***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE The aim of the current study is to investigate possibilities for episiorrhaphy with synthetic sutures and patients follow up for complains and physical status . MATERIAL S AND METHODS The present study is prospect i ve and it includes 180 patients . We used for episiorrhaphy : synthetic sutures Polyglycolic acid ( 1st group ) , Polyglactin 910 ( 2nd group ) and plain cat gut and silk ( 3rd group ) . Vaginal walls , perineum and skin , in the former two groups of patients , had been sutured only with synthetic suture material s. In the third group we used plain cat gut for vaginal walls and perineum sutures and silk sutures for the skin . We used classical surgical and anesthesiological technics . We followed up anatomical repair , presence ofperineal pain , doctors opinion and patients ' attitude . We took into account 5th day post partum results . RESULTS AND DISCUSSION Anatomical repair of the episiorrhaphy does n't differ significantly depending on the type of suture material ( n.s.-P>0.05 ) . All episiorrhaphies had been healed primary . In the groups were Polyglycolic acid or Polyglactin 910 had been used , local injury reaction ( erythema , edema ) had been developed more slightly compared with plain cat gut - silk group . Functional results as perineal pain are significantly less expressed in Polyglycolic acid and Polyglactin 910 groups . These patients had pain less frequently and with lesser degree ( s.-P<0.05 ) . In these groups patients did n't suffer from fear of sutures removal and sutures were both functional and cosmetic We aim ed to find out how long irradiated polyglactin 910 ( Vicryl Rapide ) remained in the oral tissues and to investigate the effect of chlorhexidine mouthwash on absorption time and bacterial growth on sutures . Twenty-one volunteers each had two Vicryl Rapide sutures placed intraorally under local anaesthesia . Ten of these subjects used chlorhexidine mouthwash twice daily . After 7 days , one suture was removed to be cultured for aerobic and anaerobic bacteria . The other was monitored for time from insertion to loss . The median survival value was 3 days ( range 1 - 13 ) . The median number of days to suture loss was less in the chlorhexidine group ( 3 , range 1 - 11 ) than in the control group ( 4 , range 1 - 13 ) but this was not significant . There were no significant differences in aerobic and anaerobic counts between the two groups . Vicryl Rapide may be useful for intraoral use OBJECTIVE The goal of our study was to compare the impact of 3 suture material s on  perineal pain  and on resumption of sexual intercourse . STUDY DESIGN This r and omized , controlled trial compared 3 types of suture material s ( chromic catgut , polyglactin 910 , fast-absorbing polyglactin 910 ) for second-degree perineal laceration or uncomplicated episiotomy . Patients were enrolled in early labor and assigned r and omly to 1 of the 3 suture material s. Pain was evaluated at 48 hours , 6 weeks , and 3 months . The study subjects were question ed about residual perineal pain , resumption of sexual activity , and pain-free sexual intercourse . Logistic regression analyses were undertaken . RESULTS Of the 192 patients who were assigned r and omly to groups , 66 patients had their perineal laceration repaired with chromic catgut ; 60 patients had repair with polyglactin 910 , and 66 patients had repair with fast-absorbing polyglactin 910 . At 48 hours , there was no significant difference according to the pain measurement scores , but the median consumption of analgesics was significantly lower with fast-absorbing polyglactin 910 than with st and ard polyglactin 910 . There was no difference in the resumption of sexual intercourse at 6 weeks after the delivery between chromic catgut ( 42 % ) compared with st and ard polyglactin 910 group ( 56 % ; P = .23 ) . However , it was more frequent for women in the fast-absorbing polyglactin 910 group ( 66 % ; P = .02 ) . After adjustment for confounding variables , perineal repair with fast-absorbing polyglactin 910 was associated with a higher rate of sexual intercourse ( odds ratio , 2.55 ; 95 % CI , 1.07 - 6.10 ) and a higher rate of pain-free sexual intercourse ( odds ratio , 2.51 ; 95 % CI , 1.03 - 6.10 ) at 6 weeks after delivery . CONCLUSION Fast-absorbing polyglactin 910 for perineal repair is associated with earlier resumption of sexual intercourse when compared with chromic catgut BACKGROUND Trauma to the perineum is a serious and frequent problem after childbirth , with about 350000 women each year in the UK needing sutures for perineal injury after spontaneous vaginal delivery , and many millions more worldwide . We compared the continuous technique of perineal repair with the interrupted method , and the more rapidly absorbed polyglactin 910 suture material with the st and ard polyglactin 910 material . METHODS 1542 women who had a spontaneous vaginal delivery with a second-degree perineal tear or episiotomy were r and omly allocated to either the continuous ( n=771 ) or interrupted ( 771 ) suturing method , and to either the more rapidly absorbed polyglactin 910 suture material ( 772 ) or st and ard polyglactin 910 material ( 770 ) . Primary outcomes were pain 10 days after delivery and superficial dyspareunia 3 months postpartum . Analysis was by intention to treat . FINDINGS At day 10 , three women had dropped out of the study . Significantly fewer women reported pain at 10 days with the continuous technique than with the interrupted method ( 204/770 [ 26.5 % ] vs 338/769 [ 44.0 % ] , odds ratio 0.47 , 95 % CI 0.38 - 0.58 , p<0.0001 ) . Occurrence of pain did not differ significantly between groups assigned the more rapidly absorbed material or st and ard material ( 256/769 [ 33.3 % ] vs 286/770 [ 37.1 % ] , 0.84 , 0.68 - 1.04 , p=0.10 ) . Women reported no difference in superficial dyspareunia at 3 months for the continuous vs the interrupted method ( 98/581 [ 16.9 % ] vs 102/593 [ 17.2 % ] , 0.98 , 0.72 - 1.33 , p=0.88 ) or the more rapidly absorbed versus st and ard material ( 105/586 [ 17.9 % ] vs 95/588 [ 16.2 % ] , 1.13 , 0.84 - 1.54 , p=0.42 ) . Suture removal was done less with the more rapidly absorbed material than with st and ard suture material ( 22/769 [ 3 % ] vs 98/770 [ 13 % ] , p<0.0001 ) , and with the continuous versus interrupted method ( 24/770 [ 3 % ] vs 96/769 [ 12 % ] , p<0.0001 ) . INTERPRETATION A simple and widely practicable continuous repair technique can prevent one woman in six from having pain at 10 days . Also , the more rapidly absorbed polyglactin 910 material obviates need for suture removal up to 3 months postpartum for one in ten women sutured Episiotomy continues to be a frequently used procedure in obstetrics despite little scientific support for its routine use . The incidence of episiotomy and perineal tears and also the indications for episiotomy were therefore investigated in 1007 singleton deliveries between January 1 , 1997 and December 31 , 1997 at the Lagos University Teaching Hospital . The incidence of  episiotomy  was 54.9 % of all deliveries .  Episiotomy  was more frequently performed in primipara ( 90.4 % ) . Perineal tears occurred in only 18.8 % of all deliveries , with majority in the multipara ( 93.6 % ) . Most of the team were of first degree ( 98.4 % ) . No third degree tear was recorded . The commonest indication for  episiotomy  was that of protecting the perineum from possible tears ( 80.7 % ) . All the  episiotomies  were mediolateral . Episiotomy rate was higher among deliveries conducted by doctors . Performance of episiotomy  had a positive correlation with increasing foetal weight . No major complication or maternal death attributable to episiotomy was recorded . The results of our study suggest that the use of episiotomy can be restricted to specified indications like instrumental and big babies delivery . It is also useful for the prevention of maternal morbidity through perineal laceration . R and omized control trials will however be necessary to clarify the controversies relating to restrictive episiotomy Objective To assess the long term implication s of four alternative approaches to postpartum perineal repair . Objective To compare polyglactin 910 sutures with chromic catgut sutures for postpartum perineal repair Summary . Polyglycolic acid ( PGA ) sutures and traditional catgut were compared in 190 patients undergoing episiotomy . Each group was also r and omly allocated to a double blind comparison of therapy with oral proteolytic enzymes ( Chymoral ) and placebo . The combination of Chymoral and polyglycolic acid sutures was shown to reduce the level of pain , assessed subjectively , and there was a significant reduction in analgesic requirements in the Chymoral/PGA group Summary . Glycerol‐impregnated chromic catgut and untreated chromic catgut were compared in a r and omized controlled trial involving 737 consecutive women who required repair of perineal trauma following spontaneous vaginal delivery . Medical staff preference was equally divided between the two material s. More untreated chromic catgut sutures required removal both by 10 days and by 3 months postpartum . Women whose perineal trauma was repaired with glycerol‐impregnated chromic catgut were 10 % more likely to have perineal pain at 10 days and 33 % more likely to suffer from dyspareunia in the 3 months following delivery . The high rates of maternal morbidity associated with glycerol‐impregnated chromic catgut appear to preclude its use for perineal repair Summary . Three methods of episiotomy repair were r and omly assigned after 900 consecutive deliveries . The three procedures were : ( 1 ) continuous No. 00‐plain catgut in the vagina ; No. 00‐plain catgut interrupted stiches in the perineal muscles and fascia , and No. 00‐nylon interrupted stiches in the skin . ( 2 ) The same technique as in ( l ) , but with No. 0‐polyglycolic acid ( Dexon ) in all layers . ( 3 ) The suture material as in ( 2 ) , but used with a subcuticular technique . The women treated with method 3 reported statistically significant less pain and disabilities in the early puerperium . Three months after delivery 262 women ( 33 % ) still had perineal complaints which could be directly related to the episiotomy in 25 % ( 8 % of total number ) . The group treated with method 3 had the best long‐term results and we conclude that the subcuticular technique using polyglycolic acid should be the method of choice Women suffer a significant degree of perineal morbidity in the postpartum period . For some , it can be significant and interfere with daily activities . Although there seems to be no doubt that polyglycolic acid derivatives are superior to non absorbable sutures with regard to wound healing , problems still occur with their use . In this study a relatively new product , Vicryl rapide , was compared with Vicryl OBJECTIVE to assess the effect of suture material s ( an absorbable synthetic suture material versus catgut ) used in perineal repairs undertaken by midwives who had been trained and accredited in repair techniques . DESIGN r and omised controlled trial . SETTING tertiary obstetric hospital in Australia . PARTICIPANTS 391 women with a live singleton birth at > or = 34 weeks gestation , result ing from a spontaneous vaginal delivery and who required perineal repair due to either an episiotomy or first or second degree tear . INTERVENTION eligible women were r and omly allocated for repair with either polyglycolic acid or chromic catgut . MAIN OUTCOME MEASURES perineal pain and dyspareunia up to six months postpartum . FINDINGS of the 194 women allocated to polyglycolic suture 106 ( 55 % ) were primipara compared with 79 ( 40 % ) of the 197 women allocated to catgut . Due to this unexplained imbalance , odds ratios were estimated with and without adjustment for parity . The parity-adjusted odds ratios were little changed ( < 11 % ) from the crude odds ratios . Although there were no statistically significant differences , parity-adjusted odds ratios ( aOR ) suggest that compared with women sutured with catgut , women 
    Output:
    
When catgut and glycerol impregnated catgut were compared , results were similar for most outcomes , although the latter was associated with more short-term pain .
AUTHORS ' CONCLUSIONS Catgut may increase short-term pain compared with synthetic sutures .
There were few differences between st and ard and rapidly absorbing synthetic sutures but more women needed st and ard sutures removing .