Geschreven door Charlotte de Deugd
Gepubliceerd op 4 juni 2025

Tijdens een vaginale bevalling kunnen er kleine of grotere scheurtjes (rupturen) ontstaan in de huid en het spierweefsel rond de vagina en het perineum (het gebied tussen de vagina en de anus). Dergelijke rupturen kunnen gehecht worden, zodat het weefsel dicht tegen elkaar aan ligt om snel en goed te herstellen.

Maar moet een tweedegraadsruptuur altijd gehecht worden? En als er gehecht wordt, welke techniek werkt dan het beste? En wat is de invloed van hechten op bijvoorbeeld herstel, pijnbeleving en borstvoeding?

In dit artikel geven we antwoord op deze en andere vragen. 

Abbas, A. M., Mohamed, A. A., Mattar, O. M., El Shamy, T., James, C., Namous, L. O., … Samy, A. (2018). Lidocaine-prilocaine cream versus local infiltration anesthesia in pain relief during repair of perineal trauma after vaginal delivery: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine, 33(6), 1064–1071. https://doi.org/10.1080/14767058.2018.1512576

American Academy of Family Physicians. (2021). Perineal tears: Diagnosis and management. American Family Physician, 103(12), 745-752. https://www.aafp.org/pubs/afp/issues/2021/0615/p745.html#afp20210615p745-f3

Bick, D. E., Ismail, K. M., Macdonald, S., Thomas, P., Tohill, S., & Kettle, C. (2012). How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice. BMC pregnancy and childbirth, 12, 1-10.

Bitzen PO, Gustafsson B, Jostell KG. Excretion of paracetamol in human breast milk. European journal of clinical pharmacology. 1981;20(2):123-5

Böhm G, Kahl B. Comparison of continuous versus interrupted suturing for perineal repair: A randomized controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2005;112(7):907–912. doi:10.1111/j.1471-0528.2005.00626.x.

Böhm G, Kahl B. Comparison of continuous versus interrupted suturing for perineal repair: A randomized controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology. 2005;112(7):907–912. doi:10.1111/j.1471-0528.2005.00626.x.

Bulletins-Obstetrics, C. P. (2018). ACOG practice bulletin no. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol, 132(3), e87-e102.

Committee on Practice Bulletins–Obstetrics. ACOG practice bulletin no. 198: prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol. 2018;132(3):e87-e102.

Diaz MP, Simpson N, Brown A, Diorgu FC, Steen M. Effectiveness of structured education and training in perineal wound assessment and repair for midwives and midwifery students: A review of the literature. Eur J Midwifery. 2021 May 20;5:13. doi: 10.18332/ejm/134511. PMID: 34046559; PMCID: PMC8135602.

Dumville JC, Coulthard P, Worthington HV, Riley P, Patel N, Darcey J, Esposito M, van der Elst M, van Waes OJ. Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev. 2014 Nov 28;2014(11):CD004287. doi: 10.1002/14651858.CD004287.pub4. PMID: 25431843; PMCID: PMC10074547.

East, C. E., Sherburn, M., Nagle, C., Said, J., & Forster, D. A. (2012). Perineal pain following childbirth: Prevalence, effects on postnatal recovery and analgesia usage. Midwifery, 28(1), 93–97. https://doi.org/10.1016/j.midw.2011.01.005

Elharmeel SM, Chaudhary Y, Tan S, Scheermeyer E, Hanafy A, van Driel ML. Surgical repair of spontaneous perineal tears that occur during childbirth versus no intervention. Cochrane Database of Systematic Reviews. 2011;(8):CD008534. doi:10.1002/14651858.CD008534.pub2.

Ethicon. (2024). Ethicon Product Catalog 2024 Update US (Documentnummer ETH-WOUN-113232.1-V3).https://p1.aprimocdn.net/jjamp/en/ethicon/product-catalogs/eth-wc-wc-catalog-2024-update-us-eth-woun-113232.1-v3--1--113232.pdf

Farion KJ, Osmond MH, Hartling L, Russell KF, Klassen TP, Crumley E, Wiebe N. Tissue adhesives for traumatic lacerations: a systematic review of randomized controlled trials. Acad Emerg Med. 2003 Feb;10(2):110-8. doi: 10.1111/j.1553-2712.2003.tb00027.x. PMID: 12574007.

