Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): A pilot and feasibility randomised controlled trial.

Abstract

Objective: To establish the feasibility of conducting a definitive randomised controlled trial (RCT) comparing the effectiveness of resuturing versus expectant management for dehisced perineal wounds. Design: A multicentre pilot and feasibility RCT. Setting Ten UK maternity units from July 2011 to July 2013. Population: Eligible women with a dehisced perineal wound within 2 weeks of childbirth. Methods: The 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. Outcome: The primary outcome measure was wound healing at 6-8 weeks. Results: The 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. Conclusions: PREVIEW 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.