Beard 1974.

Methods	RCT.
Participants	Setting ‐ Queen Charlotte Maternity Hospital, London, UK. 200 women 'allocated randomly' into 2 groups. Inclusion criteria ‐ women having a 'normal delivery' with an episiotomy. Exclusion criteria ‐ women with lacerations or those booked for 48 hour discharge. Parity ‐ primigravidae and multigravidae. Mean age ‐ not specified. Operator ‐ resident obstetric officers in their second obstetric appointment.
Interventions	Intervention group (n = 100) ‐ 'standard method of repair incorporating a subcuticular suture to the perineal skin' with polyglycolic acid (Dexon) 2‐0 suture material on a 40 mm round bodied atraumatic needle. Comparison group (n = 100) ‐ 'standard method of repair incorporating a subcuticular suture to the perineal skin' with chromic catgut 2‐0 suture material on a 55 mm 'loose' round bodied needle.
Outcomes	Short‐term pain ‐ day 3. Analgesia ‐ day 3. Suture dehiscence ‐ day 3 (classified as superficial and deep). Wound inflammation ‐ day 3.
Notes	Similar number of primigravida and multigravida women in each group. Method of repair not fully described. It was documented in the paper that on the 3rd day after delivery the patients were interviewed and examined by 1 of the operators without knowledge of which suture material had been used. This may have been possible if the skin was closed with a subcuticular suture as the stitches would not be visible.
Risk of bias
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Unclear risk	Allocated "randomly to two groups" ‐ method not described.
Allocation concealment?	Unclear risk	No information available regarding concealment of treatment allocation.
Blinding? Women	Unclear risk	No details given.
Blinding? Clinical staff	High risk	Difference in suture materials and needles used for the repairs.
Blinding? Outcome assessors	Unclear risk	Outcome assessors were described as being "without knowledge of which suture had been used".
Incomplete outcome data addressed? All outcomes	Low risk	All participants entered into the trial were included in the analysis.
Free of other bias?	Unclear risk	Outcomes relating to pain were not simple to interpret, for 1 measure of pain, event rates added up to more than the total sample size and women may have been counted more than once: this outcome has not been included in the review.