***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : To compare the postpartum pelvic floor function of women with sutured second-degree perineal lacerations , unsutured second-degree perineal lacerations , and intact perineums . Methods : A prospect i ve cohort of nurse-midwifery patients consented to mapping of genital trauma at birth and an assessment of postpartum pelvic floor outcomes . Women completed vali date d question naires for perineal pain and urinary and anal incontinence at 12 weeks postpartum and underwent physical examination to assess pelvic floor strength and anatomy at 6 weeks postpartum . Results : One hundred seventy-two of 212 ( 80 % ) eligible women provided follow-up assessment data at 6 or 12 weeks postpartum . Women with an intact perineum ( n = 89 ) used fewer analgesics ( P < .002 ) and had lower pain scores at the time of hospital discharge than women with second-degree lacerations ( sutured , n = 46 ; unsutured , n = 37 ; intact , n = 89 ) ( P ≤ .02 ) . The sutured group was more likely to use analgesics ( 52 % ) than the unsutured ( 35 % ) or intact ( 23 % ) groups at time of hospital discharge ( P < .002 ) , although pain scores were not different between sutured and unsutured groups . Postpartum reports of urinary or anal incontinence , sexual inactivity , or sexual function scores did not vary between groups . Weak pelvic floor exercise strength was more common among the women with second-degree lacerations compared with women with an intact perineum ( 53 % vs. 28 % ; P = .03 ) but did not differ between sutured ( 58 % ) and unsutured ( 47 % ) groups ( P = not significant ) . Likewise , perineal body or genital hiatus measurements did not vary between groups ( P = not significant ) . Conclusions : Women with sutured lacerations report increased analgesic use at the time of hospital discharge compared with women with intact perineums or unsutured lacerations . At 12 weeks postpartum , no differences were noted between groups regarding complaints of urinary or anal incontinence , sexual inactivity , or sexual function In a prospect i ve clinical investigation of 2,144 deliveries , we eluci date the indications for  episiotomy  and how different methods of anesthesia affect the frequency of episiotomy and the perineal problems after  episiotomy  compared with those after spontaneous perineal laceration . We found a significantly higher infection rate ( p less than 0.001 ) and a longer healing period in the episiotomy group . These differences remain even if only primigravida or the indication , imminent perineal laceration , is studied . The results indicate that many women will unnecessarily suffer after an episiotomy . The patient 's subjective problems are significantly increased , both immediately and at the 3-month postoperative follow-up Objective To assess the long term implication s of four alternative approaches to postpartum perineal repair . BACKGROUND The full extent of genital tract trauma in spontaneous births is not well documented . The purpose of this study was to describe the range and extent of childbirth trauma and related postnatal pain using data from a large r and omized clinical trial of perineal management techniques ( n = 5471 ) . METHODS Descriptive analysis was conducted on trial participants who delivered spontaneously at term and were examined by their midwife after birth ( n = 5404 ) . Data are reported for sites of trauma , and the relation to episiotomy , suturing , and maternal reports of pain at 2 days , 10 days , and 3 months after birth . RESULTS Eighty-five percent of all women experienced some form of trauma , with first- or second-degree perineal lacerations occurring in two-thirds of women and outer vaginal tears occurring in one-half . Tears to the rectum and vaginal vault were more common with episiotomy . Nearly all unsutured trauma was restricted to perineal first- or second-degree , outer vaginal , and labial sites . Pain declined over time , and a gradient in pain was observed according to the site and complexity of trauma . CONCLUSIONS Genital tract trauma is extremely common with spontaneous vaginal birth . Effective measures to prevent or reduce its occurrence would benefit many new mothers Objective . Surgical repair of perineal lesions after delivery is frequently associated with pain and discomfort , interfering with the normal activities of the puerperium . The aim of this study was to compare perineal skin repair after episiotomy with adhesive glue versus a subcuticular suture , regarding the incidence of pain and wound complications . Study design . R and omized clinical trial . Setting . Tertiary care university hospital . Material and methods . One hundred women having mediolateral episiotomy at vaginal delivery were enrolled . They were r and omized to receive skin adhesive ( n = 53 ) or