Cultural adaptation, validation and evaluation of the psychometric properties of Childbirth Experience Questionnaire version 2.0 in the Spanish context.

BACKGROUND: Several instruments have been designed to assess the childbirth experience. The Childbirth Experience Questionnaire (CEQ) is one of the most widely used tools. There is an improved version of this instrument, the Childbirth Experience Questionnaire (CEQ 2.0), which has not been adapted or validated for use in Spain. The aim of present study is to adapt the CEQ 2.0 to the Spanish context and evaluate its psychometric properties. METHODS: This research was carried out in 2 stages. In the first stage, a methodological study was carried out in which the instrument was translated and back-translated, content validity was assessed by 10 experts (by calculating Aiken's V coefficient) and face validity was assessed in a sample of 30 postpartum women. In the second stage, a cross-sectional study was carried out to evaluate construct validity by using confirmatory factor analysis, reliability evaluation (internal consistency and temporal stability) and validation by known groups. RESULTS: In Stage 1, a Spanish version of the CEQ 2.0 (CEQ-E 2.0) was obtained with adequate face and content validity, with Aiken V scores greater than 0.70 for all items. A final sample of 500 women participated in Stage 2 of the study. The fit values for the obtained four-domain model were RMSEA = 0.038 [95% CI: 0.038-0.042], CFI = 0.989 [95% CI: 0.984-0.991], and GFI = 0.990 [95% CI: 0.982-0.991]. The overall Omega and Cronbach's Alpha coefficients were 0.872 [95% CI: 0.850-0.891] and 0.870 [95% CI: 0.849-0.890] respectively. A coefficient of intraclass correlation of 0.824 [95% CI: 0.314-0.936] (p ≤ 0.001) and a concordance coefficient of 0.694 [95% CI: 0.523-0.811] were obtained. CONCLUSIONS: The Spanish version of CEQ 2.0 (CEQ-E 2.0), has adequate psychometric properties and is a valid, useful, and reliable instrument for assessing the childbirth experience in Spanish women.

Is the Presence of Levator Ani Muscle Avulsion Relevant for the Diagnosis of Uterine Prolapse?

OBJECTIVE: To determine if the addition of the assessment of levator ani muscle (LAM) avulsion to the measurement of the difference in the pubis-uterine fundus distance between rest and with the Valsalva maneuver could increase the diagnostic capacity of ultrasound for uterine prolapse (UP). METHODS: This multicenter, observational and prospective study included 145 patients. Ultrasound assessment was performed, establishing the diagnosis of UP as a difference between the pubic-uterine fundus distance at rest and during the Valsalva maneuver ≥15 mm (standard technique), while LAM avulsion was defined as an abnormal LAM insertion in three central slices using multislice ultrasound. A binary multivariate logistic regression model was made using nonautomated methods to predict surgical UP (general population, premenopausal, and postmenopausal patients), including the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver as well as LAM avulsion. RESULTS: A total of 143 patients completed the study. The addition of LAM avulsion criteria to the standard dynamic distance-based protocol for the diagnosis of UP resulted in a higher sensitivity for the general population (79.7 vs 68.1%) as well as for premenopausal (89.3 vs 79.9%) and postmenopausal patients (76 vs 66.1%). In contrast, the standard technique showed a higher specificity than the model based on the standard technique associated with LAM avulsion for the general population (89.2 vs 74.3%) and premenopausal women (91.7 vs 63.2%). For postmenopausal patients, the model based on the standard technique associated with LAM avulsion had a higher sensitivity (76 vs 66.1%) and specificity (91.7 vs 86.8%) than the ultrasound diagnosis of UP. CONCLUSION: The implementation of the assessment of LAM avulsion in the ultrasound diagnosis of UP is useful in postmenopausal patients, increasing sensitivity and specificity relative to the ultrasound assessment based only on the difference between the pubis-uterine fundus distance at rest and with the Valsalva maneuver.

Is It Possible to Diagnose Surgical Uterine Prolapse With Transperineal Ultrasound? Multicenter Validation of Diagnostic Software.

