Effect of tissue adhesives in repairing perineal trauma during childbirth: A systematic review and meta‐analysis

Abstract

Aims and objectives To investigate the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth. Background Due to the high incidence and severe consequences of perineal trauma during childbirth, tissue adhesives are recommended as an alternative to conventional sutures to repair perineal trauma. Although many original studies have explored the effect of tissue adhesives on perineal wound healing and pain relief in women with perineal trauma during childbirth, these studies have differed in participants, interventions and outcomes. Therefore, the effect of tissue adhesives on wound healing and pain relief in perineal trauma during childbirth is inconclusive. Design A systematic review and meta‐analysis based on PRISMA 2020. Methods A systematic and comprehensive literature search was conducted. Eight electronic databases, three clinical trial registers, and grey literature were searched from inception to 28th April 2021 and reference lists were also retrieved. Randomised controlled trials (RCTs) involving women with first‐ or second‐degree perineal lacerations or women who underwent episiotomy were included. The intervention was the use of tissue adhesives alone or in combination with sutures. For the outcome indicators of perineal wound healing and pain relief, subgroup analyses based on the extent of perineal trauma and measurement time points were conducted, respectively. Results A total of 14 RCTs involving 2264 participants were included in this research. The results indicated that for first‐degree lacerations, the incidence of wound complications was significantly higher in the tissue adhesives group. In contrast, for episiotomy, the effect of the combination of tissue adhesives and sutures was comparable to that of sutures exclusively. The pooled results revealed that tissue adhesives exerted a positive effect on relieving immediate and short‐term perineal pain, but no significant difference was found in the effect of long‐term pain relief. Moreover, this review also supported the effect of tissue adhesives in shortening intraoperative repair time and improving clinician‐maternal satisfaction. Conclusions The existing evidence illustrates that tissue adhesives effectively promote perineal wound healing and relieve immediate and short‐term pain. However, for first‐degree lacerations, the increased occurrence of wound complications must be prudently considered when applying tissue adhesives alone, whereas, for episiotomy, the combination of tissue adhesives and sutures may be a promising repair alternative. Future studies are encouraged to adopt long‐term effect, adverse effect, and cost‐effect analysis as important outcome indicators to comprehensively validate the applicability and generalisability of tissue adhesives. Relevance to clinical practice For first‐degree perineal lacerations, we do not recommend using tissue adhesives alone to repair the wound, given the increased wound complications. While for episiotomy, the combination of t...

Use of surgical glue versus suture to repair perineal tears: a randomised controlled trial

“…A literature search showed the use of surgical glue in the perineal repair of first-degree tears and perineal skin in second-degree tears. Still, it remained a lack of knowledge in Obstetrics related to the effectiveness of the perineal repair of all tissue layers in second-degree tears and episiotomy [12]. In addition, it is essential to compare several types of surgical glues with other existing methods for perineal repair concerning perineal pain intensity, the long-term perineal healing process, the procedure duration, and the postpartum infection rates.…”