Survey of Knowledge, Attitudes and Practice Managment Patterns of Obstetricians Regarding Stillbirth Preganancy Outcomes

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Form Approved

OMB No. ____________

Exp. Date ____________

Survey of Knowledge, Attitudes and Practice Management Patterns of Obstetricians Regarding Stillbirth Pregnancy Outcomes

Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

Survey Eligibility Questions

Please fill in all of the boxes below that describe your practice as a physician:

• Active in clinical practice in the field of obstetrics

• Active in clinical practice in a field other than obstetrics

• Retired from active obstetrics

• Administration

• Teaching

• Research

In what county (ies) is your practice located? Circle all that apply.

• Cherokee

• Clayton

• Cobb

• Coweta

• DeKalb

• Douglas

• Fayette

• Forsyth

• Fulton

• Gwinnett

• Henry

• Paulding

• Rockdale

• Other, specify_____________

IF YOU ARE NOT CURRENTLY INVOLVED IN CLINICAL PRACTICE IN THE FIELD OF OBSTETRICS IN EITHER: CLAYTON, COBB, DEKALB, FULTON, OR GWINNETT COUNTIES; PLEASE STOP HERE AND RETURN THIS SURVEY.

For each of the items that follow, please circle or fill in the appropriate response.

Section 1. Demographic Information

1. Age: _________

2. Gender:  Male  Female (Circle)

Race ethnicity: (circle)

1. White

2. Black or African American

3. Hispanic or Latino

d) Not Hispanic or Latino

e) Asian

f) American Indian or Alaska Native

g) Native Hawaiian or other Pacific Islander

3. What month/year did you start practicing medicine (excluding residency/fellowship training)?

___ Month _____ Year

4. In what type of practice setting do you work? (Circle ALL that apply)

1. Obstetric-gynecological partnership or group

2. Solo practice

3. University faculty and practice

4. Multi-specialty group

5. Health maintenance organization

6. Military

7. Other, specify _______________________

5. What is your primary specialty? (Circle Answer)

1. Obstetrics and gynecology

2. Maternal-fetal medicine

3. Reproductive endocrinology

4. Gynecological oncology

5. Urogynecology

6. Other primary specialties, specify ________________________________

6. Approximately how many births do you attend annually? (Circle Answer)

1. 10-20

2. 21-50

3. 51-100

4. 101-200

5. More than 200

7. What is the racial/ethnic make up of your patients? (Indicate by percentage)

1. White __ %

2. Black or African American ___ %

3. Hispanic or Latino ___%

4. Not Hispanic or Latino ___%

5. Asian ___%

6. American Indian or Alaska Native ___%

7. Native Hawaiian or other Pacific Islander ___%

Section 2. Definition and Case Ascertainment

1. On average, how many stillbirth cases do you see annually?

On average, I see _______ stillbirth cases annually.

2. What percentage of these is the cause of death not identified?

_ _ % of the cases of stillbirth I see annually has no cause identified.

3. What minimum gestational age do you consider defines a stillbirth?

_______ or more weeks gestational age.

4. In addition to question 3, how do you define “stillbirth”? (Circle Answer)

1. Death of a fetus <500g within hours of birth

2. Death within moments of birth in a non-viable fetus

3. Unsuccessful resuscitation in the delivery room

4. No heart beat or breathing at birth

5. Other, specify ______________

5. In your opinion, should the definition for stillbirth be standardized? (Circle Answer)

1. Yes

2. No

3. Uncertain

6. Please rate the extent to which you agree with the following statements: (Put a check in the box which applies)

	Disagree 1	2	3	Neither Disagree nor Agree 4	5	6	Agree 7
The use of an evaluation protocol for post-mortem stillbirth management is important							
The provider/clinician should spend sufficient time and resources to conduct a comprehensive search for the cause of stillbirth							
A standardized universal protocol for post-mortem stillbirth evaluation would be helpful							
A standardized protocol for post-mortem stillbirth evaluation should be required							
For cases of stillbirth, the provider/clinician should be meticulous in completing the fetal death report							