OBJECTIVES: To validate an ultrasound software that uses transperineal ultrasound to diagnose uterine prolapse (UP). METHODS: Multicenter, observational and prospective study with 155 patients that had indications for surgical intervention for dysfunctional pelvic floor pathology. Each patient underwent an examination with Pozzi tenaculum forceps was performed in the operating room with the patient anesthetized, followed by surgical correction of stages II-IV UP. Transperineal ultrasound was used to assess the difference in the pubis-uterine fundus measurement. With a multivariate logistic regression binary model (with the measurement ultrasound at rest, the Valsalva maneuver and age) using nonautomated methods to predict UP. With the purpose of evaluating the model, a table with coordinates of the receiver operating characteristic (ROC) curve, after which sensitivity and specificity were assessed. RESULTS: A total of 153 patients were included (73 with a diagnosis of surgical UP). It was obtained from the AUC (0.89) of the probabilities predicted by the model (95% confidence interval, 0.84-0.95; P < .0005). Based on the ROC curve for the model, obtaining a sensitivity of 91.8% and a specificity of 72.7%, values that were superior to those for the clinical exam for surgical UP (sensitivity: 80.8%; specificity: 71.3%). CONCLUSIONS: We validated software that uses transperineal ultrasound of the pelvic floor and patient age to generate a more reliable diagnosis of surgical UP than that obtained from clinical examinations.

Identification of Surgical Uterine Prolapse in Premenopausal Patients With Clinical or Ultrasound Criteria? A Multicenter Comparative Study.

OBJECTIVES: It is unknown whether diagnosing uterine prolapse (UP) via ultrasound or surgical criteria is superior. Our objective is to determine whether the diagnostic capacity of ultrasound with surgical criteria differs from that of surgical criteria only. METHODS: This was a multicenter prospective observational study with 54 premenopausal patients with surgical criteria for a dysfunctional pelvic floor pathology who were consecutively recruited for 1 year. Clinical UP with surgical criteria was defined when UP stage II-IV was identified (during pelvic floor consultation), and UP diagnosed by ultrasound with surgical criteria was established when a difference ≥15 mm was found between rest and Valsalva applied to the pubis-uterine fundus. The sensitivity, specificity and positive and negative predictive values were determined to evaluate clinical and ultrasound methodologies as diagnostic tests. RESULTS: UP diagnosed by ultrasound with surgical criteria presented better sensitivity (78.57 vs 35.71%), specificity (92.11 vs 81.58%), positive predictive value (61.83 vs 23.99%), and negative predictive value (96.35 vs 11.37%) than UP diagnosed by surgical criteria only. CONCLUSION: Ultrasound with surgical criteria is superior to surgical criteria alone when diagnosing UP.

A 39-Year-Old Woman with Endometriosis Who Developed a Subcapsular Liver Hematoma Following Laparotomic Surgical Left Adnexectomy, Rectosigmoid Anastomosis, and Bilateral Ureteral Reimplantation.

BACKGROUND Endometriosis is a chronic inflammatory disease caused by endometrial tissue that grows outside the uterus. Deep endometriosis surgery is associated with considerable rates of complications, although such rates are lower in surgical procedures carried out by expert surgical teams. This report details a case of a rare but life-threatening complication in the postoperative period following 72 h of endometriosis surgery: a giant subcapsular hepatic hematoma, which was successfully managed conservatively. CASE REPORT Here we describe the case of a 39-year-old woman with deep endometriosis with ureteral, ovarian, and intestinal involvement requiring multidisciplinary surgery. She presented with severe anemia, respiratory distress, and oliguria 72 h postoperatively. A 3-phase computed tomography (CT) scan revealed a giant intrahepatic subcapsular hematoma (180×165×50 mm) lateral to the right hepatic lobe, which was managed conservatively. The patient evolved favorably and the hematoma was reduced (77×16 mm) in a follow-up CT scan performed 5 months later. CONCLUSIONS Giant liver hematoma is a rare, life-threatening complication. The current experience relating to its management remains largely limited owing to the rarity of the condition and paucity of published cases. Actually, we found no articles on hepatic hematoma in the context of endometriosis surgery. Early diagnosis and treatment are essential to reduce the patient's risk of death. Imaging diagnosis plays an essential role.

