[Czech linguistic validation of the Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire - IUGA revised]. / Ceský preklad a validace dotazníku kvality pohlavního zivota u zen s prolapsem pánevních orgánu ci inkontinencí moci nebo stolice - PISQ-IR.

OBJECTIVE: To produce a Czech version of a validated tool for sexual quality of life assessment among women with pelvic floor disorders; PISQ-IR (Pelvic organ prolapse/Incontinence Sexual Questionnaire - Internationally Revised). DESIGN: Original study. SETTING: Department of Obstetrics and Gynecology, University Hospital and Faculty of Medicine, Charles University in Pilsen. METHODS: The whole process of translation and linguistic validation of the questionnaire followed the protocol of the International Urogynecology Association developed for this purpose. The original translation was repeatedly discussed with patients with incontinence or prolapse in order to preserve the meaning and comprehensibility of the items. The resulting questionnaire was reversely translated into English by an independent translator and sent to IUGA translation working group for validation. The translation was finalized based on recommendations from the group. RESULTS: PISQ-IR is a self-administered questionnaire improved from the previous and short versions. It contains 20 questions, the first question determines whether section 1 for sexually inactive or section 2 for sexually active women is to be completed. The first section for sexually inactive women contains five questions with 12 items. The second section comprises of 14 questions with 22 items for sexually active women with a partner or 12 questions with 19 items for those without a partner. The questionnaire is evaluated separately for individual sub-scales. Compared to former PISQ-12, the PISQ-IR was improved to enable separate assessment of individual domains and its subscales, and to be useful also in non-sexually active women and women with anal incontinence. At the same time it can be also utilized in case of incompletely filled-in questionnaire. A certain disadvantage for clinical practice is its more complex evaluation. CONCLUSION: Linguistic validation of a PISQ-IR questionnaire was performed and the questionnaire is presented. We present a Czech translation of a validated tool for assessment of quality of sexual life in women with prolapse or urinary/anal incontinence. Psychometric evaluation remains yet to be performed.

[Perineal audit: reasons for more than one thousand episiotomies]. / Perineální audit: duvody pro více nez 1000 epiziotomií.

AIM: To analyze reasons for episiotomy use in vaginal delivery among obstetricians and midwives. Consecutively, to indentify disputable indications for its use based on published research in order to facilitate the decrease in frequency of this operation, while preserving high quality of obstetrical care. METHODS: Reasons for mediolateral episiotomy use were recorded by obstetricians and midwives after each vaginal delivery with episiotomy at the Ob&Gyn Department of the Charles University Hospital in Pilsen in the period of February 2006 - June 2007. The main reason and all reasons for episiotomy use were evaluated separately. RESULTS: The reason for episiotomy use was recorded in 1069 cases (93%) out of a total of 1150 vaginal deliveries, in which mediolateral episiotomy was performed (42% of all vaginal deliveries). The most common group of main reasons for episiotomy use was a concern about postpartum pelvic floor functional impairment (624, 58% of episiotomies), especially a rigid, non-elastic perineum (401, 37%). Fetal distress (181, 17%) and abnormalities of the expulsive forces/uncooperative parturient (109, 10%) followed. When evaluating all (including secondary) reasons, the most common groups of reasons for episiotomy use were the effort of pelvic floor functionality preservation (871, 50%), abnormalities of the expulsive forces/uncooperative parturient (354, 20%) and fetal distress (253, 15%). When evaluating episiotomies performed by obstetricians and midwives separately, the concern about postpartum pelvic floor functionality prevailed in midwives (81% vs. 39% of episiotomies performed primarily for this reason). Conversely, the obstetricians performed episiotomy more frequently for fetal distress (28% vs. 4%). CONCLUSION: In view of the fact that midwives attend only physiological deliveries in our department, the spectrum of reasons for episiotomy use among midwives is narrower and the concern about postpartum pelvic floor functionality dominates. Currently, the concern about postpartum pelvic floor functionality should not be considered a legitimate indication for episiotomy use. The fact that 624 (58%) episiotomies were performed for this reason represents a significant reserve for a decrease in the frequency of episiotomy use. The reduction should be possible primarily among midwives (81% of all main reasons for episiotomy use in the midwive group, i.e. 37% of all episiotomies performed). The analysis of reasons for episiotomy use is an important step in reduction of episiotomy rates while preserving or improving the standard of treatment provided.