Fleming VE, Hagen S, Niven C. Does perineal suturing make a difference? The SUNS trial. British Journal of Obstetrics & Gynaecology. 2003;110(7):684–689. doi:10.1046/j.1471-0528.2003.03055.x.

Frohlich J, Kettle C. Perineal care. BMJ Clin Evid. 2015 Mar 10;2015:1401. PMID: 25752310; PMCID: PMC4356152.

Gilpin-Blake, D., & Elliott, S. (2001, december 1). A natural alternative to suturing. Midwifery Today. https://www.midwiferytoday.com/mt-articles/natural-alternative-suturing/

Goh R, Goh D, Ellepola H. Perineal tears—a review. Aust J Gen Pract. 2018;47(1–2):35-38.

Goh, R., Goh, D., & Ellepola, H. (2018). Perineal tears-A review. Australian journal of general practice, 47(1/2), 35-38.

Gordon B, Mackrodt C, Fern E, Truesdale A, Ayers S, Grant A. The Ipswich Childbirth Study: 1. A randomised evaluation of two stage postpartum perineal repair leaving the skin unsutured. BJOG. 1998 May;105(5):435–440. doi:10.1111/j.1471-0528.1998.tb10008.x.

Hammond A, Priddis H, Ormsby S, Dahlen HG. Improving women's experiences of perineal suturing: A pragmatic qualitative analysis of what is helpful and harmful. Women Birth. 2022 Nov;35(6):e598-e606. doi: 10.1016/j.wombi.2022.02.008. Epub 2022 Feb 22. PMID: 35216938.

Iqbal, R., Intsar, A., Khursheed, S. (2012). Outcome of continuous versus interrupted method of episiotomy stitching. Pakistan Journal of Medical and Health Sciences, 6, 759–762.

Jones C. The efficacy of lavender oil on perineal trauma: a review of the evidence. Complement Ther Clin Pract. 2011 Nov;17(4):215-20. doi: 10.1016/j.ctcp.2011.01.003. Epub 2011 Feb 22. PMID: 21982136.

Kennisinstituut van de Federatie Medisch Specialisten. (2016). Totaalruptuur: Primair herstel na totaalruptuur. Richtlijnendatabase. https://richtlijnendatabase.nl/richtlijn/totaalruptuur/primair_herstel_na_totaalruptuur.html

Kettle C, Dowswell T, Ismail KM. Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears. Cochrane Database Syst Rev. 2012;14:11.

Kettle, C., Dowswell, T., & Ismail, K. M. (2010). Absorbable suture materials for primary repair of episiotomy and second degree tears. Cochrane Database of Systematic Reviews, (6).

Kettle, C., Dowswell, T., & Ismail, K. M. (2010). Continuous and interrupted suturing techniques for repair of episiotomy or second degree tears. Cochrane Database of Systematic Reviews, (4), CD000947. https://doi.org/10.1002/14651858.CD000947.pub3

Kettle, C., Dowswell, T., Ismail, K. M., & Johanson, R. B. (2012). Continuous and interrupted suturing techniques for repair of episiotomy or second-degree tears. Cochrane Database of Systematic Reviews, (11), CD000947. https://doi.org/10.1002/14651858.CD000947.pub3

López-Lapeyrere C, Solís-Muñoz M, Hernández-López AB, Rodríguez-Barrientos R, González-Rubio R; Carol Research Group. Perineal repair of media-lateral episiotomies and 2nd degree tears by midwives: A randomised controlled trial comparing three suture techniques. Int J Nurs Stud. 2020 Jun;106:103553. doi: 10.1016/j.ijnurstu.2020.103553. Epub 2020 Mar 3. PMID: 32278106.

