Continuous versus interrupted suturing for second-degree perineal tears and episiotomies: A meta-analysis of randomized trials.

INTRODUCTION

Perineal injuries during vaginal delivery, including second-degree lacerations and episiotomies, require effective suturing techniques. Despite being associated with decreased pain and improved short-term outcomes, continuous suturing has inconclusive results regarding long-term benefits.

OBJECTIVE

To assess the comparative efficacy and safety of continuous versus interrupted suturing for the repair of second-degree perineal tears and episiotomies.

METHODS

Data were analyzed using random-effects models to calculate pooled risk ratios (RR) with 95 % confidence intervals (CI). P values < 0.05 were considered statistically significant. Heterogeneity was assessed using Cochran's Q test and I2 statistics. Statistical analyses were conducted using R version 4.3.2.

RESULTS

Seventeen RCTs were included, encompassing a total of 5,851 postpartum women. Continuous suturing significantly reduced pain (RR 0.74; 95 % CI 0.65-0.83) and analgesia use (RR 0.81; 95 % CI 0.67-0.97) at 15 days postpartum, as well as wound dehiscence at 10 days (RR 0.64; 95 % CI 0.43-0.95). No significant differences were observed between techniques for pain, analgesia, dyspareunia, or sexual resumption at 3 months. The need for resuturing was also similar.

CONCLUSIONS

Continuous suturing offers clear short-term benefits without impacting longer-term sexual or pain outcomes. These findings support its preferential use for second-degree perineal repair, while highlighting the need for further research into patient-centered outcomes like dyspareunia and quality of life.