الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 148 |  |  |
| | | from | 148 | | |
Abstract
Episiotomy is still the most common surgical procedure performed by obstetricians. 85% and more of women having vaginal delivery will suffer some perineal trauma, whether in the form of spontaneous tears or episiotomy, both will require closure at least in third of women.
Pain in the site of the episiotomy is not uncommon. Although women without episiotomies will often have perineal pain, those with episiotomies will often have pain that is more localized and lasts longer.
Suturing the perineum may optimize the meticulous closure, but also may induce reactivity and sometimes require removal, this adds no help in reducing site pain.
The current study was conducted at Ain Shams maternity hospital during the period between February 2019 and December 2020.
The aim of this work was to assess the efficacy of surgical glue and adhesive tapes compared to traditional subcuticular suturing in maintaining closed clean wound. Other outcomes were site pain, duration of closure, wound infection, cosmesis, pain during daily activities, dyspareunia, and women and operator satisfaction.
The study included 159 healthy primiparous women aged 18-35 years who underwent mediolateral episiotomy during vaginal delivery of a single non macrosomic baby. They were enrolled after informed consent had been obtained. Exclusion criteria included pre-existing local infection, medical illness that can delay healing, known hypersensitivity, instrumental delivery or the use of regional anesthesia.
They were sub divided into 3 groups:
- group A: perineal skin repair was done with subcuticular suturing technique using polyglactin (910) 2/0 suture.
- group B: perineal skin repair was done using cyanoacrylate surgical glue.
- group C: perineal skin repair was done using skin adhesive tape.
Regarding demographic data in this study the mean age of participants among the subcuticular, glue and tape groups were 22.86, 23.6 and 23.3 years respectively. No statistically significant difference was detected between the three groups regarding the maternal age, education level, occupation and neonatal birth weight.
Statistically significant difference between the studied groups was found in BMI and GA at delivery. Mean BMI values were 26.90, 25.73 and 24.72 kg/m2 while mean GA were 38.64, 38.69 and 39.34 weeks for the subcuticular, glue and tape groups respectively.
The duration of the procedure was significantly longer for subcuticular suturing technique with mean 4.12 mins while 2.3 and 2.7 mins for the glue and tape groups respectively.
Perineal pain 2 and 6 hours and 10 days postdelivery was significantly higher in suture group. No significant difference was found in pain during sitting, movement, micturition between the studied groups however pain with defecation was significantly higher in the suture group (52.8%) vs (24.5%) and (28.3%) for glue and tape.
The women needs for extra analgesia was also significantly higher in suture group. Women in suture group needed analgesia for 5.19 days compared to 3.52 and 3.37 days for glue and tape groups respectively that was also statistically significant with ρ-value=0.012.
Regarding healing and cosmesis assessment in their second visit 10 days post-operative ;( 15.1%) of the sutured group showed perineal edema versus (9.4%) in the glue group and (18.9%) in the tape group. Incidence of wound gaping was (7.5%) with suture, (7.5%) with glue while (13.2%) with tape group. Differences were not statistically significant.
Glue was associated with least wound infection rate (7.5%) vs (24.55%) for suture and (15.1%) for tape but difference was not significant (ρ-value = 0.055). Suturing was significantly associated with more wound hematomas (19%) vs (3.8%) for both glue and tape, ASEPSIS and REEDA total scores didn’t show significant difference between groups.
The need for medical advice or re-suturing also showed no statistical differences between the suture and glue group and only (1.9%) of both needed re-suture vs (5.7%) of tape group. However, maternal satisfaction with the repair technique was significantly higher among those of the glue group.
Concerning dyspareunia and persistent perineal pain there was only significant difference for dyspareunia at 6-months with subcuticular suturing.
Conclusion:
The use of surgical glue and adhesive tape in perineal skin repair following episiotomy was associated with less post-operative pain scores, less pain on defecation, less perineal pain at 6 months post-operative without increased wound complications.