Lacerations during birth that may require suture repair can occur as a fistula or in the vagina and perineum (1st degree), include perineal muscle (2nd degree), damage the anal sphincter (3rd degree) or completely tear the anal sphincter (4th degree). Suture can also repair cervical tears, which can sometimes include branches of the uterine artery and lead to extensive bleeding.
Mechanism of Action
Suture is used to hold lacerated tissue together while it heals. Although all sutures look like a needle and thread, multiple variations are used in obstetric care. Clinical trials have found that suturing these wounds leads to improved outcomes in wound closure and healing. Absorbable materials are most common for obstetric lacerations, especially chromic catgut and polyglycolic acid (PGA). Chromic catgut is derived from cattle intestines treated with a chromium salt. They are completely absorbed in 2-3 weeks. PGA is a synthetic material and lasts longer, retaining the majority of its strength at 14 days and fully absorbed in 60-90 days.
Current Use in High-Resource Settings
Roughly 85% of American mothers experience genital trauma during vaginal delivery, and 70% receive sutures for repair. Synthetic sutures are most commonly used in high-resource settings for their predictable absorption, low inflammation, and easier handling than catgut. Proprietary, branded products like Vicryl have considerable market share.
Application in Low-Resource Settings
Suture is a standard part of the skilled birth attendant tool kit in most low-resource settings. In order to use the suture optimally, skilled attendants need a good light source, antiseptic solution, gloves, a needle holder, sponge forceps, sterile gauze, a speculum, and a local anesthetic (such as lidocaine with syringe and needle). Chromic catgut and PGA are both available, but for cost reasons, generic chromic gut products are more popular. In some areas, unused lengths of suture may be rinsed and autoclaved after a procedure for use on the next patient.