Re-suturing of puerperal perineal wound: An assessment of indications, risk factors and outcomes

Objective: To assess the frequency of puerperal perineal wound re-suturing, and to evaluate the indications, risk factors and outcomes of this procedure. Study design: A retrospective series of all parturients that underwent puerperal perineal tear suturing between 2005 and 2019 was undertaken. All parturients who required re-suturing during the delivery hospitalization were identified and compared with those who had puerperal perineal wound repair and did not require re-suturing. General demographics, obstetrical history, current delivery characteristics, re-suturing indications, and outcome were obtained and analyzed. Results: During the study period, 54,934 parturients required puerperal perineal tear suturing, of which 47 (0.09%) required re-suturing within their postpartum hospitalization. Median time from delivery to perineal re-suturing was 5.38 h [IQR 4.07–7.14]. The most common indication was vulvovaginal hematoma (n = 37, 78.7%). The independent risk factors found to be associated with re-suturing were: cephalic malposition (aOR 9.3, 95% CI 1.26–67.74) and meconium stained amniotic fluid (aOR 2.1, 95% CI 1.10–3.85). Parturients who underwent re-suturing had significantly higher rates of postpartum hemorrhage (78.5% vs. 11.4%) blood transfusions (36.2% vs. 1.3%), puerperal fever, and longer hospitalizations (P < 0.01 for all). Conclusion: In our population, early re-suturing of puerperal perineal tears is rare, however, it is associated with increased short term maternal morbidity.