Almeida 2008.

Methods	RCT (individual randomisation).
Participants	Setting: birth centre in a general hospital in Brazil. Dates of recruitment: July 2001 to April 2002. 61 women requiring perineal repair after episiotomy or second‐degree tear. Parity: primigravid and multigravid women included (16/31 in group 1 and 15/30 in group 2 had had a previous vaginal delivery). Mean age: group 1 = 24.2 years; group 2 = 24.2 years. Operator: 1 of 10 trained nurse/midwives.
Interventions	Method of repair: described as below. Women divided into 2 groups. Group 1 (N = 31),vaginal trauma and perineal muscle re‐approximated with the continuous non‐locking suture technique using polyglactin 910 (Vicryl Rapide) on a 1/2 circle, taper point needle (4 or 5 cm). The skin was approximated separately with a continuous intradermal suture using a 3/8 circle, reverse cutting needle. Group 2 (N = 30), vaginal trauma continuous locking and perineal muscle sutured using the interrupted technique with polyglactin 910 (Vicryl Rapide) using a 1/2 circle needle, taper point of 4 or 5 cm The skin was approximated separately with a 3/8 circle reverse cut needle of 3 cm using interrupted sutures.
Outcomes	Included in analysis: short‐term pain measured at day 4; analgesia at day 4; long‐term pain at 6 to 8 weeks' postpartum; dyspareunia at 6 to 8 weeks; time taken to carry out the repair (minutes).
Notes	Women in both groups had antisepsis of the vulva and perineum. Data collection from women by interview by researcher or midwife.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Described as by "electronic table".
Allocation concealment (selection bias)	Unclear risk	Not described.
Blinding (performance bias and detection bias) Clinical staff	High risk	Different techniques used.
Blinding (performance bias and detection bias) Women	High risk	Different techniques.
Blinding (performance bias and detection bias) Outcome assessors	High risk	Method used would be recorded in notes.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Randomisation was "applied at the moment of delivery to 95 women. A total of 34 women were excluded from the study and replaced by others according to the randomization table". It was not clear whether women were excluded after randomisation.
Selective reporting (reporting bias)	Unclear risk	Not apparent.
Other bias	Unclear risk	Data collection from women by interview by researcher or midwife. There was some baseline imbalance.