Department of Obstetrics

SYNOPSIS

DISSERTATION

DR. SRIVIDYA.T.V.

DEPARTMENT OF OBSTETRICS

AND GYNAECOLOGY

SREESIDDHARTHAMEDICALCOLLEGE

TUMKUR

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE,
KARNATAKA, BANGALORE.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1. / NAME OF THE
CANDIDATE
& ADDRESS / Dr. SRIVIDYA.T.V.
# 59, SRI-NIVAS, 4THMAIN ROAD,
MATHIKERE, EXTENTION.
BANGALORE-560 054.
2. / NAME OF THE
INSTITUTION / SREESIDDHARTHAMEDICALCOLLEGE & r RESEARCH CENTRE.
AGALAKOTE. TUMKUR.
3. / COURSE OF THE STUDY
AND SUBJECT / M.S. IN OBSTETRICS AND GYNEACOLOGY
4. / DATE OF ADMISSION
OF COURSE / 31 – 05 – 2007.
5. / TITLE OF THE TOPIC / "STUDY OF THE OUTCOME OF OBSTETRIC EMERGENCIES OF REFERRAL CASES IN TERTIARYCENTER".

6.BRIEF RESUME OF THE STUDY.

6.1 Need for the Study.

OBSTETRICAL EMERGENCIES are life threatening medical conditions that

occur in pregnancy or during or after labour & delivery.They are significant

causes of maternal as well as foetal morbidity & mortality.

There are a number of illnesses and disorders of pregnancy that can threaten the well

being of both mother and child. It is commonly agreed that approximately 15% of all

pregnant women will develop serious complications. The major complications that may

occur are hemorrhage, sepsis, obstructed labour and hypertensive disorder.

Early recognition of these complications among emergency obstetric referrals

followed by prompt & appropriate management may reduce perinataldeaths &

alsoimprove maternal outcome. On the contrary delay in recognizing the problem, delay

in seeking care, delay in reaching care and delay in receiving care will have adverse

outcomes.

SREESIDDHARTHAMEDICALCOLLEGEHOSPITAL is a tertiary centre. A

majority of cases that we get are referred cases,amajor bulk of these being

Obstetric emergencies.

Our aim is to improve the managementskills in these high risk situations &

optimize the outcome by reducing mortality and morbidity.

Obstetric Emergencies Included in this Study are as follows.

Eclampsia and Severe PIH.

Ante partum Hemorrhage
Abruption.
Placenta Praevia.

Obstructed Labour.

Ruptured Uterus.

Uterine Inversion.

Post Partum Hemorrhage.

Others if any.

6.2 Review of Literature.

Mr. K.B.Rao Etal did a 3 year collaborative study estimating maternal mortality

rates from 41 Hospitals affiliated with teachingcenters in India. Maternal

mortality was found to be 721 / 100000 of live births. The cause of maternal

deaths was anemia in 25% cases, 75% of cases ewreaccounted for by Eclampsia,

Sepsis, Hemorrhage and Abortions. They found out that

maternal care is an important factor in reducing mortality & morbidity.

Obi SN, OzumbaBC, Okaeo JM, conducted a study at a Universityteaching

hospital Nigeria. The objective of the study was to identify factors that caused

an increase in maternal mortality in cases of unbooked Obstetric emergencies.

They came to a conclusion that lack ofbasic education & poverty are the major

identifiablerisk factors. Improving health care facilities, female education, regular

training course for medical personnel & elimination of quacks are advocated.

Bailey P, PaxtonA did a study to study the frequency with which a set of life

savinginterventionsorsignal functions were performed to treat major Obstetric

implications. Thebasic signal functions include ParenteralAntibiotics,

Anticonvulsants & Oxytocics & the procedure of manual removal of placenta,

removal of retained uterine products & assisted vaginal delivery.

4. Mr. Rajaram. P. has found from his studies that the quality of a society can be

measured by the delivery of health care and by child survival. India has been

successful at industrialization and establishment of a fine infrastructure for

health caredelivery, yethealth service delivery is poor and infant mortality and

morbidity ishigh. Poor pregnancy outcomes are related to maternal

health andhealth care. Fewer than 33% of pregnantwomen receive any

prenatal care and fewer than 20% receive trained assistance during delivery.

social customs that denigrate women are common. Feminism has not affected the

masses of women in India, where hatred of the femalegender still exists.

Gessessew A has conducted a study at Mekele College of Health science,Ethiopia which

showed that maternal mortality ratio in developing countries is very high. The frequency

of severe maternal morbidity is high and is associated with high case fatality ratio, which

indicates the need of improvement in the quality of obstetric care to prevent maternal

complications.

6.3 Objectives of the Study.

To study the impact of societal factors such as illiteracy malnutrition, early

marriages, poorly supervised pregnancies, lack of transportation & socio

economicstatus.

To study the maternal & fetal outcome in the cases of Obstetric emergencies.

To carry out in depth analysis of the various emergencies & work out how best

they can be solved.

Materials & Methods

7.1Source of Data

The study is a hospital based prospective study & will include all the cases of Obstetric

emergencies that are referred to Sree Siddhartha Medical College Hospital Tumkur,

during the Period of Sep 2007 to Aug 2008. Clinical examination, laboratory

investigationsspecial investigations if any included.

7.2Method of Collection of Data.

1.All cases of referred Obstetric emergencies admitted to Sree Siddhartha

Medical College Hospital Tumkur as per inclusion and exclusion criteria.

