ObjectiveTo explore women's lived experiences of a dehisced perineal wound following childbirth and how they felt participating in a pilot and feasibility randomised controlled trial (RCT).DesignA nested qualitative study using semistructured interviews, underpinned by descriptive phenomenology.Participants and settingA purposive sample of six women at 6–9 months postnatal who participated in the RCT were interviewed in their own homes.ResultsFollowing Giorgi's analytical framework the verbatim transcripts were analysed for key themes. Women's lived experiences revealed 4 emerging themes: (1) Physical impact, with sub-themes focusing upon avoiding infection, perineal pain and the impact of the wound dehiscence upon daily activities; (2) Psychosocial impact, with sub-themes of denial, sense of failure or self-blame, fear, isolation and altered body image; (3) Sexual impact; and (4) Satisfaction with wound healing. A fifth theme ‘participating in the RCT’ was ‘a priori’ with sub-themes centred upon understanding the randomisation process, completing the trial questionnaires, attending for hospital appointments and acceptability of the treatment options.ConclusionsTo the best of our knowledge, this is the first qualitative study to grant women the opportunity to voice their personal experiences of a dehisced perineal wound and their views on the management offered. The powerful testimonies presented disclose the extent of morbidity experienced while also revealing a strong preference for a treatment option.Trial registration numberISRCTN05754020; results.
ObjectiveTo establish the feasibility of conducting a definitive randomised controlled trial (RCT) comparing the effectiveness of resuturing versus expectant management for dehisced perineal wounds.DesignA multicentre pilot and feasibility RCT.SettingTen UK maternity units from July 2011 to July 2013.PopulationEligible women with a dehisced perineal wound within 2 weeks of childbirth.MethodsThe interventions were resuturing or expectancy. Randomisation was via web or telephone, stratified by participating centre. Blinding was not possible due to the nature of the interventions. Analysis was by intention-to-treat.OutcomeThe primary outcome measure was wound healing at 6–8 weeks.ResultsThe study revealed a number of feasibility issues, particularly strong patient and clinician preference for treatment options at recruiting centres and the timing of the primary outcome measure. Thirty-four women were randomised (17 in each arm). Data from 33 women were analysed on an intention-to-treat analysis to obtain preliminary estimates of effect size. There was a difference in wound healing at 2 weeks favouring resuturing (OR 20.00, 95% CI 2.04 to 196.37, p=0.004). However, by 6–8 weeks all but one wound in both groups had healed.ConclusionsPREVIEW revealed a number of feasibility issues, which impacted on recruitment rate. These will have to be taken into account in the design of any future definitive study. In this feasibility study, resuturing was associated with quicker wound healing and women reported higher satisfaction rates with the outcome at 3 months.Trial registration numberISRCTN05754020.
Each year, approximately 60 to 70% of women in the UK experience perineal suturing following childbirth, which equates to approximately 1000 women per day. the majority of sutured perineal wounds will heal fairly quickly by primary intention with minimal morbidity. However, for those women whose perineal wound dehisces (breaks down), the healing process takes considerably longer and is associated with increased morbidity. the exact incidence of perineal wound dehiscence is currently unknown; figures of 0.1% to 5.5% have been reported. a large proportion of dehisced wounds are managed expectantly (left to heal by secondary intention) whereas some are re-sutured during the early postpartum period. Currently, the management of dehisced wounds varies according to individual practitioner’s preferences and hospital policy as there are no robust research evidence or clear guidelines to inform best practice.
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