Appendix 3: Pre-study Questionnaire EPiMAP Obstetrics European Practices in the Management of Accidental Dural Puncture in Obstetrics All questions in this questionnaire relate to the situation in 2014 A. The Hospital characteristics: 1. Please specify the details: Country: City: Name of the Hospital: Department: Email: in the labour ward in your hospital Last name of person responsible for EPiMAP study: First name of person responsible for EPiMAP study: 2. Is the Hospital where you work: Primary Secondary Tertiary Primary: Peripheral hospital which has basic services and not a referral centre. Secondary: Regional hospital and referral centre but not directly affiliated to a University. Tertiary: University-affiliated hospital, referral and academic centre. 3. Number of deliveries/year (in the labour ward and caesarean sections) <1.000 1.000 2.000 2.000-3.000 3.000-4.000 4.000-5.000 >5.000 If exact figures available (nearest 100), please enter number here. 4. Number of obstetric epidurals performed in the labour ward <500 500-1.000 1.000-1.500 1.500-2.000 2.000-2.500 >2.500 If exact figures available (nearest 100), please enter number here. Page 1 of 7
5. % of labouring patients receiving epidural analgesia < 10 10-20 20-30 30-40 40-50 > 50 Unknown If exact figures available, please enter percentage here. 6. Is there a Database for registering obstetric epidural technique/complications in your hospital? Yes No B. The Epidural Technique 1. What is the most frequently used gauge of epidural needle? 16G 18G other: please specify 2. What is the most frequently used medium for loss of resistance (LOR)? saline air both techniques frequently used 3. What is the most frequently used technique for LOR? intermittent continuous both techniques frequently used 4. Is ultrasound technique used as an aid for correct epidural needle placement?, very rarely Yes, rarely Yes, commonly Yes, very commonly 5. What was the total number of accidental dural punctures? < 5 5-10 10-20 20-30 > 30 Unknown 5b. Is the answer to 5 (above): An estimation exact figure If exact figures are available, please enter number here.. Page 2 of 7
C. The Policy for Post dural puncture headache (PDPH) 1. Do you have clearly defined diagnostic criteria for PDPH in your institution? No Yes If yes, please describe shortly below: Patient develops classical symptoms of post-dural puncture headache? Headache worsens within 15 minutes after sitting or standing and improves within 15 minutes after lying down? Headache develops within 5 days after confirmed or suspected dural puncture? NB. The headache may or may not be accompanied by neck stiffness, vestibular, visual or auditory symptoms Differential diagnosis like intracranial lesions and infection have been ruled out if the patient first presents with headache after more than 1 week? 2. Is there a policy in your institution for routinely informing patients about the risk of PDPH before inserting the epidural? 3. Do you have a written policy on the management of PDPH in your institution? No Yes 4. Do you use Caffeine for management of PDPH? If yes, please describe shortly below (tablets, injection, coffee/tea etc):... 5. Are Anesthesiologists actively involved in the conservative management of patients? 6. Have you used any other method successfully (other than fluids, caffeine, Epidural Blood Patch)? If yes, please describe shortly what. Was it successful?: Page 3 of 7
7. Is the general policy (after confirmation of PDPH) Proactive EBP ( < 24 h)? Active EBP (24-48 h)? Wait and watch (after > 48 h)? No written policy. Each physician decides himself/herself Other: What? Please describe.. 8. How many parturients received EBP treatment? < 5 5-10 10-20 20-30 > 30 Unknown If exact figures are available, please enter here 9. What % of EBPs were put in parturients with classical symptoms of PDPH without an observed accidental dural puncture ( no CSF, fluid in needle/catheter)? < 25 25 50 50-75 > 75 Unknown 10. When using EBP, what is the success rate (%) after first EBP? < 25 25 50 50-75 > 75 Unknown 11. If EBP is not successful, would a second EBP be considered? Yes No No definite policy 12. Which percentage of EBP s administered in obstetric patients after epidural analgesia/anesthesia in 2014 were in patients without observed ADP? <25% 25-50% 50-75% >75% Unknown If exact figures are available, please enter percentage here Page 4 of 7
Comments :. 13. Is CT/MRI used in patients with suspected PDPH? Before a first EBP After failure of the first EBP After failure of the second EBP Not at all 14. Have you had any minor complications of EBP (e.g. persistent backache, meningism) in the last year? If yes, please describe: 15. Have you had any major complications of EBP (e.g. local/systemic infection)? If yes, please describe and give time frame: D. On the Education in Epidural Analgesia 1. Do you have a formal programme for teaching epidural analgesia at your hospital? If yes, please comment 2. What is the estimated % of Obstetric Epidurals performed by Specialists? < 25 25 50 50-75 > 75 Unknown 3. Do the trainees at your hospital first learn to put lumbar epidurals on: Non-obstetric patients Directly on Maternity wards 4. Do you have a model or simulator for training in epidural analgesia prior to using in humans? If yes, is it used for training junior doctors: routinely often sometimes rarely Page 5 of 7
5. How many epidurals are required to be inserted by trainees before they are allowed to do obstetric epidurals without supervision? < 10 10 20 20 30 30 40 > 40 No formal requirement 6. Do you believe that a formal training programme needs to be implemented as a model in the European countries for the future practice of training in Epidural analgesia? E. General questions 1. Do you recommend another hospital/ colleague to contact for participation in the EPiMAP study?. If yes => Please provide their contact details a. name of hospital... b. name of contact... c. email address... Thank you for participating in this questionnaire. Your participation is greatly appreciated. Page 6 of 7