Asymptomatic endometrial thickening in postmenopausal women: predictor of malignant pathology?

It is not standardised what is the endometrial thickness that discriminates between normal and potentially malignant. The objective of this study was to determine the endometrial thickness cut-off point from which the risk of endometrial cancer (EC) increases in asymptomatic postmenopausal women; and to evaluate the risk factors linked to malignant endometrial pathology as well as other associated ultrasound findings.This was a retrospective observational study that included hysteroscopies performed at the Hospital Materno-Infantil on 267 asymptomatic menopausal women with an increase in endometrial thickness (AET) >5 mm, from 2015 to 2019. The results shows that the prevalence of malignant pathology in asymptomatic postmenopausal women with a casual finding of endometrial thickening was 3.7%. This percentage was 16.3% when the cut-off point of AET was established at 10 mm. There was a significant association for the diagnosis of malignant pathology with this cut-off point.There is a significant association between the 10 mm endometrial thickness cut-off point from which the risk of EC increases in asymptomatic postmenopausal women.Impact statementWhat is already known on this subject? Several studies have established the cut-off point for asymptomatic endometrial thickening (AET) for atypical endometrial hyperplasia and endometrial cancer at 10 mm. Although no cut-off point has optimal accuracy for the diagnosis of malignant endometrial pathology, it has been found that with a cut-off value of AET >10 mm no cases are missed. Likewise, a cut-off point of AET > 11 mm may provide a balance between cancer detection and histopathological workup extension.What do the results of this study add? A significant association was found at the cut-off point of AET > 10 mm, which suggests that screening postmenopausal women at this thickness is acceptable and unlikely to miss cases of endometrial hyperplasia and endometrial cancer.What are the implications of these findings for clinical practice and/or further research? After analysing our results we can conclude, like other published studies, that by establishing a cut-off point of 10 mm we obtain a good discrimination between benign and malignant pathology, which would allow us to diagnose 100% of malignant pathology. Above this cut-off point, the risk of endometrial cancer increases, and it would therefore be advisable to extend the study. A multicentre study is needed to confirm the cut-off point at which the risk of endometrial cancer increases in postmenopausal women with asymptomatic endometrial thickening.

Multicenter study of the evolution of different types of avulsion over the 12 months after delivery.

OBJECTIVE: To perform a multicenter study of muscle recovery in levator ani muscle (LAM) avulsion during the first 12 months postpartum according to the type of LAM avulsion suffered. METHODS: This was a multicenter prospective observational study including 242 primiparas. Transperineal ultrasound was performed at 6 months and 12 months after delivery. Type I LAM avulsion was present when most of the lateral fibers of the pubovisceral muscle were observed at the muscle's insertion at the pubic level. Type II LAM avulsion was defined as complete detachment of the pubovisceral muscle from its insertion at the pubic level. RESULTS: Among the 56 patients who completed the study (with ultrasound at 6 and 12 months after delivery), 76 avulsions (10 cases of bilateral avulsion) were identified at 6 months after delivery, and the total number of avulsions had decreased to 58 at 12 months after delivery (P < 0.001; 95% confidence interval [CI] 13.9%-33.5%). This decrease was due to the disappearance of 69.2% of the cases of Type I LAM avulsions (P < 0.001; 95% CI: 50.2%-88.2%). However, the number of Type II LAM avulsions remained constant at 6 months and 12 months after delivery. CONCLUSION: The spontaneous resolution of LAM avulsion during the first 12 months postpartum occurs in cases of Type I LAM avulsion but is not observed in Type II LAM avulsion.

