Objective: To standardize obstetric simulation training curriculum on the main obstetrical emergencies in the Italian National Program for residents. Recruitment: experts all around the Country with proven experience in teaching Gynecology and Obstetrics, simulation activities and proven clinical experience in the management in labor complications and peripartum emergencies, participated at the study (SIMOBE Group). Setting: Specific Objective Structured Assessment of Technical Skills checklists were created or modified, and finally approved. Methods: Delphi study was conducted in 4 different rounds to reach a shared checklist for each emergencies Main outcome: Development of OSATS checklist for the major obstetric emergencies Results: A consensus on specific OSATS checklist has been reached in all the obstetrical emergencies. The level of appreciation for each OSATS has been considered good or excellent in most of the cases: shoulder systocia (around 82%), external cephalic version (around 94%), vacuum application (around 75%), management of abnormal CTG in labor (around 42%), post-partum hemorrhage (around 96%), reverse breech extraction (around 72%), Maternal collapse (around 94%), forceps vaginal application (around 76%), non-cephalic second twin delivery assistance (around 96%), assisted breech delivery (around 94%), third-fourth degree perineal laceration repair (around 82%) Conclusion: Development of OSATS checklists on the main obstetric emergencies is pivotal to provide standardized competencies to the personnel dedicated to childbirth.. The SIMOBE working group, recommends the use of these OSATS throughout the national territory.

Objective: Elicit preferences for treatment of vasomotor symptoms (VMS) associated with menopause. Design: Discrete choice experiment. Setting: Australia, Canada, Denmark, France, Germany, Spain, Sweden, United Kingdom. Population: Women aged 40–65 years, postmenopausal, self-reporting ≥14 moderate-to-severe VMS episodes/week. Methods: Targeted review of published literature, steering committee feedback, iterative qualitative interviews and available clinical data identified potentially relevant attributes of VMS treatments. Main Outcome Measures: Women made a series of choices between two hypothetical treatments and an opt out differing in moderate-to-severe VMS frequency, other menopause symptom improvement, time to symptom improvement, 5-year risks of breast cancer, blood clots and osteoporosis. Data analysed using a mixed-methods approach. Relative attribute importance (RAI) captured the maximum contribution of each attribute to treatment choice depending on expected duration of hormone therapy (HT). Results: The most influential attribute was 5-year blood clot risk (RAI 26.4–28.4%). Improving other menopause symptoms had a 1.4 times greater effect on preferences than reducing VMS frequency. Based on 5–9 years’ HT use (RR 1.97), breast cancer risk was the fourth most important attribute. Improvements in other menopause symptoms, VMS frequency reduction, onset time and of osteoporosis risk reduction were 1.0–1.4 times more important than remaining attributes. Women were willing to accept an extra 0.5% blood clot risk of or an extra 0.25% breast cancer risk for every 10% reduction in VMS frequency. Conclusions: Women valued safe efficacious VMS treatment, with high importance on avoiding long-term risks. Reducing VMS frequency mattered over and above wider menopause symptoms.

Objective To investigate urinary/faecal incontinence (UI/FI) prevalence during pregnancy and postpartum, and the main risk and protective factors, in a large Italian population. Design Prospective observational analysis of patient-reported outcome (PRO) measures. Population and setting All pregnant women agreed to participate to the systematic and longitudinal survey on the maternity pathway in Tuscany, Italy. Methods We employed data from four questionnaires completed by women from the beginning of pregnancy until six-months postpartum. Each questionnaire included two PRO measures – the Wexner scale for FI and the International Consultation on Incontinence Questionnaire for UI –, and several questions investigating the socio-demographic and clinical features of respondents. Main outcomes The UI/FI prevalence at each time-point and the related risk and protective factors. Results Among our 6,023 respondents, UI prevalence in the third trimester was 24.3% and almost halved six-months postpartum. Women reporting FI were 6.2% in the third trimester and 4.2% six-months postpartum. Higher UI occurrence and severity were found in highly-educated, aged > 30, and overweight/obese women. Caesarean-section was protective against postpartum UI, while spontaneous tear or episiotomy were risk factors. Protective effects were provided by performing pelvic-floor-muscle-training during pregnancy, mainly for specific risk groups. Furthermore, higher FI prevalence and severity emerged in overweight, aged > 40, highly-educated, non-Italian women and in those undergoing tear. Conclusion PRO measures systematically and longitudinally collected in a large Italian population highlighted the prevalence of pregnancy-related UI/FI and the risk and protective factors. Pelvic-floor-muscle-training may be recommended in women with peculiar socio-demographic and clinical features.