Background: The Perineal Assessment and Repair Longitudinal Study (PEARLS) is a national clinical quality
improvement initiative designed to improve the assessment and management of perineal trauma. Perineal trauma
affects around 85% of women who have a vaginal birth in the UK each year and millions more world-wide.
Continuous suturing techniques compared with traditional interrupted methods are more effective in reducing
pain and postnatal morbidity, however they are not widely used by clinicians despite recommendations of
evidence based national clinical guidelines. Perineal suturing skills and postnatal management of trauma remain
highly variable within and between maternity units in the UK as well as worldwide. Implementation of a
standardised training package to support effective perineal management practices could reduce perineal pain and
other related postnatal morbidity for a substantial number of women.
Methods/Design: PEARLS is a matched pair cluster trial, which is being conducted in maternity units across the
UK. Units within a matched pair will be randomised to implement the study intervention either early or late in the
study period. The intervention will include the cascading of a multi-professional training package to enhance
midwifery and obstetric skills in the assessment, repair and postnatal management of perineal trauma. Women
who have had an episiotomy or second degree perineal tear will be eligible for recruitment. Prior to developing
the intervention and deciding on study outcomes, a Delphi survey and a consensus conference were held to
identify what women, who previously suffered perineal trauma during childbirth, considered to be important
outcomes for them. Findings from this preliminary work (which will be reported elsewhere) and other outcomes
including women’s experiences of perineal pain and pain on activity, breastfeeding uptake and duration and
psychological well-being as assessed using the Edinburgh Postnatal Depression Scale (EPDS) will be assessed at 10
days and three months post-birth.
Discussion: Implementation of evidence-based perineal assessment and management practices, could lead to
significantly improved physical and psychological health outcomes for women in the UK and world-wide