Las experiencias de las matronas en el acompañamiento intraparto de mujeres con miedo al parto / The experiences of midwives in the intrapartum monitoring of women with fear of childbirth

Objetivo: El objetivo general del estudio fue describir las experiencias de las matronas en el acompañamiento a mujeres con miedo al parto (MAP). Método: Se planteó un estudio observacional, descriptivo, de corte transversal, donde la población a estudio fueron las matronas de la Unidad de Paritorio del Hospital Materno Infantil de Gran Canaria. Los datos se obtuvieron mediante un cuestionario estructurado ad hoc que incluía variables sobre la experiencia profesional en el acompañamiento intraparto de mujeres con MAP. Resultados: Participaron un total de 83 matronas, que identificaron como factores más frecuentes relacionados con el MAP en la práctica clínica el miedo a las complicaciones del recién nacido (90,4 %), la solicitud de cesárea (77,1 %) y la solicitud precoz de analgesia epidural (88,0 %). Con el objetivo de disminuir la ansiedad o la posibilidad de experiencia traumática, todas las matronas (n= 84) intervienen conscientemente creando un espacio de paz y escucha activa. Las mujeres con MAP producen mayormente sentimientos de empatía (80,7 %) y compasión (41 %). El 64 % de las matronas se mostró totalmente de acuerdo con la afirmación «Guiar a mujeres con miedo al parto es un desafío interesante». Conclusiones: Los resultados de este estudio evidencian que las matronas que acompañan a las mujeres intraparto son sensibles a esta problemática y se muestran motivadas para su abordaje, detectando de manera subjetiva indicadores que las alertan de que la mujer pueda tener miedo, y que este MAP puede estar asociado a consecuencias adversas. Aunque en ciertas situaciones preguntan a la mujer por su MAP, los factores que las inducen a ello presentan mucha variabilidad. (AU)

Objective: The general objective of the study was to describe the experiences of midwives in accompanying women with fear of childbirth (FOC). Method: An observational, descriptive, cross-sectional study was proposed, where the study population was the midwives of the delivery unit of the Maternal and Child Hospital of Gran Canaria. The data was obtained through a structured “ad hoc” questionnaire that included variables on professional experience in intrapartum monitoring of women with APM. Results: A total of 83 midwives participated, identifying fear of newborn complications (90.4%), request for cesarean section (77.1%), and early request for epidural analgesia (88.0%). In order to reduce anxiety or the possibility of a traumatic experience, all midwives (n=84) consciously intervene by creating a space for peace and active listening. Women with FOC produce more feelings of empathy (80.7%) and compassion (41%). 64% of midwives fully agreed with the statement “Guiding women with fear of childbirth is an interesting challenge”. Conclusions: The results of this study show that midwives who accompany intrapartum women are sensitive to this problem and are motivated to address it, subjectively detecting indicators that alert them that the woman may be afraid, and that this FOC may be associated with adverse consequences. Although in certain situations they ask the woman about her FOC, the factors that lead them to do so are highly variable. (AU)

First-Trimester Sequential Screening for Preeclampsia Using Angiogenic Factors: Study Protocol for a Prospective, Multicenter, Real Clinical Setting Study.

Introduction: The incidence of preeclampsia (PE) is about 2-8%, making it one of the leading causes of perinatal morbidity and maternal mortality in the world. Early prophylactic low dose administration (150 mg) of acetylsalicylic acid is associated with a significant reduction in the incidence of early-onset PE, intrauterine growth restriction (IUGR), and neonatal mean stay in the intensive care unit (ICU). Universal implementation of a first-trimester screening system including angiogenic and antiangiogenic markers [the Placental Growth Factor (PlGF) and/or soluble fms-like Tyrosine Kinase-1 (sFlt-1)] has shown a prediction rate of 90% for early-onset PE but entails a high financial cost. The aim of this study is to determine the predictive and preventive capacity of a universal PE first-trimester two-step sequential screening model, determining the PlGF only in patients previously classified as intermediate risk by means of a multivariate model based on resources already used in the standard pregnancy control, in a real clinical setting. We hypothesize that this screening model will achieve similar diagnostic performance as the universal determination of PlGF but at a lower economic cost. Methods and Analysis: This is a prospective, multicentric, cohort study in a real-world clinical setting. Every singleton pregnancy will be recruited at the routine first pregnancy visit. In a first step, the first-trimester risk of PE will be calculated using a multivariate Gaussian distribution model, based on medical history, mean blood pressure, Pregnancy-Associated Plasma Protein A (PAPP-A), and Uterine Artery Doppler Pulsatility Index (UTPI). Patients will be classified into three risk groups for PE: (1) risk ≥ 1/50, high-risk with no further testing (blinded PlGF); (2) risk between 1/51 and 1/500, medium-risk requiring further testing; and (3) risk ≤ 1/501, low-risk with no further testing. In a second step, the PlGF will only be determined in those patients classified as intermediate risk after this first step, and then reclassified into high- or low-risk groups. Prophylactic administration of aspirin (150 mg/day) will be prescribed only in high risk patients. As a secondary objective, sFlt-1 values will be blindly determined in patients with high and intermediate risk to assess its potential performance in the screening for PE. Ethics and Dissemination: The study will be conducted in accordance with the principles of Good Clinical Practice. This study is approved by the Aragon Research Ethics Committee (CEICA) on 3 July 2020 (15/2020). Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04767438.

