SMFM Global Health Committee Abstract Mentorship Program Survey

1.Contact Information(Required.)

Email Address:

Family/Last Name

Given/First Name

2.SMFM Membership Status(Required.)

Regular (board-certified MFM)

Associate (MD/DO without MFM training or PhD/MS in related fields)

Associate - Fellow (MFM Fellows)

Not an SMFM member

Other (please specify)

3.Institution Name:(Required.)

4.Institution Country(Required.)

5.Home Country(Required.)

6.Telephone/WhatsApp Number with country/area code(Required.)

7.Study Design: RCT – Primary Analyses being presented are required to include the trial registration. If a trial is not registered, it will not be considered for acceptance.

8.If you selected RCT Primary Analysis above, please provide the NCT Registration Number or "N/A" if you did not select RCT Primary Analysis above.

9.Category: To ensure that your abstract receives proper scientific consideration, indicate the appropriate category. Dropdown choices for Category Field with their corresponding Indexing Category dropdown choices in parentheses:

Clinical Obstetrics (Cesarean delivery, Cervical insufficiency, Hypertensive disorders of pregnancy, Labor and labor management, Multiple gestation, Obstetric anesthesia, Obstetric hemorrhage (antenatal or postpartum), Operative vaginal delivery, Preterm birth, Pregnancy termination, Prenatal care including antenatal surveillance, Recurrent pregnancy loss, Stillbirth, Uterine anomalies, Other)

Genetics and Teratology (Gene therapy, Genetic screening, Genetic testing, Teratology and environmental exposures, Other)

Health Policy and Economics (Abortion regulations and restrictions, Healthcare efficiency, Healthcare insurance, Healthcare reform, Other)

Medical Complications of Pregnancy (Cancer, Cardiac disease, Chronic hypertension, Critical care, Diabetes, Endocrinologic disease (other than diabetes), Gastroenterological disease, Hematologic disease, Immunologic disease, Infectious diseases, Maternal congenital heart disease, Musculoskeletal disease, Neurologic disease, Psychiatric disease/maternal mental health, Pulmonary disease, Renal disease, Rheumatologic disease, Substance use disorder, Other)

Neonatology and Pediatrics (Complications of prematurity, Hypoxic ischemic encephalopathy, Longterm pediatric follow-up, Other)

Obstetric Imaging and Fetal Intervention (Fetal anomalies, Fetal echocardiography, Fetal growth, Fetal medical therapy, Fetal MRI, Fetal surgical therapy (other than laser), Isoimmunization/alloimmunization, Laser therapy, Maternal imaging, Ultrasound techniques, Other)

Placental Abnormalities (Placenta accreta, Placenta previa, Placental abruption, Placental pathology, Other)

Practice Management (Billing and coding, Human resources management, Medical practice efficiency and operations, Physician compensation, Other)

10.Please submit your abstract in Microsoft Word (.doc) or Adobe Acrobat PDF (.pdf) format(Required.)

No file chosen