Optimizing Early Episiotomy Wound Healing

Optimizing Early Episiotomy Wound Healing: A Randomized Controlled Trial of Hydrophilic Methacrylate Gel Versus Beta-Sitosterol Ointment

This randomized controlled trial compares hydrophilic methacrylate gel versus beta-sitosterol ointment for early episiotomy wound healing. A total of 107 women who underwent mediolateral episiotomy during vaginal delivery were allocated to receive either hydrophilic methacrylate gel (n=53) or beta-sitosterol ointment (n=54). Wound outcomes were assessed by trained observers blinded to treatment allocation and by patients at two time points approximately 12 days apart. The primary outcome was the REEDA score (Redness, Edema, Ecchymosis, Discharge, Approximation). Secondary outcomes included patient-reported pain, cosmetic appearance, satisfaction, perceived treatment effectiveness, ease of application, and likelihood of recommending treatment.

Wound healing following episiotomy is a complex biological process influenced by mechanical stress, inflammatory response, tissue perfusion, and patient-related factors. This prospective randomized single-blinded controlled trial enrolled adult women who underwent mediolateral episiotomy during vaginal delivery at a tertiary care maternity hospital in Qatar. Exclusion criteria included known dermatological conditions affecting wound healing, hypersensitivity to study products, systemic inflammatory disease, chronic conditions delaying healing (e.g., coagulation disorders, diabetes, anemia with Hb <9 g/dl), prior perineal injury, surgery, or visible lesions, or inability to attend follow-up. A total of 107 women were allocated to receive either hydrophilic methacrylate gel (n=53) or beta-sitosterol ointment (n=54).Outcome assessments were performed by trained observers blinded to treatment allocation and by patients at two time points approximately 12 days apart. Observer-assessed outcomes used the REEDA scale (Redness, Edema, Ecchymosis, Discharge, Approximation). Patient-reported outcomes included pain, cosmetic appearance, overall satisfaction, perceived treatment effectiveness, ease of application, and likelihood of recommending treatment.

Inclusion Criteria:

• Age ≥18 years
• Primigravida (first pregnancy)
• Live term singleton pregnancy
• Underwent mediolateral episiotomy without tear during vaginal delivery
• Adequate reading and writing literacy

Exclusion Criteria:

• Known dermatological conditions affecting wound healing
• Hypersensitivity to study products
• Systemic inflammatory disease
• Chronic systemic disease that delays wound healing (e.g., coagulation disorders, diabetes, anemia with Hb <9 g/dl)
• Prior perineal injury, surgery, or visible lesions (e.g., genital warts, hemorrhoids)
• Inability to attend follow-up appointments