Feelings of being a second victim among Spanish midwives and obstetricians.

AIM: The aim of this study was to determine the prevalence of feelings of being a second victim among midwives and obstetricians in Spain and to explore possible differences between the two professions. DESIGN: Cross-sectional descriptive-analytical observational study. METHODS: An online survey collecting several variables was administered throughout the Spanish territory. Spanish version of the Second Victim Experience and Support Tool (SVEST) was used. The data collection period was from May to December 2020. RESULTS: A total sample of 719 obstetricians and midwives were studied. There were significant differences between the two groups with respect to seven dimensions of SVEST: greater feelings of being a second victim among obstetricians in the dimensions physical distress/p ≤ .001, non-work-related support/p ≤ .001 and absenteeism/p ≤ .001 and greater feelings of being a second victim among midwives in the dimensions psychological distress/p ≤ .001, supervisor support/p = .011, professional self-efficacy/p ≤ .001 and intention to change jobs/p ≤ .001.

Chylous Ascites Secondary to Retroperitoneal Para-Aortic Lymphadenectomy: A Case Report.

Chylous ascites is caused by an accumulation of lymphatic fluid in the peritoneal cavity secondary to a rupture or obstruction of the abdominal lymphatic ducts. It has a milky appearance and is rich in triglycerides. The most frequent etiologies are neoplasms, liver cirrhosis, and ruptured lymphatic vessels after abdominal surgery. Clinically, it manifests as abdominal distention and increased abdominal girth. The presence of triglycerides in ascites fluid is the most useful diagnostic criterion. Treatment consists of a high-protein diet with fat restriction and medium-chain triglyceride supplements. Surgery is reserved for refractory cases. We present the case of a 66-year-old patient with a diagnosis of chylous ascites secondary to retroperitoneal lymphadenectomy.

Protective ostomies in ovarian cancer surgery: a systematic review and meta-analysis.

OBJECTIVE: To assess the benefit of protective ostomies on anastomotic leak rate, urgent re-operations, and mortality due to anastomotic leak complications in ovarian cancer surgery. METHODS: A systematic literature search was performed in MEDLINE, Web of Science, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for all studies on anastomotic leak and ostomy formation related to ovarian cancer surgery. Non-controlled studies, case series, abstracts, case reports, study protocols, and letters to the editor were excluded. Meta-analysis was performed on the primary endpoint of anastomotic leak rate. Subgroup analysis was carried out based on type of bowel resection and bevacizumab use. Secondary endpoints were urgent re-operations and mortality associated with anastomotic leak, length of hospital stay, postoperative complications, 30-day readmission rate, adjuvant chemotherapy, survival, and reversal surgery in ostomy and non-ostomy patients. RESULTS: A total of 17 studies (2,719 patients) were included: 16 retrospective cohort studies, and 1 case-control study. Meta-analysis of 17 studies did not show a decrease in anastomotic leak rate in ostomy patients (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.60-1.70; p=0.980). Meta-analysis of ten studies (1,452 women) did not find a decrease in urgent re-operations in the ostomy group (OR=0.72; 95% CI=0.35-1.46; p=0.360). Other outcomes were not considered for meta-analysis due to the lack of data in included studies. CONCLUSION: Protective ostomies did not decrease anastomotic leak rates, and urgent re-operations in ovarian cancer surgery. This evidence supports the use of ostomies in very select cases.

