First- and second-degree post-partum perineal lacerations: non-surgical versus surgical management. A meta-analysis of randomized controlled trials

Background: Perineal lacerations and their repair can be associated with physical and psychological morbidity in the postpartum period with potential long - term consequences . However, there is still no shared consensus on the optimal management for 1st and 2nd degree perineal lacerations. Objective: To compare non-surgical versus surgical management of first and second-degree post-partum perineal lacerations. Search strategy: Medline, Cochrane Library, EMBASE, Pubmed Central, Scopus, ClinicalTrial.gov were electronically searched from their inception to December 2024. No restriction for geographic location or temporal limit was applied. Selection criteria : We included all RCTs comparing non-surgical versus surgical management of first and second-degree perineal post-partum lacerations. The primary outcome was Pain score assessed by VAS Scale 24 hours after delivery. Secondary outcomes were pain at 10 days and at 8 weeks; pain killer use at 10 days and 3 months; and dyspareunia at 3 months. Data Collection and Analysis: The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI). P value <0.05 was considered statistically significant. Main Results : Five RCTs including 522 pregnancies were analyzed. Overall, there was high clinical heterogeneity among RCTs. Non-surgical management of first and second-degree perineal lacerations was associated with decreased VAS Scale score at 24 hours (1.9 vs 2.3, p value = 0.04 ) and reduced pain killer use at 24 hours (RR 0.71, 95% CI 0.52 to 0.98), compared to surgical management. Incidences of mid- and late- pain assessment and analgesic use, as well as of dyspareunia and wound healing were similar in the two groups. Conclusions: : Non-surgical management of first and second-degree perineal lacerations is associated with decreased incidence of VAS pain scores and analgesic use at 24 hours, but similar dyspareunia and wound healing, compared to surgical management. Hence, non-surgical repair of 1 st and 2 nd degree perineal lacerations may be left optional to clinical judgement and patient’s choice.