title: PErineal Assessment and Repair Longitudinal Study (PEARLS): protocol for a matched pair cluster trial.
abstract: 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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  PEARLS is registered with the Current Controlled Trials Registry (no: ISRCTN28960026). NIHR UKCRN portfolio no: 4785.
authors.affiliation: King's College London, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London, UK. debra.bick@kcl.ac.uk
authors.forename: Debra E
authors.initials: DE
authors.lastname: Bick
authors.forename: Christine
authors.initials: C
authors.lastname: Kettle
authors.forename: Sue
authors.initials: S
authors.lastname: Macdonald
authors.forename: Peter W
authors.initials: PW
authors.lastname: Thomas
authors.forename: Robert K
authors.initials: RK
authors.lastname: Hills
authors.forename: Khaled M K
authors.initials: KM
authors.lastname: Ismail
mesh_terms: D054869:Clinical Audit; D002985:Clinical Protocols; D016000:Cluster Analysis; D004841:Episiotomy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D009774:Obstetrics / Q000193:education / Q000379:methods; D010502:Perineum / Q000293:injuries*; D011181:Postnatal Care / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012107:Research Design; D013536:Suture Techniques / Q000193:education / Q000592:standards; D017749:Total Quality Management; D006113:United Kingdom / Q000453:epidemiology