Lundquist M, Olsson A, Nissen E, Norman M. Is it necessary to suture all lacerations after a vaginal delivery? Birth. 2000;27(2):79–85. doi:10.1046/j.1523-536x.2000.00079.x.

Martínez-Galiano JM, Arredondo-López B, Hidalgo-Ruiz M, Narvaez-Traverso A, Lopez-Morón I, Delgado-Rodriguez M. Suture type used for perineal injury repair and sexual function: a randomised controlled trial. Sci Rep. 2020 Jun 29;10(1):10553. doi: 10.1038/s41598-020-67659-2. PMID: 32601329; PMCID: PMC7324616.

Pazandeh F, Savadzadeh S, Mojab F, Alavi Majd H. Effects of Chamomile Essence on Episiotomy Healing in Primiparous Women. J Ardabil Univ Med Sci 2008; 8 (4) :364-370

Prins, M., Van Roosmalen, J., Smit, Y., Scherjon, S. A., & Van Dillen, J. (2019b). Praktische verloskunde. In Bohn Stafleu van Loghum eBooks. https://doi.org/10.1007/978-90-368-2279-4  

Restaino S, Degano M, Rizzante E, Battello G, Paparcura F, Biasioli A, Arcieri M, Filip G, Vetrugno L, Dogareschi T, Bove T, Petrillo M, Capobianco G, Vizzielli G, Driul L; LISPRAY Group. Lidocaine spray vs mepivacaine local infiltration for suturing 1st/2nd grade perineal lacerations: a randomised controlled non-inferiority trial. BMC Pregnancy Childbirth. 2024 Jun 24;24(1):439. doi: 10.1186/s12884-024-06640-7. PMID: 38914976; PMCID: PMC11194923.

Schmidt, C., & Fenner, D. E. (2024). Obstetric perineal trauma: Current practice and materials. Journal of Women’s Health, 33(1), 34–41

Schmidt, P. C., & Fenner, D. E. (2023). Repair of episiotomy and obstetrical perineal lacerations (first–fourth degree). American Journal of Obstetrics and Gynecology, 232(4), 385–399. https://doi.org/10.1016/j.ajog.2022.07.005

Schmidt, P. C., & Fenner, D. E. (2024). Repair of episiotomy and obstetrical perineal lacerations (first-fourth). American Journal of Obstetrics and Gynecology, 230(3S), S1005-S1013. https://doi.org/10.1016/j.ajog.2022.07.005

Seijmonsbergen-Schermers AE, Sahami S, Lucas C, Jonge Ad. Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review. Birth. 2015 Jun;42(2):100-15. doi: 10.1111/birt.12166. Epub 2015 Apr 11. PMID: 25864727.

Smith CA, Hill E, Denejkina A, Thornton C, Dahlen HG. The effectiveness and safety of complementary health approaches to managing postpartum pain: A systematic review and meta-analysis. Integr Med Res. 2022 Mar;11(1):100758. doi: 10.1016/j.imr.2021.100758. Epub 2021 Jul 22. PMID: 34485073; PMCID: PMC8408636

Sweeney, J., et al. (2017). Patient outcomes following perineal repair with lidocaine anesthesia: A prospective study. Journal of Clinical Anesthesia, 48(5), 267-273.

Taema, M. I., & Alayed, N. (2023). A prospective cohort multicentre comparison of two episiotomy repair techniques: Skin adhesive strips vs. subcuticular suture. Ginekologia i Położnictwo, 18(1). https://www.ginekologiaipoloznictwo.com/articles/a-prospective-cohort-multicentre-comparision-of-two-episiotomy-repair-techniques-skin-adhesive-strips-vs-subcuticular-suture-97732.html

Walter K, Dilger C. Ibuprofen in human milk. Br J Clin Pharmacol. 1997;44(2):211-2.

White C, Atchan M. Postpartum management of perineal injury - A critical narrative review of level 1 evidence. Midwifery. 2022 Sep;112:103410. doi: 10.1016/j.midw.2022.103410. Epub 2022 Jun 22. PMID: 35792304.

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