Varying Incidence and Definitions of Infection and Wound Dehiscence After Second-Degree Tear or Episiotomy: A Systematic Review.

INTRODUCTION AND HYPOTHESIS: Obstetric tears are a common complication of vaginal delivery, with second-degree tears and episiotomies being the most prevalent types. Despite their prevalence, the incidence of healing complications are not clearly defined. This review aims to consolidate the current knowledge.

METHODS

This systematic review examines the risk of wound dehiscence and infection following second-degree tears and episiotomies. Literature searches were conducted across three databases: PubMed, Embase, and Cochrane. Two authors independently and blindly selected studies deemed relevant based on their title and abstract. Full-text screening was then performed, and included studies were assessed for risk of bias.

RESULTS

The review included 15 papers and found that the risk of infection ranged from 0 to 30%, and wound dehiscence from 0 to 22%. However, the review revealed substantial variation in definitions, evaluation methods, assessment timing, and preventive treatments. Studies incorporating clinical evaluations 1-3 weeks postpartum reported a higher prevalence of complications (infection 5.3%, dehiscence 9.3%) compared to those without such assessments (infection 1.8%, dehiscence 3.6%).

CONCLUSIONS

Second-degree tears and episiotomies are common, with up to 30% experiencing healing complications. This review found higher rates in studies with clinical follow-up 1-3 weeks postpartum, though precise estimates are limited by varying follow-up times and outcome definitions. This underscores the need for further research and increased clinical focus on these complications.