SAMMANFATTNING Bakgrund: Globalt sett drabbas cirka 70-80 procent av alla kvinnor av någon typ av bristning i underlivet när de föder sitt första barn och dessa skador kan orsaka både smärta och lidande. Det är av stor vikt att barnmorskor och obstetriker känner till det kvinnliga könsorganets anatomi så att både diagnostisering och handläggning av bristningar blir korrekt. Forskning kring hur dessa skador skall kunna undvikas är ständigt pågående. En av de många frågor som ställs är huruvida förekomsten av dessa skador minskar när barnmorskan utför perinealskydd och hur detta används när kvinnan föder i vatten. Vattenfödsel är ett omdiskuterat ämne och forskare har olika uppfattning om dess för- och nackdelar. Syfte: Syftet med detta arbete var att beskriva utfallet och handläggningen av perinealbristningar vid vattenfödslar. Metod: En kvantitativ ansats har använts och information ifrån 123 kvinnors förlossningsjournaler har sammanställts. Alla kvinnorna födde sina barn i vatten på BB Sophia eller Södra BB från mars 2014 till mars 2015. Bristningsgrad har beskrivits i tabeller och diagram i förhållande till variablerna paritet, barnets vikt, utdrivningsskedets längd, barnets huvudomfång, tid för bad, BMI, ålder och suturering. Resultat: Betydligt fler av förstföderskorna drabbades av perinealbristning än vad omföderskorna gjorde. Av de kvinnor som fick en grad 3 eller grad 4 bristning hade alla längre utdrivningsskeden och var förstföderskor. Nio procent av kvinnorna i studien fick en grad 3 bristning vilket ses som en hög siffra. Av de totalt 101 kvinnorna som fick någon typ av perinealbristning lämnades tio stycken osuturerade och nästan hälften av barnmorskorna som besvarat enkäten använde sig av perinealskydd vid vattenfödslar. Slutsats: Att vara förstföderska ökar risken för perinealbristningar oavsett om kvinnan föder i vatten eller inte. Utdrivningsskedets längd kan ha betydelse samt även om barnmorskan använder perinealskydd eller inte. Vad som i övrigt påverkar utfallet av bristningar vid vattenfödsel är inte säkerställt. Mer forskning i ämnet behövs.

Toxins produced by the Gram-positive bacteria Clostridium botulinum cause transient chemodenervation of mammalian muscle. The toxin binds to specific proteins within cholinergic presynaptic nerve terminals which regulate the release of acetylcholine in the synaptic space resulting is loss of muscle activation and function. Local injections with botulinum toxins are currently used in humans for the treatment of disorders that benefit from prolonged neuromuscular blockade such as strabismus, blepharospasm, focal dystonias, spasticity, tremors, and anal fissures. Injections with botulinum toxin type A into the internal or external anal sphincter cause relaxation of the anal canal and allow healing of chronic anal fissures. Perineal lacerations in mares, which occur during foaling often dehisce after surgical repair due to the high pressure across the incision resulting from accumulation of feces in the rectum. We hypothesized local injections of Clostridium botulinum type B toxin into the external anal sphincter could cause a decrease in anal pressures, thus reducing the incidence of dehiscence if used before surgical repair of perineal laceration in mares. The purpose of this project was to determine the effects of BTB injection in the external anal sphincter in normal horses. Our hypothesis was that local injection of BTB would result in transient reduction of anal tone without causing clinical side effects. Peak and resting anal sphincter pressures of horses were measured with a custom made rectal probe connected to a pressure transducer. Pressures were measured before treatment and after injection with Clostridium botulinum type B toxin (BTB) or saline. Dose titration with 500, 1000, 1500 and 2500 units of BTB was completed. The horses' physical changes, behavior, and anal pressure were recorded. Injection of 1000 units of BTB produced significant reduction in peak anal pressure from days 2 to 84 when compared to control animals (P<0.05). Maximal effect of the toxin was observed within the first 15 days after injections followed by a slow return to baseline over 168 days. Injection in the anal sphincter with 2500 units of BTB in one horse produced signs of depression, generalized weakness, and dysphagia for 14 days. Clinical side effects were not observed in horses after injections with 500, 1000, or 1500 units of BTB. In summary, local injections of botulinum toxin type-B in the external anal sphincter of horses caused transient relaxation of the anus and reduction of peak anal pressures. Systemic side effects were observed in one horse, which suggested a narrow dosage range to avoid toxicity. Further research to test the effects of botulinum toxin in clinical cases is needed to determine the full potential of this treatment modality. / Master of Science

