Volnme 185, Number 6 Am.] Obstet Gynecol

296 PRECONCEPTION HEALTH PROMOTION:EVALUATION OF AN ON- LINE INTERACTIVE RISK ASSESSMENT T O O L MK MENARD 1, M BOATWRIGHT 1 , 1Medical University of South Carolina, Charleston, SC

OBJECTIVE: To assess the acceptabili ty and utility of a computer ized interactive reproductive health risk assessment (RHRA) designed for women considering pregnancy.

STUDY DESIGN: An ondine RHRA ('~wv.b4pregnancy.org) was evaluated using qualitative methods a n m n g a sample of 30 volunteers f rom varied socioeconomic and ethnic backgrounds. Participants completed the RHRA on- line. The program then generated a personalized list of potential reprodnctive health risks and related questions fi)r possible discussion with her healthcare provider. Evaluation data were collected ff i rough s t ruc tured interviews. Content analysis was used to identify recurr ing themes.

RESULTS: Major themes included efficiency, convenience, privacy, compre- hensiveness, and personal empowerment . Most par t ic ipants repor ted a preference for on-line assessment over a face-to-face interview because of efficiency and confidentiality. Sensitive questions were received without embar rassment and answered honestly. The average tinle to complete the assessment was 14.6 minutes (range 10-20 minutes) . The p rog ram was described as "easy" to use and the time reqnired ' just right." Most participants reported the program as valuable and would r ecommend it to a friend. Many commented that the section on healfficare rights and benefits was particularly thought provoking. Most respondents felt that this RHRA was a valuable tool to use in conjunction with a visit to a preconcept ion care provider.

CONCLUSION: This interactive RHRA generates personalized intorma- tion and related questions that respondents can discuss with their preconcep- tion health care provider. Women overwhelnfingly accepted this vehicle as an efficiem, informative and confidential process. The availability of an on-line RHRA tool allows women to increase their knowledge about potential factors that may eltect their pregnancy. Tltis enhanced knowledge base should lead to grea ter pat ient empowerment , improved patient-provider interaction, thus improved qualiW preconcept ion care.

298

SMFM Abstracts S161

ARE WE PROVIDING MATERNAL-FETAL MEDICINE FELLOWS WITH SUFFICIENT TRAINING IN INVASIVE PRENATAL DIAGNOSTIC TECH- NIQUES? THOMAS JENKINS 1, ANTHONY SCISCIONE2; 1Thomas Jefferson University, Maternal-Fetal Medicine, Philadelphia, PA; ~Christiana Care, Newark, DE

OBJECTIVE: We sought to de te rmine the availability a n d opt ions for training in invasive prenatal diagnostic techniques [chorionic villus sampling (CVS), and secoud-t r imester amniocentesis] for fellows in maternal-fetal medicine (MFM) in the United States.

STUDY DESIGN: A survey addressing training availability, methods for training, and plans ft)r ~uture practice was sent to all MFM fellows registered with the SMFM in the spring of 2001.

RESULTS: Fifty-five of 91 surveys were re turned (60.4% return rate). M1 respondentS were trained in second-trimester amniocentesis. Fifty-three of 55 (96.4%) were t ra ined on con t inu ing pregnancies . All fellows p l anned on pe r fo rming second-tr imester amniocentesis after training: Despite 82% of training institutions pertb~vfing CVS, only 24/55 (43.6%) of fellows had access to CVS training. Of those that received training in (NS, 58% were trained on non-cont inuing pregnancies (see Table). Sixty-seven percent of fellows felt that <50 CVS procedures were needed to be proficient, and 88.2% believed <70 were needed . All the respondents felt that t ra ining in prena ta l invasive diagnostic techniques was necessary. Ninety-three percen t believed that training in first trimester prenatal diagnostic techniques such as CVS should be part of fellmvship training.

CONCLUSION: Less than half of all r esponding fellows have t raining available in CVS despite >90% believing that first t r imester t ra ining is necessa W. Fellowship programs may wish to address these findings.

