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

Journal of Midwifery and Women's Health - Tập 64 Số 5 - Trang 567-577 - 2019
Carolyn W. Swenson1, Lisa Kane Low1,2, Katherine M. Kowalk1,3, Dee E. Fenner1
1Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
2School of Nursing, University of Michigan, Ann Arbor, Michigan
3Department of Physician Assistant Studies University of Toledo Toledo Ohio

Tóm tắt

IntroductionPerineal 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.MethodsA 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.ResultsA 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).DiscussionCompared with no suture and surgical glue, suturing the perineal skin was associated with the highest postpartum pain scores.

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Journal of Midwifery and Women's Health

Tập 64 Số 5

567-577

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