Randomized Trial of 3 Techniques of Perineal Skin Closure During Second-Degree Perineal Laceration Repair.
Carolyn W Swenson, Lisa Kane Low, Katherine M Kowalk and 1 others
PMID 31433108WHAT IT FOUND
In 35 women after second-degree tears, suturing the perineal skin was associated with higher pain at 2 weeks than leaving it unsutured or using glue.
Wound healing and sexual function did not differ.
Key findings
01At 2 weeks postpartum, median McGill Short Form pain scores were 15.0 with suture repair, 2.0 with no suture, and 2.0 with surgical glue (P=.03).
02At 3 months postpartum, median McGill Short Form pain scores were 1.0 in the suture group and 0 in the surgical glue group (P=.04).
03At 6 weeks postpartum, provider-rated wound healing on the REEDA scale did not differ significantly by repair method.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 35 of 56 women received the allocated repair, and 21 eligible women did not receive it because providers forgot or chose standard suture repair, so the groups were small and may not represent usual care. The study stopped before reaching the planned 50 participants per group, so many comparisons were underpowered. It was done at one tertiary hospital and included only uncomplicated term births with spontaneous second-degree lacerations, so it may not apply to other settings or more complicated births. Providers could not be blinded, and participants might have known their repair method. The higher estimated blood loss in the glue group (475 mL versus 325 mL with suture and 400 mL with no suture) may be due to small numbers and subjective estimation.
Declared interests
The paper states the authors have no conflicts of interest. It does not report a funder.
The easy way to misread this
Do not conclude that surgical glue or leaving the skin unsutured is proven better care. The trial had only 35 analysed women, although 50 per group were planned, and providers often did not perform the allocated repair.