Outcomes of suture material, suture technique and tissue adhesives for repair of childbirth-related perineal trauma: A systematic review and meta-analysis

Background: Childbirth related perineal trauma is the most frequent complication experienced following vaginal delivery, affecting up to 90 % of women. This review aimed to identify the best material and technique for closure of first- and second-degree tears and episiotomies. Methods: MEDLNE, Embase, Web of Science and CINAHL databases were searched to April 2025 (PROSPERO: CRD42023458738). Randomised controlled trials were included if they evaluated outcomes for different suture materials, suture techniques or tissue adhesives compared with suture, for first and second-degree tear and episiotomy repairs. Obstetric anal sphincter injuries or non-obstetric perineal trauma were excluded. Primary outcomes were pain and dehiscence. Risk of bias was assessed using the Joanna Briggs Institute tool. Results: 55 papers were included (22 suture technique, 15 suture material, 6 both material and technique and 12 tissue adhesives respectively). Continuous suture was preferable to interrupted technique, regarding pain scores at <24 h (Standardised Mean Difference (SMD) 1.69 (95 % Confidence Interval (CI), 0.58–2.80), repair time (MD 2.21 (95 % CI,1.18–3.23)) and wound healing at <24 h (p = 0.04) and 10–20 days post-repair (p = 0.03). Rates of wound dehiscence were non-significant between techniques (p = 0.08). Suture material did not significantly influence pain. Tissue adhesives significantly reduced pain versus sutures, (SMD −0.93 (95 % CI, −1.41– −0.46)) and decreased repair time (MD −5.01 (95 % CI, −7.11– −2.91)). However, tissue adhesives significantly increased rates of wound dehiscence (p = 0.0004). Conclusion: Suture material did not influence pain outcomes; however, continuous suture techniques were superior to interrupted techniques. Tissue adhesives cannot be recommended due to increased rates of dehiscence.