You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial
Abstract 1:
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


Title 2:
A randomised controlled trial of care of the perineum during second stage of normal labour
Abstract 2:
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


Title 3:
Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation.
Abstract 3:
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


Title 4:
A prospective randomised controlled trial of perineal repair after childbirth, comparing interrupted chromic catgut to subcuticular prolene for skin closure
Abstract 4:
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


Title 5:
West Berkshire perineal management trial.
Abstract 5:
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


Title 6:
The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma
Abstract 6:
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 ( Dexon plus ) with chromic catgut for repair of the vagina and deep perineal tissues there was no clear difference other than less short‐term analgesia being required in association with polyglycolic acid . Outcome was also similar after skin repair with either polyglycolic acid or chromic catgut or silk , although silk repair required more packets of material and was associated with delay in resuming sexual intercourse  ; polyglycolic acid was more likely to need removal than chromic catgut but it appeared to reduce the need for resuturing . There was no clear difference between continuous subcuticular and interrupted transcutaneous sutures for repair of perineal skin


Title 7:
A randomized comparison of suturing techniques for episiotomy and laceration repair after spontaneous vaginal birth.
Abstract 7:
STUDY OBJECTIVE To compare the continuous knotless technique of perineal repair with the interrupted method after spontaneous vaginal birth DESIGN A r and omized controlled trial . DESIGN CLASSIFICATION Canadian Task Force Classification I. SETTING This study was undertaken in a university hospital with more than 2200 deliveries per year . The static population of this district includes a wide range of socioeconomic classes and is predominately white . PATIENTS From May 1 to November 19 , 2003 , 214 primiparous women with a second-degree perineal tear or episiotomy were r and omly allocated to either the continuous knotless technique ( CKT ; n=107 ) or the interrupted technique ( IT ; n=107 ) suturing method . INTERVENTIONS The interrupted technique ( IT ) involves placing 3 layers of sutures whereas the continuous knotless technique ( CKT ) involves reapproximating vaginal trauma , perineal muscles , and skin with a loose , continuous , nonlocking technique . MEASUREMENTS AND MAIN RESULTS The primary outcomes of the study were perineal pain ( evaluated by visual analogue scale ) at 48 hours and day 10 and dyspareunia 3 months after delivery . Secondary outcomes included suture removal , wound dehiscence , analgesia use up to 48 hours , and satisfaction with repair established at 3 and 12 months after childbirth . At day 10 , 19 women had dropped out of the study . Significantly fewer women reported pain at 10 days with the CKT than with the IT ( 32.3 % vs 60.4 % ; p<.001 ) . Analgesia use up to 48 hours postpartum was less in the CKT group than in the IT group ( 33.6 % vs 54.2 % ; p<.05 ) . No difference was found in superficial dyspareunia at 3 months for the CKT versus the IT group . CONCLUSION The use of a continuous knotless technique for perineal repair is associated with less short-term pain than techniques with interrupted sutures
AUTHORS ' CONCLUSIONS The continuous suturing techniques for perineal closure , compared to interrupted methods , are associated with less short-term pain .
Moreover , if the continuous technique is used for all layers ( vagina , perineal muscles and skin ) compared to perineal skin only , the reduction in pain is even greater