Using complaints from obstetric care for improving women's birth experiences - a cross sectional study.

INTRODUCTION: Staff shortages and quality in obstetric care is a concern in most healthcare systems and a hot topic in the public debate that has centred on complaints about deficient care. However there has been a lack of empirical data to back the debate. The aim of this study was to analyse and describe complaints in obstetric care. Further, to compare the obstetric complaint pattern to complaints from women about other hospital services. MATERIALS AND METHODS: We used the Healthcare Complaints Analysis Tool to code, analyse and extract contents of obstetric complaint cases in a region of Denmark between 2016 and 2021. We compared the obstetric complaint pattern to all other hospital complaint cases in the same period regarding female patients at a large University Hospital in a cross-sectional study. RESULTS: Complaints regarding obstetric care differed from women's complaints regarding other healthcare services. Women from obstetric care raised more problems per complaint, and tended to complain more about relational issues indicated by odds for complaints about staff shortage four times higher in the obstetric care group. Women from obstetric care had a lower proportion of compensation claims. CONCLUSION: Systematic complaint analysis acknowledged women's experience in obstetric care and may point to areas that potentially need further attention. Complaints from obstetric care show that women experience deficiencies related to relational problems like recognition and individualized support compared to complaints from women receiving other hospital healthcare services.

Clinical performance and acceptability of self-collected vaginal and urine samples compared with clinician-taken cervical samples for HPV testing among women referred for colposcopy. A cross-sectional study.

OBJECTIVES: To increase effectiveness of the cervical cancer screening program, self-sampling can be an option. Both self-collected vaginal samples (SCV) and urine samples may be useful alternatives to clinician-taken cervical samples (CS). DESIGN: Cross-sectional study. SETTING: Colposcopy clinic. PARTICIPANTS: Women (n=305) referred to colposcopy after abnormal cervical screening result or conditions like postcoital bleeding. INTERVENTION: All women self-collected a urine and a vaginal sample prior to colposcopy, where a CS and biopsies were taken. All samples were tested for high-risk human papillomavirus (HPV) using the Cobas HPV assay. The gold standard was histology diagnoses (CIN2+/CIN3+) from biopsies obtained at the same examination. PRIMARY OUTCOME: Absolute and relative sensitivity and specificity of HPV testing on SCV and urine to detect CIN2+/CIN3+ compared with the CS. SECONDARY OUTCOME: The acceptability by women of self-sampling. RESULTS: Both the vaginal and urine sample were comparable to the CS in identifying severe intraepithelial neoplasia (CIN2+/CIN3+). Absolute sensitivity ranged from 93% for urine samples to 96% for SCV for detecting CIN2+, which is comparable to the sensitivity of CS (overlapping 95% CI).The relative sensitivity for detecting CIN2+ was 1.00 (95% CI 0.96 to 1.04) for SCV and 0.96 (95% CI 0.91 to 1.03) for urine samples. At CIN3+, the relative sensitivity was 1.00 (95% CI 0.96 to 1.08) and 0.97 (95% CI 0.89 to 1.07) for SCV and urine samples, respectively. There were no statistical differences between the self-collected samples and the CS (McNemar's test >0.05). The relative specificity was also similar (1.03 (95% CI 0.95 to 1.12) for SCV and 0.98 (95% CI 0.89 to 1.09) for urine samples) (McNemar's test >0.05).The acceptability of self-sampling was evaluated by questionnaire. The women found the instructions on sample collection easy to understand and were positive about self-sampling with a preference for the urine sample. CONCLUSION: Self-sampling by SCV and urine is a clinically safe alternative to CS with a high degree of acceptability.

[Acquired clitoral phimosis causing a periclitoral pseudocyst].

Clitoral phimosis or preputial fusion may occur as a result of atrophic vaginitis among other conditions. A 72-year-old woman presented with atrophic vaginitis, preputial fusion, and a painful periclitorial pseudocyst. We suggest that a minimal surgery approach in a manual retraction of the synarchies without making an incision is a gentle and effective surgical management of preputial fusion. Suturing the ends from each other combined with continuous topical prophylaxis will minimise the risk of recurrence of pseudo-cyst and prevent worsening scar tissue formation.

The Size of Labia Minora and Perception of Genital Appearance: A Cross-Sectional Study.

OBJECTIVES: The aims of the study were to describe and to assess the size of labia minora in normal women, including the women's perception of their genitals to offer better counseling to the women seeking for labiaplasty. MATERIALS AND METHODS: This cross-sectional study was undertaken in the outpatient clinic at the Department of Obstetrics and Gynaecology at Kolding Medical Center between May 2012 and October 2013, when study participants were recruited in connection with their routine visits. Main outcomes of interest were visibility and width of the patients' labia minora. In addition, women were asked whether they perceived their genitals as being normal. Information about age, body mass index, and parity was also collected. We used descriptive statistics and paired t test to compare the clinical measurements. RESULTS: In total, 244 women were included in the study. The median width of labia was 15 mm, and 90% of labia were less than 26.5 mm. Fifty-six percent of the women had visible labia minora. Regarding perception, 86.5% considered their labia as being normal. Within the group of women who perceived their genitals to be abnormal, 73.3% had visible labia minora. Among women with the largest labia (>26.5 mm), two thirds considered themselves normal. There was no statistically significant association between the measurements of labia minora and age, body mass index, or parity. CONCLUSIONS: One of 10 women had a measurement of labia minora of at least 26.5 mm in width. It is just as common to have visible labia minora as hidden labia minora. Women who considered their genitals to be abnormal more often had visible labia minora than women who considered their genitals to be normal.

Post-coital genital injury in healthy women: A review.

Female genital injury following penile sexual intercourse in healthy women is a matter of importance and debate in many parts of society. However, the literature on the subject is sparse. There are a few studies regarding minor injury that does not require treatment in adult, pre-menopausal women, a single study of adolescent women, and none regarding post-menopausal women. Larger lesions requiring treatment are described casuistically. The purpose of this article is to provide a short, easy-to-read review of the literature regarding the prevalence and nature of female genital injury following consensual sexual intercourse in otherwise healthy women.

[Perivascular epithelioid cell tumours of the uterus]. / Perivaskulær epiteloidcelletumor i uterus.

Perivascular epithelioid cell tumours (PEComas) are rare tumours with unknown malignant potential. We report a case of a 48-year-old woman, who had had many tumours, initially diagnosed as leiomyomas, removed from her uterus and vagina over 16 years. A recurrent tumour and revision of prior specimens revealed PEComa. As free surgical margins could not be obtained, the woman is regularly controlled by magnetic resonance imaging. So far recurrence has not been detected. This case shows that knowledge of PEComas is important to ensure relevant follow-up as these are low malignant tumours that tend to reoccur.