7. When providing stillbirth-related patient care, how frequently do you do each of the following:

	Never 1	2	3	Some-times 4	5	6	Always 7
Discuss the need for stillbirth evaluation with your patients to determine the cause of death							
Recommend autopsy							
Send placenta and cord for histopathologic examination							

8. Following a case of stillbirth, how frequently do you recommend/offer an autopsy?

1. <25%

2. 26-50%

3. 51-75%

4. 76-100%

9. How many of your patients who have experiencedsuffered a stillbirth consent to a fetal autopsy?

5. <25%

6. 26-50%

7. 51-75%

8. 76-100%

10. Which of the following do you regularly offer to your patients if they refuse an autopsy? (Circle ALL that apply)

1. Cytogenetic testing

2. Radiographs

3. Limited/focused autopsy

4. Photographs

5. Other (specify) __________________

6. Usually do not offer additional studies

10.1 In your opinion, what is the MOST important factor determining whether an autopsy is conducted? (Circle only one Answer)

1. Extent to which medical staff member(s) (i.e., neonatologist, obstetrician, midwife or neonatal
   nurse) encouraged the patient to have an autopsy conducted

2. Patient refusal

3. Concern for liability issues

4. Cost/reimbursement

5. Cause is usually suspected and an autopsy is not needed

6. Other (specify) __________________

11.2 Who usually completes the fetal death certificate? (Circle ALL that apply)

1. Physician

2. Labor and delivery nurse

3. Pathologist

4. Physician assistant

5. Not sure

6. Other, specify _____________________

13. Is the fetal death certificate usually completed before all test results, (e.g. cultures, histopathology and autopsy) are available: (Circle Answer)

1. Yes

2. No

3. Never had to fill out a fetal death certificate

4. unsure

14. Have you ever filed an amendment to a fetal death certificate to update it with new information? (Circle Answer)

1. Yes

2. No

15. How many times per year does your institution review cases of stillbirth?

1. Always and usually on a regular basis

2. Always but not on a regular basis

3. Sometimes, but not on a regular basis

4. Never

16. Do you routinely use a post-mortem stillbirth evaluation protocol?

1. Always

2. Sometimes

3. Never

17. If you responded “Always” or “Sometimes” to Item 15, is the use of a post-mortem stillbirth protocol required or recommended by your facility? (Circle Answer)

1. Required

2. Recommended

3. Neither Required or Recommended

18. Following a case of stillbirth, how frequently do you recommend grief counseling for the patient and family? (Put a check in the box which apply)

Never 1	2	3	Sometimes 4	5	6	Always 7
						

19. Is grief counseling by trained professionals available at your facility? (Circle Answer)

1. No

2. Yes

3. Not Sure

20. Are there other resources that you recommend for grief services?

1. Yes, specify name if known __________________

2. No

Section 3. Stillbirth Surveillance Research Agenda

1. Do you believe that information on fetal death certificates is reliable? (Circle Answer)

1. Yes

2. No

3. Don’t know

2. Please rate the degree of importance for each of the following: (Put a check in the box which apply)

	Not important 1	2	3	Some-what important 4	5	6	Very important 7
Ongoing surveillance to monitor the frequency of stillbirth							
A national research agenda on causes of stillbirth							
Allocation of public funding to support state and federal agencies tasked with collecting data on stillbirths							

Section 4. Professional Education and Self-Evaluation

1. Please rate your level of comfort in each of the following areas related to the management of stillbirth-related patient care: (Put a check in the box which apply)

	Not comfortable 1	2	3	Somewhat comfortable 4	5	6	Very comfortable 7
Ability to manage high risk pregnancies							
Knowledge regarding the causes and prevention of stillbirth							

2. Which of the following have you found MOST helpful as a source of knowledge on the causes, prevention, and management of stillbirth? (Circle up to three)

1. Medical school

2. On-line Tutorials

3. Residency

4. Continuing Medical Education (CME)

5. American College of Obstetrics and Gynecology (ACOG) materials

6. Journals

7. Textbooks

8. Self study materials

9. Conferences/meetings

10. Other source (specify) ___________________________________________

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