Clinical Study

Comparison of a single- knot versus three layered technique of perineal repair after vaginal delivery in women requiring episiotomy: A double blind randomized controlled trial

  • Shamsa Zafar

Received Date: 19.03.2008 Accepted Date: 24.07.2008 J Turk Ger Gynecol Assoc 2008;9(3):129-133


Episiotomy is a common procedure performed after vaginal deliveries and perineal pain along with discomfort are the major morbidities associated with it. Exploring various options to make this procedure less painful would benefit a large number of women. We compared a single knot technique of repair with the traditional three layer technique, for duration of surgery and postoperative pain using visual analogue scale (VAS) in this study.


After consent 110 women having spontaneous vertex delivery and requiring episiotomy were randomly allocated to either the traditional repair in three layers (n=55) or to the single knot (S-knot) technique (n=55).Main outcome measures were postoperative pain within 12 hours and the duration of surgery in seconds. Duration of surgery and visual analogue scale (VAS) scoring for pain was recorded by an independent observer at the time of discharge, and at follow up visit after 7 days. Data was analyzed using standard statistical methods.


The episiotomy rate was 75 % at our setting. The mean age of the study population was 27 ± 5 years (range 19-38 yrs). Both the study groups were similar in variables like age, socioeconomic status, parity, gestation, length of episiotomy and suture material used. The mean VAS score for postoperative pain in the first 12 hours and the mean duration of surgery were significantly lower in the S-knot technique compared to the traditional technique (3.5 versus 5.5, p=0.000 and 232.6 versus 317.3 sec, p=0.000)


S-knot technique was less painful within the first 12 hours of surgery and was quicker to perform as compared to the traditional technique.

Keywords: Episiotomy, Single –Knot Technique, vas score, duration of surgery, pain