Validation and Psychometric Properties of the Spanish Version of the Second Victim Experience and Support Tool Questionnaire.

OBJECTIVES: This study aimed to assess the validity and psychometric properties of the Spanish version of the Second Victim Experience and Support Tool (SVEST-E) questionnaire. METHODS: This was a cross-sectional study aimed at midwives and obstetricians in Spain. An online survey was conducted consisting of 2 parts: the first part collected different variables, and the second part collected the SVEST-E. The temporal stability of the instrument was evaluated using the test-retest method. For the construct validity and reliability, an exploratory factor analysis and a confirmatory factor analysis were performed using FACTOR program v.10 with a polychoric correlation matrix. RESULTS: A total of 689 professionals participated in the study (323 obstetrician physicians/366 midwives). The mean (SD) score on the SVEST-E for the total sample was 3.09 (0.50). The parallel analysis of the exploratory factor analysis suggested a 5-factor solution, with a total explained variability of 61.8%. The goodness-of-fit indices of the model were the following: root mean square error of approximation = 0.038 (95% confidence interval [CI], 0.031-0.042) and comparative fit index = 0.989 (95% CI, 0.988-0.992). The factor model obtained was confirmed by confirmatory factor analysis, obtaining the values of root mean square error of approximation = 0.038 (95% CI, 0.026-0.053) and comparative fit index = 0.989 (95% CI, 0.969-1.000). The intraclass correlation coefficient was 0.97 (95% CI, 0.94-0.99). CONCLUSIONS: The SVEST-E instrument maintains the same items as the original questionnaire but introduces changes in the organization of its dimensions. The Spanish version maintains adequate construct validity, reliability, and temporal stability, so it is a valid tool to evaluate the second victim experience in Spanish health professionals.

Role of hysteroscopy during conservative management of atypical endometrial hyperplasia and early-stage endometrial cancer in patients who desire pregnancy.

Twenty-five percent of cases of endometrial cancer appear in women with unfulfilled reproductive desires. An adequate selection of patients and a close hysteroscopic follow-up to monitor the endometrial response to the levonorgestrel-releasing intrauterine system (LNG-IUS) may be a valid and safe option for these patients. This is a case series and review of the literature study. We included eight patients diagnosed of complex endometrial hyperplasia with atypia (CEHA) or stage 1AG1 well-differentiated endometrial cancer without myometrial invasion who desired to get pregnant and opted for a conservative treatment. Follow-up was performed with hysteroscopy and directed biopsy at 3, 6 and 12 months. Of the 854 cases of complex endometrial hyperplasia with atypia (CEHA)/endometrial cancer were diagnosed, 2.3% were candidates for conservative management. We obtained a favourable regression of 71.2% at 6 months and 57% at one year with hormonal treatment. Conservative treatment in complex endometrial hyperplasia with atypia (CEHA)/low-grade endometrial cancer in reproductive age patients with a strong desire for pregnancy is feasible.

Adaptación transcultural al contexto español y evaluación de la validez de contenido del cuestionario Second Victim / Cross-cultural adaptation to the Spanish context and evaluation of the content validity of the Second Victim Experience and Support Tool (SVEST-E) questionnaire

Objetivo: Realizar la adaptación transcultural del cuestionario Second Victim Experience and Support Tool (SVEST) al contexto español, así como evaluar la validez de contenido. Método: Traducción y adaptación transcultural de un instrumento de medida mediante la traducción y retrotraducción y pilotaje con la participación de 20 profesionales sanitarios. La validación de contenido se realizó con la participación de diez expertos. Se calculó la validez de contenido de cada ítem (CVI-I), índice de validez de contenido por experto (CVI-E) y la validez de contenido total (CVI-T) para el cuestionario. Se realizó corrección del probable acuerdo al azar y el cálculo estadístico del Kappa modificado para cada ítem del instrumento. Resultados: El instrumento final obtenido (SVEST-E) posee un CVI-Total de 0,87 y consta de 36 ítems totales, subdivididos en siete dimensiones, dos variables resultado y una sección de formas de apoyo, manteniendo la misma estructura de que el cuestionario original. Treinta ítems mostraron una CVI-I con valores por encima de ≥°0,79. Conclusiones: El cuestionario SVEST-E preserva la equivalencia con el original y es un instrumento con una adecuada validez de contenido para medir la experiencia de segundas víctimas en los profesionales sanitarios en España.(AU)

