Skip to main content
SpringerLink
Log in

Perineal resuturing versus conservative treatment for dehisced perineal wounds and episiotomies: a systematic review and meta-analysis

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Perineal wound dehiscence is associated with complications, such as infections, perineal pain, dyspareunia, and altered sexual function, that severely affects women’s health. Currently, few studies have examined secondary repair of first- and second-degree perineal wound dehiscence and episiotomies, and there is currently no consensus on the optimal treatment option for dehisced perineal wounds. The objective was to evaluate whether resuturing or conservative treatment of first- and second-degree dehisced perineal wounds and episiotomies is the optimal treatment modality in terms of postoperative healing time and other secondary outcomes.

Methods

A systematic literature search was carried out using PubMed, Embase, and Cochrane databases. All included studies were evaluated using the SIGN methodology checklist, with the purpose of assessing the study quality.

Results

Three randomized controlled trials were included. Only two small sample-sized studies presented data regarding healing time for both the resuturing and the conservative treatment groups. However, no significant difference was found between the two groups at 4–6 weeks’ healing time (RR 1.16, 95% CI 0.53–2.52). One study found that women being resutured experienced a significantly reduced healing time and higher satisfaction with the appearance of the wound healing at 3 months compared with the conservative treatment group.

Conclusion

We found no significant differences in the healing time between the resuturing group and the conservative treatment group. However, the sample sizes of the studies were small. A well-designed, large, and prospective randomized controlled trial is needed to evaluate the optimal treatment modality for dehisced perineal wounds.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Schmidt LM, Kindberg SF, Glavind-Kristensen M, Bek KM, Nohr EA. Early secondary repair of labial tears, 1st and 2nd degree perineal lacerations and mediolateral episiotomies in a midwifery-led clinic. A retrospective evaluation of cases based on photo documentation. Sex Reprod Healthc. 2018;17:75–80. https://doi.org/10.1016/j.srhc.2018.07.004.

    Article  PubMed  Google Scholar 

  2. Dudley L, Kettle C, Thomas PW, Ismail KMK. Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a pilot and feasibility randomised controlled trial. BMJ Open. 2017;7(2):e012766. https://doi.org/10.1136/bmjopen-2016.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Dudley LM, Kettle C, Ismail KMK. Secondary suturing compared to non-suturing for broken down perineal wounds following childbirth. Cochrane Database Syst Rev. 2013. https://doi.org/10.1002/14651858.CD008977.pub2.

    Article  PubMed  Google Scholar 

  4. Ramin SM, Ramus RM, Little BB, Gilstrap LC. Early repair of episiotomy dehiscence associated with infection. J Obstet Gynecol. 1992;167:1104–7.

    Article  Google Scholar 

  5. Rotem R, Sela HY, Reichman O, Weintraub AY, Grisaru-Granovsky S, Rottenstreich M. Re-suturing of puerperal perineal wound: an assessment of indications, risk factors and outcomes. Eur J Obstet Gynecol Reprod Biol. 2020;251:42–7. https://doi.org/10.1016/j.ejogrb.2020.05.028.

    Article  PubMed  Google Scholar 

  6. Dudley L, Kettle C, Waterfield J, Ismail KMK. Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a nested qualitative study. BMJ Open. 2017;7:13008. https://doi.org/10.1136/bmjopen-2016.

    Article  Google Scholar 

  7. Okeahialam NA, Thakar R, Kleprlikova H, Taithongchai A, Sultan AH. Early re-suturing of dehisced obstetric perineal wounds: a 13-year experience. Eur J Obstet Gynecol Reprod Biol. 2020;254:69–73. https://doi.org/10.1016/j.ejogrb.2020.09.013.

    Article  PubMed  Google Scholar 

  8. Uygur D, Yesildaglar N, Kis S, Sipahi T. Early repair of episiotomy dehiscence. Aust N Z J Obstet Gynaecol. 2004;44:244–6.

    Article  PubMed  Google Scholar 

  9. Hankins GD, Hauth JC, Gilstrap LC, Hammond TL, Yeomans ER, Snyder RR. Early repair of episiotomy dehiscence. Obstet Gynecol. 1990;75:48–51.

    PubMed  Google Scholar 

  10. Christensen S, Andersen G, Detlefsen GU, Hansen PK. Treatment of episiotomy wound infections. Incision and drainage versus incision, curettage and sutures under antibiotic cover—a randomized trial. Ugeskr Laeger. 1994;156:4829.

    PubMed  Google Scholar 

  11. Monberg J, Hammen S. Ruptured episiotomia resutured primarily. Acta Obstet Gynecol Scand. 1987;66:163–4.

    Article  PubMed  Google Scholar 

  12. PRISMA Statement http://www.prisma-statement.org/PRISMAStatement/Checklist. Accessed 4 April 2023.

  13. Rayyan—AI Powered Tool for Systematic Literature Reviews. https://www.rayyan.ai/. Accessed 4 April 2023.

  14. SIGN Checklist. https://www.sign.ac.uk/what-we-do/methodology/checklists/. Accessed 4 April 2023.

  15. Lallemant M, D’Antona A, Vidal C, et al. Conservative management versus systematic suture of isolated vaginal or first-degree perineal tears after delivery: a preliminary randomized efficacy trial. Birth. 2022;50(3):513–24. https://doi.org/10.1111/birt.12671.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Seijmonsbergen-Schermers AE, Sahami S, Lucas C, De Jonge A. Nonsuturing or skin adhesives versus suturing of the perineal skin after childbirth: a systematic review. Birth. 2015;42(2):100–15.

  18. Alvarenga MB, Francisco AA, De Oliveira SMJV, Da Silva FMB, Shimoda GT, Damiani LP. Episiotomy healing assessment: redness, oedema, ecchymosis, discharge, approximation (REEDA) scale reliability. Rev Lat Am Enfermagem. 2015;23:162–8. https://doi.org/10.1590/0104-1169.3633.2538.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Ulla Bismark Kullab, Lærke Vinberg Moestrup, Thomas Bergholt, Niels Klarskov & Hanna Jangö

  2. Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark

    Ulla Bismark Kullab, Thomas Bergholt, Niels Klarskov & Hanna Jangö

Authors
  1. Ulla Bismark Kullab
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lærke Vinberg Moestrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Bergholt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Niels Klarskov
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hanna Jangö
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Design: U.B.K., L.V.M., H.J.; literature search: U.B.K., H.J.; screening process: U.B.K., L.V.M., H.J.; data analysis and writing process: U.B.K., L.V.M., T.B., N.K., H.J.

Corresponding author

Correspondence to Ulla Bismark Kullab.

Ethics declarations

Ethical approval

This study was exempt from ethical approval.

Conflicts of interest

None.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kullab, U.B., Moestrup, L.V., Bergholt, T. et al. Perineal resuturing versus conservative treatment for dehisced perineal wounds and episiotomies: a systematic review and meta-analysis. Int Urogynecol J 34, 2859–2866 (2023). https://doi.org/10.1007/s00192-023-05642-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-023-05642-x

Keywords

Search

Navigation