Early Resuturing versus expectant Management for Perineal Wound Dehiscence: A systematic review

Perineal wound dehiscence is a common complication of vaginal birth that impacts maternal well-being and quality of life. This systematic review compares early resuturing with expectant management in the treatment of perineal wound dehiscence.

We searched Ovid MEDLINE, CINAHL, and PubMed databases, and hand-searched recent reviews and relevant studies. Human prospective and retrospective studies, randomized controlled trials (RCTs), and case series evaluating early resuturing within the postnatal period were included. Two reviewers independently assessed the studies for outcomes and risk of bias. The primary outcome was healing time; secondary outcomes included dyspareunia, long-term symptoms, functional outcomes, infection rates, and anal sphincter injury.

Thirteen studies (1987-2022) were included: three RCTs, four prospective cohort studies or case series, and six retrospective studies-heterogeneity in study designs and outcomes limited data synthesis. Early resuturing was associated with reduced healing time, particularly for wounds not involving the anal sphincter, but increased the risk of complications such as fistula formation. Many studies emphasized meticulous preoperative wound care.

Limited evidence suggests that early resuturing may reduce healing time without increasing wound infection risk. However, the increased risk of complications necessitates cautious application and highlights the importance of preoperative wound care. Further robust research is needed, although challenging to conduct. Alternative analytical methods, such as data mining and decision tree algorithms, should be explored. Based on current evidence, clinicians should carefully individualize recommendations on the benefits and risks of early resuturing.