subcuticular suture ( n = 47 ) for closure of perineal skin . The main outcome measure was self‐evaluated pain in the 30 days following delivery . Secondary outcome measures were technical difficulties reported with the procedure , duration of surgical repair , wound complications observed at 42–68 hours post‐partum and re‐initiation of sexual activity by 30 days post‐partum . Results . No significant differences were observed between the two groups in incidence of technical difficulties and failed procedures , pain during the procedure , wound complications at hospital discharge , self‐evaluated measures of pain at 7 and 30 days or re‐initiation of sexual activity by 30 days post‐partum . The skin adhesive group had a significantly shorter mean duration of the procedure ( four minutes less ) . Conclusion . Perineal skin closure using adhesive glue is faster than subcuticular suture , and associated with a similar incidence of complications and pain in the first 30 days The association between  episiotomy and severe ( third- and fourth-degree ) perineal lacerations was studied in 24,114 women . The overall rates of severe lacerations were 8.3 and 1.5 % for primiparous and multiparous women , respectively . Women who had  midline episiotomies  were nearly 50 times more likely and women who had mediolateral episiotomies were over eight times more likely to suffer a severe laceration than were women who did not undergo an episiotomy .  Severe lacerations were also more common after use of forceps , in occiput transverse and posterior presentations , among women with smaller pelvic outlet measurements or lower prepregnant weight , and with larger fetuses . The same factors that caused a woman to have an increased risk of laceration also made performance of an episiotomy more likely . After statistical adjustment for these risk factors , mediolateral episiotomy was associated with a 2.5-fold reduction in the risk of severe lacerations among primiparous women , and a statistically nonsignificant 2.4-fold increase among multiparous women , compared with no episiotomy . Midline episiotomy was associated with statistically significant 4.2- and 12.8-fold increases in the risk of lacerations among primiparous and multiparous women , respectively . We conclude that the risks and benefits of midline episiotomy should be evaluated in a r and omized clinical trial that compares policies of “ usual ” versus conservative use of episiotomy Summary . Histoacryl‐tissue adhcsive ( B. Braun Melsungen AG W. Germany ) was used in place of skin sutures ( 2/0 chromic catgut , Ethicon Ltd , Edinburgh , Scotl and ) for episiotomy repair in a group of 20 women . This group was compared with two groups of women undergoing first and repeat episiotomy .  Variables analysed included pain in the episiotomy site , pain while walking , sitting , sleeping , lying down , breast‐feeding , micturating and defaecating . The Histoacryl group was superior with regard to all the variables . This simple , new method can reduce pain and inconvenience for patients , especially following the first delivery Objective To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth OBJECTIVES The purpose of the study was to evaluate the use of enbucrilate tissue adhesive compared with subcuticular polyglycolic acid sutures in episiotomy wound closure . METHODS In a prospect i ve controlled trial , two groups were studied after undergoing an episiotomy skin wound repair using either enbucrilate tissue adhesive ( n=32 ) or a subcuticular polyglycolic acid suture ( n=30 ) . The variables measured included pain scores during selected activities in the first 5 postnatal days , the time taken to become pain free after childbirth and the time taken to resume pain free sexual intercourse .  Suitable patients were invited by the midwives to participate in the trial . If they gave consent to the trial , the gynecologist was contacted . If available , he would perform a repair using enbucrilate tissue adhesive . If he was not available , one of the midwives would perform a repair using subcuticular polyglycolic acid sutures . In this group , 90 % of the women were recruited and sutured by one midwife . RESULTS Patients treated with enbucrilate were found to have significantly less postnatal pain while walking , became pain free in a shorter period ( mean=25 days vs. 18 days ; P<0.01 ) and were able to resume pain-free intercourse sooner ( mean=34 days vs. 52 days ; P<0.001 ) . CONCLUSIONS Tissue adhesives incorporate the qualities of an ideal skin-closure material . The results demonstrate their advantage over the current st and ard suture-based methods of repair in the perineum . The use of adhesives merits further evaluation Objective To examine differences in outcome between primiparous women who do and who do not have suturing to first or second degree