: A Case-Control Study. Female pelvic medicine \u0026amp; reconstructive surgery. 2016;22(4):276\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKettle C, Dowswell T, Ismail KM. Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears. The Cochrane Library. 2012(11).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeroux N, Bujold E. Impact of chromic catgut versus polyglactin 910 versus fast-absorbing polyglactin 910 sutures for perineal repair: a randomized, controlled trial. American journal of obstetrics and gynecology. 2006;194(6):1585\u0026ndash;90; discussion 90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson A, Thakar R, Sultan AH. Obstetric perineal wound infection: is there underreporting? British Journal of Nursing. 2012;21(Sup5):S28-S35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZiaie T, Porhidary M, Nazifkar H, Kazemnejad E. Comparison of Wound Repair Outcomes of Chromic Catgut versus Vicryl Sutures for Episiotomy Repair: A clinical trial. Advances in Nursing \u0026amp; Midwifery. 2016;26(92):1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalekpoor P, Sehati Shafaei F, Del Azar A, Ghojazadeh M. Effect of Turmeric solution on pain relief after episiotomy in primiparus women. Nursing and Midwifery. Journal of Tabriz University of Medical Sciences. 2009;16:4\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. The Journal of pain. 2003;4(7):407\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlvarenga MB, Francisco AA, Oliveira SMJVd, Silva FMBd, Shimoda GT, Damiani LP. Episiotomy healing assessment: redness, oedema, ecchymosis, discharge, approximation (REEDA) scale reliability. Revista latino-americana de enfermagem. 2015;23(1):162\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdullah M, Noreen A, Iqbal M, Sohail R. Comparison between chromic catgut and vicryl rapide for analgesia requirement in episiotomy repair in primigravidas. Annals of King Edward Medical University. 2015;21(3):193-.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGemynthe A, Langhoff-Roos J, Sahl S, Knudsen J. New VICRYL* formulation: an improved method of perineal repair? British Journal of Midwifery. 1996;4(5):230\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcElhinney B, Glenn D, Dornan G, Harper M. Episiotomy repair: Vicryl versus Vicryl rapide. The Ulster medical journal. 2000;69(1):27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKettle C, Johanson R. Absorbable synthetic versus catgut suture material for perineal repair. Cochrane database of systematic reviews. 1996;2(1): CD000006. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD000006\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD000006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTalbot AW, Meadows AE, Tyers AG, Shah-Desai S. Use of 7/0 Vicryl (coated polyglactin 910) and 7/0 Vicryl-rapide (irradiated polyglactin 910) in skin closure in ophthalmic plastic surgery. Orbit (Amsterdam, Netherlands). 2002;21(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoseph K, Shantha B, Prakash S. Comparative study of episiotomy repair: Absorbable synthetic versus chromic catgut suture material. Journal of Obestetrics and Gynecology of India. 2008;58(6):495\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMackrodt C, Gordon B, Fern E, Ayers S, Truesdale A, Grant A. The Ipswich Childbirth Study: 2. A randomised comparison of polyglactin 910 with chromic catgut for postpartum perineal repair. BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology. 1998;105(4):441\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKettle C, Hills RK, Jones P, Darby L, Gray R, Johanson R. Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial. The Lancet. 2002;359(9325):2217\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Suture, Episiotomy, Severity of pain, Clinical Trial Study, Iran","lastPublishedDoi":"10.21203/rs.3.rs-1659930/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1659930/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Episiotomy is one of the common surgical procedures in maternity wards. A large number of women who undergo episiotomy suffer from short-term postpartum complications, which are associated with a type of applied suture. Chromic catgut, polyglactin 910 (Coated Vicryl) and Vicryil rapide are the most common suture materials for the perineal repair. The aim of this study is to compare three suture materials on perineal pain, infection, and inflammation at the site of perineal repair of episiotomy. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This randomized clinical trial was conducted on 114 patients referred to the labor ward of Besat Hospital, Sanandaj City, Iran in 2017-2018. Random allocation was conducted using envelopes containing a number from one to three for the three suture materials. Each envelope was opened by the gynecology resident and each group was treated by a specific suture material. The severity of perineal pain, infection, incidence rate of inflammation, and residual materials were evaluated at the 48\u003csup\u003eth\u003c/sup\u003e hours, 7\u003csup\u003eth\u003c/sup\u003e day, and 42\u003csup\u003end\u003c/sup\u003e day and in the case of pain during sexual intercourse at the 6\u003csup\u003eth\u003c/sup\u003e week after episiotomy.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The severity of perineal pain was significantly different between the three groups at 48\u003csup\u003eth\u003c/sup\u003e hour, 7\u003csup\u003eth\u003c/sup\u003e day, and 42\u003csup\u003end\u003c/sup\u003e day after episiotomy (P\u0026lt;0.001). Moreover, 15.4% of the patients (n=6) who used Vicryil rapide suture reported no pain (P\u0026lt;0.001). Moreover, the severity of the moderate and severe pains at the 7\u003csup\u003eth\u003c/sup\u003e day and 42\u003csup\u003end\u003c/sup\u003e day were significantly lower in Vicryil rapide group in comparison with the chromic catgut and polyglactin 910 groups. The inflammation at the site of perineum repair was also significantly lower in the Vicryil rapide group in comparison with other two other groups at the 48\u003csup\u003eth\u003c/sup\u003e hour and 7\u003csup\u003eth\u003c/sup\u003e day after episiotomy (P\u0026lt;0.001). Furthermore, the pain severity during sexual intercourse was significantly lower in the Vicryil rapide group (P\u0026lt;0.001). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e According to the results, using Vicryil rapide suture for episiotomy repair was associated with earlier pain and inflammation reduction at the site of perineum repair.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eIRCT20141208020249N5 (\u003ca href=\"http://en.irct.ir/trial/34194\" rel=\"noopener noreferrer\" target=\"_blank\"\u003ehttp://en.irct.ir/trial/34194\u003c/a\u003e)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDate trial registration: \u003c/strong\u003e02 February 2019 (The trial was retrospectively registered)\u003c/p\u003e","manuscriptTitle":"A comparison of chromic catgut, polyglactin 910, and Vicryil rapide sutures for episiotomy repair: a randomized clinical trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-05-18 18:28:43","doi":"10.21203/rs.3.rs-1659930/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"441aa47e-b7ad-448d-8dc2-3cdc7eb09f38","owner":[],"postedDate":"May 18th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-06-09T00:59:16+00:00","versionOfRecord":[],"versionCreatedAt":"2022-05-18 18:28:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1659930","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1659930","identity":"rs-1659930","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}