Introdução: A laceração obstétrica do esfíncter anal (LOEA) está associado com incontinência anal. A episiotomia foi proposta como uma forma de proteção do esfíncter anal no parto, especialmente a episiotomia mediolateral; entretanto, diversos estudos mostraram que o uso de rotina da episiotomia não reduz o risco de LOEA. Objetivo: Este estudo tem por objetivo analisar se a redução na taxa de episiotomia em hospital escola no Brasil foi associada a um aumento na incidência de lacerações obstétricas do esfíncter anal, além de fatores associados a elas. Métodos: Estudo observacional, transversal e retrospectivo, realizado no Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brasil. Foram incluídos todos os partos vaginais de gestações únicas, apresentação cefálica, a partir de 34 semanas de idade gestacional, realizados em 2011-2012 (uso liberal da episiotomia) e 2015-2016 (uso restrito da episiotomia), e comparados em relação a taxa de episiotomia mediolateral e de LOEA. Resultados: foram analisados 4268 partos (2043 no período de 2011-2012, 2225 de 2015-2016), foram analisados 2043 partos. A taxa de episiotomia reduziu de 59.4% para 44.2% (p≤0.0001). No período 2011-2012, ocorreram 10 lacerações obstétricas do esfíncter anal em 2043 partos (0.48%), enquanto que no período 2015-2016, ocorreram 31 lacerações em 2225 partos (1.39%). Houve interação quando comparado os dois períodos em relação a realização de episiotomia e a ocorrência de LOEA (p≤0.0001). A episiotomia foi fortemente associada a não ocorrência de LOEA em 2011-2012 (59.5%), enquanto que não ter episiotomia foi associado ao grupo com (67.7%) e sem LOEA (55.7%) em 2015-2016. Fatores associados a LOEA foram indução do parto e distócia de ombro. Conclusão: Houve um aumento na taxa de lacerações do esfíncter anal com a diminuição da taxa de episiotomia. A episiotomia de rotina foi prote / Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery, especially mediolateral episiotomy; however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study, conducted at Hospital de Clínicas, Porto Alegre, Rio Grande do Sul, Brazil. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015- 2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p≤0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p≤0.0001). Episiotomy was strongly related to 2011-2012 group with no OAST (59.5%), while not having an episiotomy was related to both OAST (67.7%) and no OAST (55.7%) group in 2015-2016. Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with a decrease in the rate of episiotomy. Routine episiotomy was protective.

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline. / Bakgrund: Sfinkterskada är en allvarlig komplikation i samband med vaginal förlossning. Önskan om att undvika vaginal förlossning igen ses hos kvinnor som tidigare drabbats av sfinkterskada. Syfte: Syftet med studien var att ta reda på om det fanns riktlinjer gällande sfinkterskada i samband med förlossning vid Sveriges förlossningskliniker samt sammanställa och granska innehållet i riktlinjerna. Metod: Innehållsanalys med en kombination av deduktiv och induktiv ansats. Resultat: Av de 39 kliniker som svarade hade 31 riktlinjer gällande sfinkterskada. I riktlinjerna beskrevs vanligast förekommande riskfaktorer samt prevention med hjälp av perinealskydd. Läkaren ställde diagnos och utförde reparation av sfinkterskadan på operationsavdelningen. Komplikationer som samlagssmärta och anal inkontinens fanns beskrivet i riktlinjerna. Paracetamol och diklofenak var den vanligast förekommande smärtlindringen. Profylax som antibiotikabehandling och laxantia gavs av de flesta förlossningskliniker. Information till den nyförlösta kvinnan beskrevs. Uppföljning hos läkare, barnmorska och sjukgymnast rekommenderades efter fyra veckor till sex månader. Vid kommande graviditet och förlossning föredrogs kejsarsnitt. Slutsats: Riktlinjerna var uppbyggda på samma sätt och hade till stor del liknande innehåll. Författarna till föreliggande fördjupningsarbete efterfrågar en nationell riktlinje.