Objectives: To carry out a cross-cultural adaptation of the Second Victim Experience and Support Tool (SVEST) questionnaire to the Spanish context, and to evaluate its content validity (CVI). Methods: The translation and cultural adaptation of a measuring instrument by means of translation and back translation conducted through the participation of 20 health professionals. The content validation was carried out through the participation of 10 experts. The content validity of each item (CVI-I), the content validity index per expert (CVI-E) and the content validity total (CVI-T) were calculated for the questionnaire. Corrections were carried out for probable random agreement and the statistical calculation Kappa (K*) modified for each item of the instrument. Results: The final instrument obtained (SVEST-E) has a CVI-Total of 0.87 and consists of 36 total items, subdivided into 7 dimensions, 2 outcome variables and a support option section maintaining the same structure as the original questionnaire. Thirty items had a CVI-I with values over ≥̊0.79. Conclusions: The SVEST-E questionnaire is an equivalent of the original and is an instrument that could help to evaluate the second victim experiences of healthcare professionals in our country. It is an instrument with adequate content validity to measure the experience of second victims in health professionals in our country.(AU)

Post-Conization FIGO stage IA1 squamous cell cervical carcinoma; is hysterectomy necessary?

OBJECTIVE: To compare and evaluate the results and suitability of two different approaches to the treatment of post-conization International Federation of Gynaecology and Obstetrics (FIGO) stage IA1 cervical carcinoma: a more radical approach, directly scheduling a second surgery versus a more conservative one, which consists of performing a cotest (PAP plus HPV-test) in a follow-up visit and deciding whether to apply a second surgery on the basis of the results. STUDY DESIGN: Retrospective descriptive study including 144 cases of stage IA1 cervical carcinoma diagnosed after a loop electrosurgical excisional procedure (conization), between 1987 and 2019 in the Mother-and-Child University Hospital of Gran Canaria (Spain). Selected patients were split into two groups for analysis: patients directly undergoing a second surgical intervention (hysterectomy or re-conization) after diagnosis and patients who were followed-up before making a decision whether to schedule a second surgery or continue to follow-up. RESULTS: 75% of women directly receiving a second surgical intervention (no post-conization follow-up) underwent hysterectomy, while 25% underwent re-conization. Histological outcomes from hysterectomized patients showed 65% negative results for intraepithelial lesions, 9% low-grade squamous intraepithelial lesions (LSIL), 16% high-grade squamous intraepithelial lesions (HSIL) and only 10.5% confirmed invasive lesions: hysterectomy complication rate was 7%. Histological studies from women subjected to re-conization showed 32% negative results, 37% LSIL, 5% HSIL and 26% malignancy. In the group of patients who were followed-up after diagnosis, 8.8% needed a second intervention; none of them showed negative histological results, while 100% hysterectomized and 25% patients with re-conization showed HSIL. No unnecessary hysterectomy procedures were conducted in this group. HPV-16 was the most common genotype in both groups. CONCLUSION: Conization proved to be a suitable alternative to hysterectomy as a treatment for post-conization stage IA1 cervical cancer. Our results showed that 65% hysterectomy procedures conducted without previously monitoring for residual disease corresponded to negative results and were therefore, unnecessary. We conclude that confirmation of the presence of residual disease by using cotest is essential to make a decision on further treatment and that a conservative management is often possible and, in our opinion, preferable.

Cross-cultural adaptation to the Spanish context and evaluation of the content validity of the Second Victim Experience and Support Tool (SVEST-E) questionnaire.

