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Introduction and Hypothesis: The exact positioning of the dominant hand at the time of manual perineal protection is not clearly specified. The overarching aim of this work was to collect data on the bregma to posterior fourchette distance (BFD), as a surrogate measure for the degree of fetal head extension, and maternal perineal body length (PBL) at the time of manual perineal protection (MPP). Methods: This was a two-center study. Term cephalic singleton nulliparous women having spontaneous vaginal delivery were considered eligible for recruitment into the study. Once crowning was diagnosed and just prior the initiation of manual perineal protection (MPP) or cutting an episiotomy, the BFD and PBL were measured using a standardized measurement protocol.Results: A total of 100 women (50 women in each center) were recruited into the study. The overall mean BFD was 2.8 ± 0.5 cm. The overall mean PBL was 4.4 ± 0.8 cm. There were no statistically significant differences between the measurements taken in both units regarding BFD or PBL (p = 0.81 and 0.10 respectively). There was a weak correlation between both measurements.Conclusion: This is the first study to generate data on the bregma to fourchette distance and the perineal body length just prior to fetal head expulsion. This information will probably be useful to inform future biomechanical computational modeling studies to optimize hands and fingers placement during manual perineal protection.

Background: The aim of this study was to explore the personal views of female gynecologists regarding the management of POP with a particular focus on the issue of uterine sparing surgery. Methods: A questionnaire based survey of practicing female gynecologists in the Czech Republic, Slovenia and Slovakia.Results: A total of 140 female gynecologists from 81 units responded to our questionnaire. The majority of respondents stated they would rely on a urogynecologist to aid them with their choice of POP management options. The most preferred options for POP management were sacrocolpopexy and physiotherapy. Almost 2/3 of respondents opted for a hysterectomy together with POP surgery, if they were menopausal, even if the anatomical outcome was similar to uterine sparing POP surgery. Moreover, 81.4% of respondents, who initially opted for a uterine sparing procedure, changed their mind if the anatomical success of POP surgery with concomitant hysterectomy was superior. Discussing uterine cancer risk in relation to other organs had a less significant impact on their choices.Conclusions: The majority of female gynecologists in our study opted for hysterectomy if they were postmenopausal at the time of POP surgery. However, variation in information provision had an impact on their choice.Trial registration: not included