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Objective To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. Methods This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. Results In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36–3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95–4.85); P = 0.068). Conclusion When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Objectives: To assess the validity and describe the psychometric properties of the Spanish version of the Second Victim Experience and Support Tool (SVEST-E) questionnaire. Methods: Cross-sectional observational study aimed at midwives and obstetricians in Spain. An online survey was conducted consisting of two 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 (EFA) and a confirmatory factor analysis (CFA) were performed using FACTOR programme v.10 with a polychoric correlation matrix. Results: A total of 689 professionals participated in the study, of which 323 were obstetrician physicians and 366 were midwives. The mean score on the SVEST-E for the total sample was 3.09 (SD = 0.50). The parallel analysis of the EFA suggested a 5factor solution, with a total explained variability of 61.8%. The goodness of fit indices of the model were RMSEA = 0.038 (95% CI: 0.031-0.042), NNFI = 0.985 (95% CI: 0.984-0.989) and CFI = 0.989 (95% CI: 0.988-0.992). The factor model obtained was confirmed by CFA, obtaining the values of RMSEA = 0.038 (95% CI: 0.026-0.053), NNFI = 0.985 (95% CI: 0.957-1.000) and CFI = 0.989 (95% CI: 0.969-1.000). The intraclass correlation coefficient for SVEST-E 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 organisation of its dimensions, containing 4 factors and the desired support responses. The Spanish version of the instrument maintains adequate content validity, construct validity, reliability, and temporal stability, so the SVEST-E is a valid tool to evaluate the second victim experience in Spanish

Objectives: The objective of this study is to investigate a multicenter study to establish if differences exist in the levator ani muscle avulsion (LAM) rates between deliveries performed with Malmstrom's vacuum and the Kiwi vacuum. Study design:A prospective, multicenter observational study with 199 primiparous subjects was performed. All patients had undergone vaginal delivery by vacuum (Malmstrom's or Kiwi). Avulsion was defined as an abnormal insertion of LAM in the lower pubic branch in the multiplanar mode, as identified in the three central sections by transperineal 3/4D echography 6 months after delivery. The area of the levator hiatus was measured in the plane of minimum dimensions at rest, during the Valsalva maneuver and during contraction.Results: LAM avulsion occurred in 33.1% of cases in which Malmstrom's vacuum was used and in 29.4% of cases in which the Kiwi vacuum was used (the difference was not statistically significant), which resulted in a crude odds ratio (OR) of 0.977 (0.426, 2.241; P = .957) and an adjusted OR of 2.90 (0.691; 12.20; P = .146). Women in the Malmstrom's vacuum group had a larger LHA at rest 14.77 vs 12.64 cm 2 ; P = .001) and at maximum contraction (13.41 vs 10.83 cm 2 ; P < 0.001) in comparison with the Kiwi group, although the difference did not reach statistical significance under Valsalva maneuver (18.71 vs 17.21 cm 2 ; P = .051).Differences between both groups were detected in the measurements of the hiatus area levator at rest (14.77 vs 12.64 cm 2 ), during the Valsalva maneuver (18.71 vs 17.21 cm 2 ) and during maximum contraction (13.41 vs 10.83 cm 2 ). Conclusions:In the present study, Malmstrom's vacuum was not associated with a higher risk of LAM in comparison with Kiwi's Omnicup. K E Y W O R D Skiwi omnicup vacuum, levator ani muscle, malmstrom's vacuum, pelvic floor, ultrasound

Introduction Forceps use is the main risk factor for levator ani muscle (LAM) injuries. We believe that the disengagement of the forceps branches before delivery of the fetal head could influence LAM injuries, so we aimed to determine the influence of the disengagement of the forceps on the occurrence of LAM avulsion during forceps delivery. Material and methods A prospective, observational, multicenter study was conducted with 261 women who underwent forceps delivery. The women were classified according to whether the branches of the forceps had been disengaged before delivery of the fetal head. LAM avulsion was defined using a multislice mode (3 central slices). Results In all, 255 women completed the study (160 without disengagement and 95 with disengagement). LAM avulsions were observed in 37.9% of women in the group with disengagement and in 41.9% of women in the group without disengagement. The crude OR (without disengagement vs with disengagement) for avulsion was 0.90 (95% CI 0.49‐1.67, P = 0.757) and an adjusted OR of 0.82 (95% CI 0.40‐1.69, P = 0.603). Conclusions We did not observe a statistically significant reduction in the LAM avulsion rate with disengagement of the forceps branches before delivery of the fetal head.

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ResumenObjetivo: Recopilar recomendaciones y evidencias en el manejo práctico de las gestantes con infección por COVID-19 para clarificar pautas de atención obstétrica ante esta nueva enfermedad. Método: Scope review a partir de búsqueda bibliográfica en bases de datos nacionales e internacionales en ciencias de la salud (PubMed/Medline, Biblioteca Virtual en Salud, SciELO, Cochrane y CUIDEN) y sitios web y adicionalmente mediante sistema de «bola de nieve». Se utilizaron los términos MeSH: «COVID-19», «Pregnancy», «Delivery, Obstetric», «Pregnant Women» y «Maternal». Como límites en la búsqueda se seleccionaron los idiomas español e inglés. No se establecieron límites en referencia al año de publicación o el tipo de artículo. Resultados: Se detectaron un total de 49 documentos y artículos, de los cuales 27 fueron analizados, utilizándose 18 y desechándose 9 que no contenían recomendaciones prácticas. Las recomendaciones fueron agrupadas en 10 temáticas: prevención de la infección en la embarazada; prevención de la infección en el personal sanitario que atiende a la embarazada; forma de presentación y severidad en la embarazada; transmisión materno-fetal (vertical y perinatal); control materno-fetal de la gestante con COVID-19; control de la gestante grave por COVID-19; tratamiento de la gestante con COVID 19; manejo y vía de finalización del parto; resultados neonatales en mujeres con COVID-19, y lactancia materna. Conclusiones: Falta una evidencia sólida que sustente muchas de las recomendaciones para la mujer gestante respecto a la COVID-19, ya que están basadas en la experiencia previa con las infecciones provocadas por los virus SARS-CoV y MERS-CoV. Se necesitan nuevos estudios que confirmen la idoneidad de muchas de las recomendaciones y pautas de actuación en el caso concreto de la mujer gestante y la COVID-19.