OBJECTIVES: To carry out a cross-cultural adaptation of the Second Victim Experience and Support Tool (SVEST) questionnaire to the Spanish context, and to evaluate its content validity (CVI). METHODS: The translation and cultural adaptation of a measuring instrument by means of translation and back translation conducted through the participation of 20 health professionals. The content validation was carried out through the participation of 10 experts. The content validity of each item (CVI-I), the content validity index per expert (CVI-E) and the content validity total (CVI-T) were calculated for the questionnaire. Corrections were carried out for probable random agreement and the statistical calculation Kappa (K*) modified for each item of the instrument. RESULTS: The final instrument obtained (SVEST-E) has a CVI-Total of 0.87 and consists of 36 total items, subdivided into 7 dimensions, 2 outcome variables and a support option section maintaining the same structure as the original questionnaire. Thirty items had a CVI-I with values over ≥°0.79. CONCLUSIONS: The SVEST-E questionnaire is an equivalent of the original and is an instrument that could help to evaluate the second victim experiences of healthcare professionals in our country. It is an instrument with adequate content validity to measure the experience of second victims in health professionals in our country.

Rotational forceps: a retrospective study evaluating anatomical and functional consequences for the pelvic floor.

INTRODUCTION AND HYPOTHESIS: The use of Kielland's rotational forceps is considered to involve greater technical difficulty and may be associated with a higher rate of pelvic floor trauma. Our main objective was to evaluate the association between avulsion of the levator muscle and rotational and non-rotational forceps. METHODS: This was an observational study carried out at a tertiary hospital that recruited singleton cephalic vaginally primiparous women with previous Kielland's forceps delivery between March 2012 and May 2017. Patients were retrieved from a local database, contacted consecutively and blinded to all clinical data. Power calculations determined a sample of n = 160 patients. All women underwent a urogynecological interview, clinical examination and 4D translabial ultrasound (TLUS). The 4D TLUS volumes were stored and analyzed offline by an experienced ultrasound examiner who was blinded to all clinical data. RESULTS: A total of 165 patients were available for analysis. Rotational forceps accounted for 27.3% (45 out of 165) of the study sample. Avulsion was present in 41.8% (69 out of 165) of all forceps deliveries. On multivariate analysis, rotational forceps was associated with avulsion, with an adjusted odds ratio (OR) of 2.57 (CI 95% 1.20-5.62, p = 0.016). Body mass index at the beginning of gestation was found to be a protective factor, with an adjusted OR of 0.918 (CI 95% 0.847-0.986, p = 0.025). CONCLUSION: Rotational forceps is associated with a higher avulsion rate than non-rotational forceps, with an adjusted OR of over 2.5. Obstetricians need to consider the potential long-term consequences of performing a rotational forceps for mothers.

Cross-cultural adaptation to the Spanish context and evaluation of the content validity of the Second Victim Experience and Support Tool (SVEST-E) questionnaire. / Adaptación transcultural al contexto español y evaluación de la validez de contenido del cuestionario Second Victim Experience and Support Tool (SVEST-E).

OBJECTIVES: To carry out a cross-cultural adaptation of the Second Victim Experience and Support Tool (SVEST) questionnaire to the Spanish context, and to evaluate its content validity (CVI). METHODS: The translation and cultural adaptation of a measuring instrument by means of translation and back translation conducted through the participation of 20 health professionals. The content validation was carried out through the participation of 10 experts. The content validity of each item (CVI-I), the content validity index per expert (CVI-E) and the content validity total (CVI-T) were calculated for the questionnaire. Corrections were carried out for probable random agreement and the statistical calculation Kappa (K*) modified for each item of the instrument. RESULTS: The final instrument obtained (SVEST-E) has a CVI-Total of 0.87 and consists of 36 total items, subdivided into 7 dimensions, 2 outcome variables and a support option section maintaining the same structure as the original questionnaire. Thirty items had a CVI-I with values over ≥̊0.79. CONCLUSIONS: The SVEST-E questionnaire is an equivalent of the original and is an instrument that could help to evaluate the second victim experiences of healthcare professionals in our country. It is an instrument with adequate content validity to measure the experience of second victims in health professionals in our country.