Introdução: A laceração obstétrica do esfíncter anal (LOEA) está associado com incontinência anal. A episiotomia foi proposta como uma forma de proteção do esfíncter anal no parto, especialmente a episiotomia mediolateral; entretanto, diversos estudos mostraram que o uso de rotina da episiotomia não reduz o risco de LOEA. Objetivo: Este estudo tem por objetivo analisar se a redução na taxa de episiotomia em hospital escola no Brasil foi associada a um aumento na incidência de lacerações obstétricas do esfíncter anal, além de fatores associados a elas. Métodos: Estudo observacional, transversal e retrospectivo, realizado no Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brasil. Foram incluídos todos os partos vaginais de gestações únicas, apresentação cefálica, a partir de 34 semanas de idade gestacional, realizados em 2011-2012 (uso liberal da episiotomia) e 2015-2016 (uso restrito da episiotomia), e comparados em relação a taxa de episiotomia mediolateral e de LOEA. Resultados: foram analisados 4268 partos (2043 no período de 2011-2012, 2225 de 2015-2016), foram analisados 2043 partos. A taxa de episiotomia reduziu de 59.4% para 44.2% (p≤0.0001). No período 2011-2012, ocorreram 10 lacerações obstétricas do esfíncter anal em 2043 partos (0.48%), enquanto que no período 2015-2016, ocorreram 31 lacerações em 2225 partos (1.39%). Houve interação quando comparado os dois períodos em relação a realização de episiotomia e a ocorrência de LOEA (p≤0.0001). A episiotomia foi fortemente associada a não ocorrência de LOEA em 2011-2012 (59.5%), enquanto que não ter episiotomia foi associado ao grupo com (67.7%) e sem LOEA (55.7%) em 2015-2016. Fatores associados a LOEA foram indução do parto e distócia de ombro. Conclusão: Houve um aumento na taxa de lacerações do esfíncter anal com a diminuição da taxa de episiotomia. A episiotomia de rotina foi prote / Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery, especially mediolateral episiotomy; however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study, conducted at Hospital de Clínicas, Porto Alegre, Rio Grande do Sul, Brazil. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015- 2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p≤0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p≤0.0001). Episiotomy was strongly related to 2011-2012 group with no OAST (59.5%), while not having an episiotomy was related to both OAST (67.7%) and no OAST (55.7%) group in 2015-2016. Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with a decrease in the rate of episiotomy. Routine episiotomy was protective.

Introdução: A laceração obstétrica do esfíncter anal (LOEA) está associado com incontinência anal. A episiotomia foi proposta como uma forma de proteção do esfíncter anal no parto, especialmente a episiotomia mediolateral; entretanto, diversos estudos mostraram que o uso de rotina da episiotomia não reduz o risco de LOEA. Objetivo: Este estudo tem por objetivo analisar se a redução na taxa de episiotomia em hospital escola no Brasil foi associada a um aumento na incidência de lacerações obstétricas do esfíncter anal, além de fatores associados a elas. Métodos: Estudo observacional, transversal e retrospectivo, realizado no Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brasil. Foram incluídos todos os partos vaginais de gestações únicas, apresentação cefálica, a partir de 34 semanas de idade gestacional, realizados em 2011-2012 (uso liberal da episiotomia) e 2015-2016 (uso restrito da episiotomia), e comparados em relação a taxa de episiotomia mediolateral e de LOEA. Resultados: foram analisados 4268 partos (2043 no período de 2011-2012, 2225 de 2015-2016), foram analisados 2043 partos. A taxa de episiotomia reduziu de 59.4% para 44.2% (p≤0.0001). No período 2011-2012, ocorreram 10 lacerações obstétricas do esfíncter anal em 2043 partos (0.48%), enquanto que no período 2015-2016, ocorreram 31 lacerações em 2225 partos (1.39%). Houve interação quando comparado os dois períodos em relação a realização de episiotomia e a ocorrência de LOEA (p≤0.0001). A episiotomia foi fortemente associada a não ocorrência de LOEA em 2011-2012 (59.5%), enquanto que não ter episiotomia foi associado ao grupo com (67.7%) e sem LOEA (55.7%) em 2015-2016. Fatores associados a LOEA foram indução do parto e distócia de ombro. Conclusão: Houve um aumento na taxa de lacerações do esfíncter anal com a diminuição da taxa de episiotomia. A episiotomia de rotina foi prote / Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery, especially mediolateral episiotomy; however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study, conducted at Hospital de Clínicas, Porto Alegre, Rio Grande do Sul, Brazil. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015- 2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p≤0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p≤0.0001). Episiotomy was strongly related to 2011-2012 group with no OAST (59.5%), while not having an episiotomy was related to both OAST (67.7%) and no OAST (55.7%) group in 2015-2016. Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with a decrease in the rate of episiotomy. Routine episiotomy was protective.

