THE EFFECT OF MEDIOLATERAL EPISIOTOMY KNOT PLACEMENT ON POSTPARTUM OUTCOMES IN MOTHERS: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background:
Episiotomy remains a widely performed obstetric intervention, particularly in assisted vaginal deliveries. While mediolateral episiotomy reduces the risk of severe perineal trauma, short-term maternal discomfort persists. Technical factors such as the position of the final suture knot have not been systematically studied despite their potential impact on pain and wound healing.

Objectives:
To evaluate whether right-sided knot placement during mediolateral episiotomy repair improves maternal comfort and wound outcomes compared to left-sided knot placement.

Methods:
This prospective, randomized controlled trial included 100 postpartum women undergoing mediolateral episiotomy. Participants were randomized into two groups: Group A (knot placed on the left side) and Group B (knot placed on the right side). Primary outcome was maternal pain assessed using the Visual Analog Scale (VAS) on postpartum days 1, 3, and 7. Secondary outcomes included pain during sitting/walking, local wound complications, and REEDA scores. Statistical analysis was performed using Student’s t-test and Chi-square test, with p< 0.05 considered significant.

Results:
Baseline characteristics were comparable between the two groups. Group B reported significantly lower VAS scores across all time points (Day 1: 4.2 ± 1.2 vs. 5.8 ± 1.4, p< 0.001; Day 3: 2.9 ± 1.0 vs. 4.3 ± 1.1, p< 0.001; Day 7: 1.3 ± 0.8 vs. 2.1 ± 0.9, p = 0.002). Functional pain was also reduced in Group B (pain on sitting: 54% vs. 84%, p = 0.001; walking: 50% vs. 78%, p = 0.003). Local complications such as swelling (8% vs. 24%, p = 0.026) and redness (6% vs. 20%, p = 0.039) were significantly lower in Group B. REEDA scores on Day 7 were lower in Group B (0.7 ± 0.5 vs. 1.7 ± 0.8, p< 0.001), indicating better wound healing.

Conclusion: Right-sided knot placement during mediolateral episiotomy repair significantly improves maternal comfort and promotes superior wound healing compared to left-sided placement. This simple, cost-free modification may enhance postpartum outcomes and warrants consideration in routine obstetric practice.