Table Training in CVS

No. fellows with access to CVS training 24 (43.6%) Median No. of procedures per formed 3 (0-120) Median No. expecting to per form 40 (0-140) No. fellows planning to per form CVS after training 28 (51%) No. not sure 17 (31%)

297 INTRAUTERINE GROWTH RESTRICTION DRAMATICALLY INCREASES THE RISK OF PERINATAL DEATH AT TERM AND PRETERM: EVIDENCE FROM 262,681 DELIVERIES IN A SINGLE YEAR ROGELIO GONZALEZL RICARDO GOMEZ 1, PAOLA VIVIANI 2, RENE CASTRO 3, MARIO CARSTENSI, JYH KAE NIEN l, LUIS MEDINA 1, WAN RQJASI: 1CEDIP, Hosp. Sotero del Rio, Dpt. Ob-Gin, E Universidad Catolica de Chile, Puente Alto, Stgo; eP. Universidad Catolica de Chile, Statistics, Puente A/to, Stgo; '3Minist~7 of Health, Stgo

OBJECTIVE: Traditionally, in t rauter ine growth restriction (IUGR) was considered a protective factor against death tbr p re te rm neonates . This concept has been recently challenged. This study was designed to test the hypothesis that IUGR increases perinatal nrortality at any gestational age.

STUDY DESIGN: A national curve for bir thweight according to gesta- tional age was constructed by including all deliveries in Chile dur ing 1999. Percentiles (p) used were <p5, pS-pl0, p10-p90 and >p90. To illustrate the relationship between birth weight percentile and perinatal nmrtality we chose the weeks 28 and 37 and determined the perinatal mortality associated to each of these percentile intervals. Chi square was used for analysis.

RESULTS: There were 262,681 deliveries dur ing the study period, with a per inatal mortal i ty (>22 weeks of gestat ion and up to 7 days of life) of 8.54/1000 live births. Fetuses with a birth weight <p5 and between p5 and p l 0 had a significantly higher perinatal mortality than fetuses with a birth weight >pl0 in both gestadonal ages (see Table, *P < .05 compared with fetuses whose birthweight is >p l 0).

CONCLUSION: IUGR imposes an additional risk for perinatal death in both preterm and term deliveries.

Table Perinatal mortality by birthweight percentile

<P5 P5-10 PI0-90 >P90 T O T A L

PM at 28 weeks 785.1" 720.7* 257.9 232.6 313.6 PM at 37 weeks 50.7* 33.6* 6.1 6.5 8.94

299 AMELIORATING COMMUNICATION WITH PREGNANT WOMEN RE- DUCES LITIGATION IN OBSTETRICS ANDREA L. TRANQU1LLI 1, MAURO CATTANEO 1, STEFANO R. GIANNUBILO '2, G. GIOELE GARZETTI]; ]Uni- versity of Ancona, M~cona; 2University of Ancona, Obstetrics and Gynecology, ,~fflcooa

OBJECTIVE', Litigation' in obsterics is the result of a complex of events where malpractice (presumed or real) impacts on the attitude of the patientS and their em,ironment. To reduce litigation, increasing at tention and care should get along with a better comnmnicadon.

STUDY DESIGN: We moni tored the customer satisthction questionnaires dur ing the three months before and after a training course on communicat ion in Obstetrics our University Hospital. A total of 1815 questionnaires where analyzed, and the frequency and type of complaims compared.

RESULTS: In the first three months following the communicat ion n~aining the complaints were less frequent (20/915 or 2% post- vs. 63/900 or 7% pre-) and in the vast majority targeted to the quality of hospital em4ronment and stay rather than to the medical or nursing staff (2/18 or 11% post- vs. 20 /63 or 31.7% pre-) than betore training.

CONCLUSION: Obstetrics is a multidisciplinary setting where different professionals ("birth a t tendants") cluster. Obstetricians, midwives, pedia- tricians, nurses, all interact with the pregnant woman and her environment (hnsband, parents, relatives, friends, media). In such complexity, information is mandatory but may be often misinterpreted, if messages are not tailored on the receiver capacity. Conmmnicat ing well with pregnant patient, therefore, becomes crucial. Communicat ion should be clean targeted, effective, fexible, empath ic to share a c o m m o n language and decisions. Socializing the information ameliorates the professional pertbl~lance, creates solidarity and reciprocal comprehension, reducing the risk of misunderstanding, revenge and litigation. Conmmnicat ion training should be offered to professionals in their curriculum or when hired in a Department.