Bakgrund: Perineala bristningar är vanligt förekommande vid vaginal förlossning. Bristningar kan leda till bland annat smärta i underlivet som i sin tur kan påverka den sexuella hälsan negativt. Befintlig forskning visar att en förlossningsställning kan påverka både uppkomsten samt graden av bristning, dock framkommer inte förklaring om varför. Syfte: Undersöka barnmorskors uppfattning av förlossningsställningens betydelse för perineala bristningar under utdrivningsskedet. Metod: Studien baseras på en fenomenografisk forskningsmetod där tio intervjuer har genomförts med barnmorskor från sex olika förlossningsavdelningar i södra och mellersta Sverige. Resultat: Förlossningsställningen uppfattas av barnmorskor kunna avlasta trycket mot perineum, undvika ett utdraget utdrivningsskede, vara avgörande för kvinnors kroppskontroll samt bidra till ett långsamt framfödande, vilket uppfattas minska risken för uppkomst av perineala bristningar. Förlossningsställningen uppfattas även kunna öka belastningen mot perineum, minska kvinnors möjlighet att själv kontrollera sin kropp samt bidra till spänd muskulatur i bäckenbotten, vilket uppfattas öka risken för perineala bristningar. I denna studie belyser även barnmorskor värdet av kommunikation med de födande kvinnorna under utdrivningsskedet. Detta uppfattas vara en av de viktigaste faktorerna för att förebygga perineala bristningar. Konklusion: Barnmorskor uppfattar att förlossningsställningen har olika betydelser för perineala bristningar. De för också ett resonemang kring varför och hur bristningar kan uppkomma samt förebyggas relaterat till olika förlossningsställningar. / Background: Perineal tears are common in vaginal delivery. The injury can lead to vaginal pain, which in turn can affect the sexual health negatively. Existing research shows that a birth position can influence both the onset and the degree of rupture, but does not reveal the explanation of why. Aim: Investigate midwives perception of the birth positions significans to perineal tearing during the second stage of labor. Method: The study is based on a phenomenographical research where ten interviews were conducted with midwives from six maternity hospitals in southern and central Sweden. Result: Birth positions is perceived by midwives to relieve pressure on the perineum, avoid prolonged second stage of labor, be crucial to women's body control and contribute to a slow birth, which is perceived to reduce the risk of perineal tearing. The birth position perceived also to be able to increase the pressure against the perineum, reduce women's ability to control their body and contribute to tense muscles in the pelvic floor, which is perceived to increase the risk of perineal tearing. This study also highlights the value of midwives communication with women giving birth during the second stage of labor. This is perceived to be one of the most important factors for the prevention of perineal tearing. Conclusion: Midwives perceive that birth position has different meanings for perineal tearing. Midwives also reason why and how perineal tearing can occur and be prevented related to different birth positions.

Os Bichos-Preguiça são mamíferos (Classe Mammalia) da ordem Xenarthra (ou Edentata) Utilizamos nesta pesquisa preguiças-de-coleira (Bradypus torquatus) sendo seis machos e uma fêmea de diferentes faixas etárias. Estes animais foram cedidos para o Laboratório de Anatomia do Departamento de Cirurgia da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (FMVZ -USP) pela Reserva Zoobotânica - Matinha Ilhéus/Bahia (Registro Ibama nº 02006.001.348/98-31), nos quais utilizamos as técnica de injeção vascular de látex (Neopreme&reg; 650) e a injeção intra muscular de solução aquosa de formaldeido à 10%, posteriormente analisados por microscopia de luz. Os resultados mostraram que a presença da coleira nos animais adultos permite diferenciar machos de fêmeas. O períneo é encontrado extra cavitário com formato oval, delimitado pelo osso interpubiano, púbico e sacrococcigeo; divide-se em três regiões: aponeurotica, gordurosa e muscular. Os músculos perineais são representados através dos músculos: levantador do ânus, esfíncter uretral, retrator do pênis e o músculo esfíncter anal. Os órgãos reprodutores masculinos da preguiça de coleira (Bradypus torquatus) estão representados: por um par de testículos; pelos epidídimos, compostos de cabeça, corpo e cauda, por dois pares de glândulas genitais acessórias; sendo um par de vesiculares e um par composto pela próstata; pela uretra masculina e o pênis / Sloths are mammals (Class: Mammalia) from Order Xenarthra (or Edentata). We used in this research three-toed sloth (Bradypus torquatus) being six males and one female at different ages. These animals had been yielded to the Anatomy Laboratory of Surgery Department at College of Veterinary Medicine and Zootecny of São Paulo University (FMVZ/USP) from the Matinha Zoo botanic Reserve, Ilhéus/Bahia (IBAMA Register nº 02006.001.348/98-31). We used the technique of vascular latex injection (Neopreme&reg; 650) and the muscular injection of watery formaldehyde solution to 10%, later analyzed by light microscopy. The results shown the presence of the necklace in adult animals allows to differentiate males from females. The perineal region is found extra cavity with oval shape, delimited by the interpubic, pubic bone and socrococcigeo; it is divided in three regions: aponeurotic, fatty and muscular. The perineal muscles are represented through the muscles: elevator of the anus, sphincter urethral, penis retractor and the muscle sphincter anal. The male reproductive organs of three-toed sloth sloth (Bradypus torquatus) are represented: for a pair of testis; epididimus, composed of head, body and tail, two pairs of accessory genital glands; one composed by a pair of vesicular glands and another pair, the prostate; for male urethra and penis.