perineal lacerations sustained during spontaneous vaginal births after 37 weeks of gestation Summary . Three methods of episiotomy repair were r and omly assigned after 900 consecutive deliveries . The three procedures were : ( 1 ) continuous No. 00‐plain catgut in the vagina ; No. 00‐plain catgut interrupted stiches in the perineal muscles and fascia , and No. 00‐nylon interrupted stiches in the skin . ( 2 ) The same technique as in ( l ) , but with No. 0‐polyglycolic acid ( Dexon ) in all layers . ( 3 ) The suture material as in ( 2 ) , but used with a subcuticular technique . The women treated with method 3 reported statistically significant less pain and disabilities in the early puerperium . Three months after delivery 262 women ( 33 % ) still had perineal complaints which could be directly related to the episiotomy in 25 % ( 8 % of total number ) . The group treated with method 3 had the best long‐term results and we conclude that the subcuticular technique using polyglycolic acid should be the method of choice BACKGROUND Midwives tend to leave minor perineal lacerations to heal spontaneously , and clinical experience and studies show that women can suffer from their stitched lacerations . The study purpose was to determine any differences in the healing process and experience of minor perineal lacerations when they were sutured or not sutured . METHODS Eighty term pregnant primiparas with minor perineal lacerations of grade s I-II were r and omized after childbirth . The experimental group was nonsutured and the control group was sutured . A follow-up examination was performed at 2 to 3 days , 8 weeks , and 6 months after the delivery . Participants were asked about the type of discomfort , and the effect of the laceration on breastfeeding and sexual intercourse . RESULTS No significant differences were found in the healing process . The type of pain differed between the groups , but the amount of discomfort was the same . The sutured group had to visit the midwife more often because of discomfort from the stitches . Sixteen percent of the women in the sutured group , but none in the nonsutured group ( p = 0.0385 ) , considered that the laceration had had a negative influence on breastfeeding . CONCLUSIONS Minor perineal lacerations can be left to heal spontaneously . The benefits for the woman include the possibility of having a choice , avoiding the discomfort of anesthesia and suturing , providing positive affects on breastfeeding One thous and women were allocated at r and om to one of two perineal management policies , both intended to minimise trauma during spontaneous vaginal delivery . In one the aim was to restrict episiotomy to fetal indications ; in the other the operation was to be used more liberally to prevent perineal tears . The result ant episiotomy rates were 10 % and 51 % respectively . An intact perineum was more common among those allocated to the restrictive policy . This group experienced more perineal and labial tears , however , and included four of the five cases of severe trauma . There were no significant differences between the two groups either in neonatal state or in maternal pain and urinary symptoms 10 days and three months post partum . Women allocated to the restrictive policy were more likely to have resumed sexual intercourse within a month after delivery . These findings provide little support either for liberal use of episiotomy or for cl aims that reduced use of the operation decreases postpartum morbidity Changes in sexual function are common in postpartum women . In this comparative , descriptive study , a prospect i ve cohort of midwifery patients consented to documentation of genital trauma at birth and assessment of sexual function at 3 months postpartum . The impact of spontaneous genital trauma on postpartum sexual function was the focus of the study . Trauma was categorized into minor trauma ( no trauma or first-degree perineal or other trauma that was not sutured ) or major trauma ( second- , third- , or fourth-degree lacerations or any trauma that required suturing ) .  Women who underwent episiotomy or operative delivery 
    Output:
    
There is limited evidence available from RCTs to guide the choice between surgical or non-surgical repair of first- or second-degree perineal tears sustained during childbirth .
Therefore , at present there is insufficient evidence to suggest that one method is superior to the other with regard to healing and recovery in the early or late postnatal periods .
Until further evidence becomes available , clinicians ' decisions whether to suture or not can be based on their clinical judgement and the women 's preference after informing them about the lack of long-term outcomes and the possible chance of a slower wound healing process , but possible better overall feeling of well being if left un-sutured