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Objective To assess the feasibility and validity of a maternal satisfaction measurement tool, the SaFE study Patient Perception Score (PPS), after operative delivery.Design Cross-sectional survey.Setting A large maternity unit in England.Sample 150 women who had had an operative birth.Methods We recruited women within 24 hours of birth and quantified their satisfaction with two questionnaires: PPS, and the Mackey Childbirth Satisfaction Rating Scale (CSRS; modified).Main Outcome Measures Participation rate to determine feasibility; Cronbach's alpha as measure of internal consistency; PPS satisfaction scores for groups of accoucheurs of different seniority to assess construct validity; correlation coefficient of PPS scores with total scores from the CSRS questionnaire to establish criterion validity.Results Participation rate approached 85%. We observed high scores for most births except a few outliers. Internal consistency of the PPS was high (Cronbach's alpha = 0.83). Total PPS scores correlated strongly with total CSRS scores (Spearman's r = 0.64, P < 0.001).Conclusions The PPS is a simple and valid tool for patientcentred assessments. High scores were observed for most births but there were a small minority of accoucheurs who consistently scored poorly and these data could be used during appraisal and training.

Thyroid disease is a common condition in the reproductive medicine setting due to the complex interplay between the hypothalamo-pituitary axis and the thyoid gland. Abnormalities in thyroid function, including hyperthyroidism and hypothyroidism, can have an adverse effect on reproductive health and result in reduced rates of conception, increased early pregnancy loss, and adverse pregnancy and neonatal outcomes. There is increasing evidence for the role of autoantibodies in subfertility and early pregnancy loss, even in euthyroid women. Evidence suggests that treating thyroid disorders and keeping thyroid-stimulating hormone levels at the lower end of normal in euthyroid women may improve conception rates in subfertile women and reduce early pregnancy loss. Learning objectivesTo gain an overview of the effect of thyroid disorders on reproductive health. To review the evidence on how to optimise thyroid function to improve reproductive outcomes. Ethical issuesScreening for thyroid disease should be considered in women presenting with subfertility and recurrent early pregnancy loss.

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