Severe perineal trauma with injury to the anal sphincter at childbirth can have a profound effect on the physical and psychological wellbeing of women. This thesis describes literature examining resulting outcomes including effects on body image. It describes patient-based outcome measures used to capture this information, and evaluation of their psychometric properties. Body Image can be defined as an individual's perceptions and feelings about their own body. There is a growing interest in how this concept can influence quality of life and psychosocial dysfunction in medical disorders. This thesis aimed to examine relationships between severity of perineal trauma, general and genital specific body image and potentially influences such as symptoms of pelvic floor dysfunction. No patient-reported outcome measure validated for use in women after anal sphincter injury exists and this thesis also aimed to psychometrically evaluate an existing electronic questionnaire, ePAQ (electronic personal assessment questionnaire), for this application. In the thesis, a retrospective review of body image and physical outcomes attending a perineal clinic shows over half of women report perceived changes in body image after anal sphincter injury, with negative effects on self-esteem. A prospective observational cohort study explored genital and general body image in primiparous women grouped according to degree of perineal trauma or caesarean delivery. Women completed the Female Genital Self Image Score, the modified Body Image Score, ePAQ and the Edinburgh Postnatal Depression Scale a mean of 15.5 weeks (standard deviation 1.6) after delivery. There were significant differences in genital body image scores between the groups, but not in general body image, with regression analysis showing the greatest influence on genital body image to be the anatomical extent of the trauma. Embedded into this study was the evaluation of reliability (internal consistency and test-retest) and validity (face, content and construct) of ePAQ in the group of women with anal sphincter tears. This thesis presents the first research to quantify issues surrounding severe perineal trauma and body image and demonstrates that more severe trauma leads to a poorer genital body image. It also reports psychometric evaluation of ePAQ in women after anal sphincter injury providing the first single instrument with validity and reliability for use in this context.

<p><strong>Syfte</strong></p><p>Syftet med studien var att undersöka om det fanns skillnader mellan kvinnor som blivit suturerade med ett snabbabsorberande monofilt suturmaterial, Caprosyn® och ett multifilt suturmaterial, Polysorb® då det gällde kvinnans uppfattning om hur bristningen läkte åtta veckor postpartum.</p><p><strong>Urval</strong></p><p>Ett konsekutivt randomiserat urval. Fyrahundratvå kvinnor som fått en bristning vid förlossningen randomiserades till att sutureras med antingen Caprosyn® eller Polysorb®. Den slutgiltiga svarsfrekvensen var 67 %, det största bortfallet var på förlossningsavdelningen.</p><p><strong>Metod</strong></p><p>En experimentell kvantitativ studie. Två enkäter användes i studien, en som barnmorskan besvarade direkt efter förlossningen om bristningens art samt en till de medverkande kvinnorna åtta veckor postpartum.</p><p><strong>Resultat</strong></p><p>Inga skillnader fanns mellan suturmaterialen då det gäller kvinnornas smärta i underlivet, obehag i underlivet, återupptagande av sexualliv, samlagssmärta, amning eller hur många kvinnor som sökt sjukvård samt varför de sökt sjukvård åtta veckor postpartum. Fler positiva kommentarer gavs av barnmorskorna om Polysorb® än om Caprosyn®. Om kvinnan ammade delvis och hade samlagssmärta var denna smärta större än för de kvinnor som ammade helt. Ju lägre kvinnan skattade sin förlossningsupplevelse desto mer smärta hade kvinnan vid samlag åtta veckor postpartum.</p><p><strong>Slutsats</strong></p><p>De två studerade suturmaterialen skiljer sig inte åt enligt de deltagande kvinnornas upplevelse åtta veckor efter förlossningen. Däremot fanns ett samband mellan smärta i underlivet och upplevelse av förlossningen samt mellan hur mycket kvinnan ammade och samlagssmärta. Sammanfattningsvis kan barnmorskor inom förlossningsvården använda sig av båda materialen vid suturering av bristningar efter förlossning utan att det påverkar kvinnans hälsa negativt.</p>