title: Nonsuturing or Skin Adhesives versus Suturing of the Perineal Skin After Childbirth: A Systematic Review.
abstract: BACKGROUND
  Suturing of perineal trauma after childbirth can cause problems such as pain, discomfort because of tight sutures, the need for suture removal, and dyspareunia. It is unclear whether leaving the perineal skin unsutured or using skin adhesives might prevent these problems.
  
  
  METHODS
  CENTRAL, MEDLINE, EMBASE, CINAHL, and prospective trial registers until January 2013 were searched for (quasi-)randomized controlled trials comparing nonsuturing of the perineal skin or skin adhesives versus suturing of the skin when repairing a second-degree perineal tear or episiotomy. Primary outcome measure was short-term and long-term pain and need for analgesic medication.
  
  
  RESULTS
  Four randomized and two quasi-randomized controlled trials (involving 2,922 women) with heterogeneity in contexts, designs, and methodological quality were included. Nonsuturing of the skin leads to less short-term and long-term pain compared to suturing and an increased rate of skin separation. Skin adhesives lead to less short-term pain without an increased rate of skin separation. Nonsuturing or skin adhesives lead to less complaints and there are no other adverse effects.
  
  
  CONCLUSIONS
  Nonsuturing of the skin or the use of skin adhesives appears preferable in terms of pain. Nonsuturing could lead to more short-term skin separation when no adhesives are used, but there is no evidence for the clinical importance of skin separation. There is a need for studies with a follow-up of at least 6 months, in which pain is measured homogeneously and for studies comparing the use of skin adhesives with nonsuturing of the skin with the focus on long-term cosmetic results.
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Anna E
authors: AE
authors: Seijmonsbergen-Schermers
authors: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Saloomeh
authors: S
authors: Sahami
authors: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Cees
authors: C
authors: Lucas
authors: Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
authors: Ank de
authors: Ad
authors: Jonge
mesh_terms: D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D004841:Episiotomy / Q000379:methods*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000209:etiology / Q000628:therapy; D010502:Perineum / Q000293:injuries / Q000601:surgery; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013536:Suture Techniques / Q000706:statistics & numerical data*; D014014:Tissue Adhesives / Q000494:pharmacology*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D014014:Tissue Adhesives
keywords: pain; perineal skin; skin separation; suturing