***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIMS The study aim ed to highlight any differences between the sequelae of episiorrhaphy performed using the Blair-Donatti and Guilmen-Pontonnier techniques . METHODS A total of 202 pregnant women were recruited in the Obstetrics Ward of Codogno Civic Hospital in 1994 and 1995 . Subjects were r and omly divided into two groups matched for socioeconomic status , age and parity ( group A : Guilmen-Pontonnier suture , group B : Blair-Donatti suture ) . The following parameters were evaluated : pain twenty-four hours , sixty-six hours and one , two and three months after labour , pain during sexual relations , the onset of infection , hematoma , dehiscence of the wound , and lastly the cosmetic results . RESULTS No significant differences were found between the parameters examined in both groups , barring the improved cosmetic result in group Episiotomy is a very common operation but little is known of its short-term or long-term morbidity . A prospect i ve study was design ed to record postpartum perineal discomfort and to investigate the presence and persistence of  dyspareunia following episiotomy  in 140 primigravidae . A comparison was made between those whose perineal skin was sutured with a subcuticular polyglycolic acid ( ; Dexon ' ) stitch and those sutured with interrupted black silk stitches . Patients sutured with subcuticular ; Dexon ' had significantly less perineal discomfort on the third , fourth , and fifth postpartum days . Patients who had epidural analgesia in labour had significantly more pain during the first five postpartum days irrespective of the suture material used . The timing of first coitus after delivery did not influence the presence or persistence of dyspareunia . Dyspareunia was commoner and lasted longer in patients sutured with ; Dexon ' and it was also commoner in older primigravidae irrespective of the suture technique BACKGROUND Trauma to the perineum is a serious and frequent problem after childbirth , with about 350000 women each year in the UK needing sutures for perineal injury after spontaneous vaginal delivery , and many millions more worldwide . We compared the continuous technique of perineal repair with the interrupted method , and the more rapidly absorbed polyglactin 910 suture material with the st and ard polyglactin 910 material . METHODS 1542 women who had a spontaneous vaginal delivery with a second-degree perineal tear or episiotomy were r and omly allocated to either the continuous ( n=771 ) or interrupted ( 771 ) suturing method , and to either the more rapidly absorbed polyglactin 910 suture material ( 772 ) or st and ard polyglactin 910 material ( 770 ) . Primary outcomes were pain 10 days after delivery and superficial dyspareunia 3 months postpartum . Analysis was by intention to treat . FINDINGS At day 10 , three women had dropped out of the study . Significantly fewer women reported pain at 10 days with the continuous technique than with the interrupted method ( 204/770 [ 26.5 % ] vs 338/769 [ 44.0 % ] , odds ratio 0.47 , 95 % CI 0.38 - 0.58 , p<0.0001 ) . Occurrence of pain did not differ significantly between groups assigned the more rapidly absorbed material or st and ard material ( 256/769 [ 33.3 % ] vs 286/770 [ 37.1 % ] , 0.84 , 0.68 - 1.04 , p=0.10 ) . Women reported no difference in superficial dyspareunia at 3 months for the continuous vs the interrupted method ( 98/581 [ 16.9 % ] vs 102/593 [ 17.2 % ] , 0.98 , 0.72 - 1.33 , p=0.88 ) or the more rapidly absorbed versus st and ard material ( 105/586 [ 17.9 % ] vs 95/588 [ 16.2 % ] , 1.13 , 0.84 - 1.54 , p=0.42 ) . Suture removal was done less with the more rapidly absorbed material than with st and ard suture material ( 22/769 [ 3 % ] vs 98/770 [ 13 % ] , p<0.0001 ) , and with the continuous versus interrupted method ( 24/770 [ 3 % ] vs 96/769 [ 12 % ] , p<0.0001 ) . INTERPRETATION A simple and widely practicable continuous repair technique can prevent one woman in six from having pain at 10 days . Also , the more rapidly absorbed polyglactin 910 material obviates need for suture removal up to 3 months postpartum for one in ten women sutured Purpose To compare different repair techniques and different suture material s for episiotomy . Methods 160 women having vertex delivery with right-mediolateral episiotomy were r and omly allocated to four groups . In the groups where continuos technique was performed , vaginal mucosa , perineal muscles and the skin were sutured continuously . In the groups of interrupted technique , vaginal mucosa was sutured with continuous sutures , then muscle layers and skin were closed by interrupted sutures . Two different types of synthetic absorbed suture material were used : monofilament type is in form of polyglycolide-co-caprolactone and multifilament one is polyglactin 910-Rapide .  Perineal pain during different activities on the first and tenth day postpartum and also during sexual intercourse 6 weeks after the delivery was question ed by visual analogous scale ( VAS ) . Furthermore , repair time , amount of suture and episiotomy complications were investigated in each groups . Results On the first day after delivery , the perineal pain scores , the repair time , the amount of suture were statistically less in the continuous technique groups . The differences between the pain at tenth day and during sexual intercourse 6 weeks after the delivery were statistically same . Conclusions The continuous suturing techniques for episiotomy closure , compared to interrupted methods , are associated with less short-term pain , are quicker and also need less suture material Objective To assess the long term implication s of four alternative approaches to postpartum perineal repair . Objective To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth The aim was to compare healing and perineal pain with the use of continuous and interrupted suture techniques in women after normal delivery . A r and omized controlled trial was carried out at a hospital birth center in Itapecirica da Serra , Sao Paulo , Brazil . A total of 61 women participated with episiotomy or second degree perineal tear , allocated in two groups according to the continuous ( n=31 ) or interrupted ( n=30 ) suture techniques . The main outcomes evaluated were edema , ecchymosis , hyperemia , secretion , dehiscence , fibrosis , frequency and degree of pain ( evaluated by numerical scale from 1 to 10 ) . Data were collected during hospitalization and after discharge ( four and 41 days after birth ) . Healing occurred by first intention in 100 % of cases in both suture techniques . There were no statistically significant differences for the occurrence of morbidities , except for perineal pain due to palpation at four days after delivery , which was more frequent among women with interrupted suture OBJECTIVE Our purpose was to compare consequences for women of receiving versus not receiving median episiotomy early and 3 months post partum on the outcomes perineal pain , urinary and pelvic floor functioning by electromyography , and sexual functioning and to analyze the relationship between episiotomy and third- and fourth-degree tears . STUDY DESIGN A secondary cohort analysis was performed of participants within a r and omized clinical trial , analyzed by type of perineal trauma and pain , pelvic floor , and sexual consequences of such trauma , while controlling for trial arm . The study was conducted in three university or community hospitals ; 356 primiparous and 341 multiparous women were studied . RESULTS Early and 3-month-postpartum perineal pain was least for women who gave birth with an intact perineum . Spontaneous perineal tears were less painful than episiotomy . Sexual functioning was best for women with an intact perineum or perineal tears . Postpartum urinary and pelvic floor symptoms were similar in all perineal groups . At 3 months post partum those delivered with an intact perineum had the strongest pelvic floor musculature , those with episiotomy the weakest . Among primiparous women third- and fourth-degree tears were associated with median episiotomy ( 46/47 ) . After forceps births were removed and 21 other variables potentially associated within such tears were controlled for , episiotomy was strongly associated with third- and fourth-degree tears ( odds ratio + 22.08 , 95 % confidence interval 2.84 to 171.53 ) . Physicians using episiotomy at high rates also used other procedures , including cesarean section , more frequently . CONCLUSION Perineal and pelvic floor morbidity was greatest among women receiving median episiotomy  versus those remaining intact or sustaining spontaneous perineal tears . Median episiotomy was causally related to third- and fourth-degree tears . Those using episiotomy at the highest rates were more likely use other interventions as well . Episiotomy use should be restricted to specified fetal-maternal indications typic abnormalities in early onset severe growth retardation ( Fisk et al. 1989 ; Nicolaides et al. 1989 ; Sipes et al. 1991 ) . However , since there is an overlap in mean corpuscular volume between triploid and chromosomally normal growth-retarded fetuses ( Nicolaides et al. 1989 ) it is necessary that the diagnosis is confirmed by cytogenetic analysis which usually takes 7 - 10 days . Using flow cytometry and st and ard DNA quantification techniques , which are now widely used in the clinical management of haematological and other neoplasias , it is possible to diagnose fetal triploidy from fetal blood , within l h of sampling Summary . Three methods of episiotomy repair were r and omly assigned after 900 consecutive deliveries . The three procedures were : ( 1 ) continuous No. 00‐plain catgut in the vagina ; No. 00‐plain catgut interrupted stiches in the perineal muscles and fascia , and No. 00‐nylon interrupted stiches in the skin . ( 2 ) The same technique as in ( l ) , but with No. 0‐polyglycolic acid ( Dexon ) in all layers . ( 3 ) The suture material as in ( 2 ) , but used with a subcuticular technique . The women treated with method 3 reported statistically significant less pain and disabilities in the early puerperium . Three months after delivery 262 women ( 33 % ) still had perineal complaints which could be directly related to the episiotomy in 25 % ( 8 % of total number ) . The group treated with method 3 had the best long‐term results and we conclude that the subcuticular technique using polyglycolic acid should be the method of choice One thous and women were allocated at r and om to one of two perineal management policies , both intended to minimise trauma during spontaneous vaginal delivery . In one the aim was to restrict episiotomy to fetal indications ; in the other the operation was to be used more liberally to prevent perineal tears . The result ant episiotomy rates were 10 % and 51 % respectively . An intact perineum was more common among those allocated to the restrictive policy . This group experienced more perineal and labial tears , however , and included four of the five cases of severe trauma . There were no significant differences between the two groups either in neonatal state or in maternal pain and urinary symptoms 10 days and three months post partum . Women allocated to the restrictive policy were more likely to have resumed sexual intercourse within a month after delivery . These findings provide little support either for liberal use of episiotomy or for cl aims that reduced use of the operation decreases postpartum morbidity We set out to compare a policy of two-layered postpartum perineal repair leaving the skin unsutured with a policy of three-layered repair , which involved skin closure . Parturients who sustained a second-degree tear or an episiotomy in four Nigerian centers were r and omised to have either a  two-layered repair ( 417 women ) or a  three-layered repair ( 406 women ) . Fewer women in the two-layered group reported perineal pain at 48 hours ( 57 % vs. 65 % , relative risk [ RR ] 0.87 , 95 % confidence interval [ CI ] 0.78 - 0.97 ) and 14 days postpartum ( 22 % vs. 28 % , RR 0.77 , CI 0.61 - 0.98 ) . The two-layered repair was also associated with reduced risk of suture removal ( 6 % vs. 10 % , RR 0.62 , CI 0.39 - 0.99 ) , and less superficial dyspareunia at 3 months ( 6 % vs. 12 % , RR 0.52 , CI 0.33 - 0.81 ) . The rates of wound healing were similar between the two groups . Leaving the skin unsutured during postpartum perineal repair reduces perineal pain and dyspareunia Commonly used suture material s and techniques for perineal repair following vaginal delivery were compared in a r and omized controlled trial involving 1574 women . Three comparisons were made using a modified factorial design . In the comparison of teflon‐coated polyglycolic acid ( D 
    Output:
    
AUTHORS ' CONCLUSIONS The continuous suturing techniques for perineal closure , compared with interrupted methods , are associated with less short-term pain , need for analgesia and suture removal .