Randomized Trial of 3 Techniques of Perineal Skin Closure During Second‐Degree Perineal Laceration Repair

Abstract

Introduction: Perineal lacerations during childbirth are common, and suturing the perineal skin during repair has been associated with increased postpartum pain. This study sought to test the hypothesis that no difference in postpartum perineal pain exists between 3 methods of skin closure for second-degree repair: suture, no suture, and surgical glue.Methods: A single-blind randomized controlled trial of women after vaginal birth who had a second-degree perineal laceration was conducted at a tertiary care teaching hospital from August 2014 to April 2017. Women were randomized to perineal skin closure with suture, no suture, or surgical glue using a 1:1:1 allocation. Pain was assessed using the short-form McGill Pain Questionnaire, a 100-mm visual analog scale (VAS), and Present Pain Index (PPI) at one day, 2 weeks, 6 weeks, and 3 months postpartum. Wound healing was assessed at 6 weeks using the Redness, Edema, Ecchymosis, Drainage, Approximation (REEDA) scale. Pain scores were compared across groups using a chi-square test, Mann-Whitney U test, or analysis of variance where appropriate. Results:A total of 35 women were randomized: 14 received suture, 11 had no suture, and 10 received surgical glue for perineal skin repair. Demographic characteristics were similar between groups. At 2 weeks postpartum, women with suture had higher median pain scores on the short-form McGill Pain Questionnaire (15.0 suture vs 2.0 glue vs 2.0 no suture, P = .03) and VAS (50.0 suture vs 3.0 glue vs 7.0 no suture, P = .02). Significant differences in pain were not seen on the PPI. At 3 months, women in the suture group had higher median pain scores on the short-form McGill Pain Questionnaire compared with surgical glue (1.0 vs 0, P = .04). Wound healing was similar across groups (REEDA score: 0 suture vs 1.0 no suture, vs 0 surgical glue, P = .24). Discussion:Compared with no suture and surgical glue, suturing the perineal skin was associated with the highest postpartum pain scores.

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

“…Assessed with a 100 mm visual analogue scale, the mean pain in the second postpartum week was 3.0 with glue, 5.0 with suture and 7.0 with no suture ( p = 0.02). This difference was no longer observed three months after delivery ( p = 0.31) [ 18 ]. Other studies also confirm the positive findings of using glue [ 11 , 19 , 20 ].…”

“…The difference in edge coaptation was due to a lower score in the CG than in the EG, and it occurred mainly among women with second-degree tears up to 10 days after delivery. Other clinical trials that compared the use of glue to suture for perineal skin repair showed no significant difference in any of the items of the REEDA scale [ 20 , 11 , 19 , 18 , 9 ].…”

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

“…In the last three decades, many studies have explored the effect of tissue adhesives in promoting perineal wound healing and relieving local pain during and after childbirth (Adoni & Anteby, 1991;Bowen & Selinger, 2002;Chamariya et al, 2016;Dasrilsyah et al, 2021;Feigenberg et al, 2014;Li, 2013;Li et al, 2011;Mota et al, 2009;Ochiai et al, 2020;Swenson et al, 2019; 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.…”

“…In the last three decades, many studies have explored the effect of tissue adhesives in promoting perineal wound healing and relieving local pain during and after childbirth (Adoni & Anteby, 1991; Bowen & Selinger, 2002; Chamariya et al, 2016; Dasrilsyah et al, 2021; Feigenberg et al, 2014; Li, 2013; Li et al, 2011; Mota et al, 2009; Ochiai et al, 2020; Swenson et al, 2019; Teixeira et al, 2020; Wang et al, 2017; Wu, 2012; Zheng et al, 2014). However, these studies have differed not only in types of participants but also in terms of interventions.…”

“…However, these studies have differed not only in types of participants but also in terms of interventions. The participants in some studies (Dasrilsyah et al, 2021; Feigenberg et al, 2014; Ochiai et al, 2020; Teixeira et al, 2020) were women with first‐degree lacerations and the intervention was the use of the tissue adhesives alone, while the participants in the other studies (Adoni & Anteby, 1991; Bowen & Selinger, 2002; Chamariya et al, 2016; Li, 2013; Li et al, 2011; Mota et al, 2009; Swenson et al, 2019; Wang et al, 2017; Wu, 2012; Zheng et al, 2014) were women with second‐degree lacerations or women who underwent episiotomy and the intervention was a combination of tissue adhesives and sutures. Therefore, a systematic review of the effect of tissue adhesives in repairing different extents of perineal trauma during childbirth is needed.…”