2. A detailed history, complete physical examination & routine investigation will

be done for all patients.

A. Inclusion Criteria.

All cases of referred Obstetric emergencies

B. Exclusion Criteria

Obstetric emergencies below 28 weeks of gestation.

Any case with associated surgical and medical complications.

7.3Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so describe briefly.

Yes, on pregnant women presenting with Obstetric emergencies.

The List of Investigations are:

Hemoglobin %

Blood Group & Rh

Urine albumin, Micro & Sugar.

Bleeding time & Clotting time

Blood urea, Serum creatinine & Serum uric acid.

Liver function test

Blood platelet count

HIV / VDRL / HBsAg

USGWhen required.

7.4. Has ethical clearance been obtained from your institution in case of 7.3?

YES / NO.

References.

Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group Essay Author is Paula Anne Ford-Martin.

Rao K.B. How safe motherhood in India is. J Indian Medical

Association 1995Feb. 93 (2): 41-2.

Obi SN, Ozumba BC, Okaeo JM. Emergency obstetric referrals at a university teaching hospital, Nigeria.East Africa Medical Journal 2001 May. 78 (5): 262-4.

Bailey P, Paxton A, Lobis S, Fry D. The Availability of Life Saving

Obstetric Services inDevelopingCountries. International Journal Gynecology Obstetric2006 Jun. 93(3): 285-91.

5. Child Survival: maternal factors. Indian Journal Maternity Child

Health 1990 April-June;1(2):39-45.

6. Gessessew A Maternal complications in a zonal hospital.Ethiopian

Med J. 2007 Jan; 45 (1): 47-54.

7. Chamberlain, Geoffrey & Philip Steer ‘Obstetric Emergencies’. BMJ

1999 May; 318 1342-1345

8. Pearl Man, Mark D & Judith ‘Emergency care of Women.

9. Effective referrals for Obstetrics emergencies.

9. / Signature of the Candidate
10. / Remarks of the Guides / 1. Our healthcare facilities are widespread
and every attempt is made to reach rural and rema
remote parts of the country with greater
emphasis on the “Safe Motherhood
Initiative”.Inspite of this there appears to be
some lacunae in delivering healthcare to the
pregnant women of rural population and still
large number of cases are referred late in
pregnancy/labour for treatment at a tertiary
centre.Hence this study has been taken up
to know the profile of case references with
regard to pregnancy outcome among these
referred cases and to consider strategies
improve health care delivery to pregnant
women.
11. / Name & Designation of the Guide / Dr. Ganesh Rao K.V.
Prof. of Obstetrics & Gynecology
Dept ofObstetrics & Gynecology
Sree Siddhartha medical College &
Research Centre
Tumkur.
12. / Signature of the Guide
13 / Head of the Department / Dr. K.S.Shakuntala Devi.
Prof. and HOD
Dept of Obstetrics and Gynecology,
SreeSiddharthaMedicalCollege
ResearchCentre
Tumkur.
14. / Signature of the HOD.
15. / Remarks of the Principal & the
Chairman
16. / Remarks of the Principal & the
Chairman

Sree Siddhartha Institute of post GraduationHospital and Research Centre

Agalkote, B.H.Road, Tumkur – 572101

(Recognized by the Medical Council of India and Affiliated to BangaloreUniversity / R.G.U.H.S)

Ph: 0816-278867 Fax: 0816-2752110.

______

Ref No. SSMC/PRI/ /2007-2008.

To,

The Registrar,

R.G.U.H.S.

Jayanagar, 4th Block,

Bangalore – 560 011.

Karnataka.

Respected Sir,.

Sub: Departmental Ethical Clearance.

************

With regard to subject mentioned above the dissertation subject titled

“STUDY OF THE OUTCOME OF OBSTETRIC EMERGENCIES OF

REFERRAL CASES IN TERTIARY CENTRE”is justifiable and has taken

ethical clearance from the department.

Thanking You,

Yours Faithfully,

Prof. & HOD

Department of Obstetric and Gynecology

SSMC, Tumkur.

Sree Siddhartha Institute of post GraduationHospital and Research Centre

Agalkote, B.H.Road, Tumkur – 572101

(Recognized by the Medical Council of India and Affiliated to BangaloreUniversity / R.G.U.H.S)

Ph: 0816-278867 Fax: 0816-2752110.

______

Ref No. SSMC/PRI/ /2007-2008.

To,

The Registrar,

R.G.U.H.S.

Jayanagar, 4th Block,

Bangalore – 560 011.

Karnataka.

Respected Sir,.

Sub: Departmental Ethical Clearance.

************

With regard to subject mentioned above the dissertation subject titled

“STUDY OF THE OUTCOME OF OBSTETRIC EMERGENCIES OF

REFERRAL CASES IN TERTIARY CENTRE”is justifiable and has taken

Ethical clearance from the Department.

Thanking You,

Yours Faithfully,

PRINCIPAL

SSMC, Tumkur.

PROFORMA

Name / IP No.
Age / Date of Admission
Address / Date of Discharge
Husband's Name / Booked / Unbooked
Socio Economic
Status / Educational Status
a. of the patient.
b. of the Husband

Referred From:

1. Primary Health Centre[]

2. Nursing Home[]

3. Midwife / Dai[]

4. Health Worker[]

5. Clinic[]

Place from which referred:______

Distance travelled:______

Time since reference:______

Direct reference / Second reference:______

2. H/O Amenorrhoea:______

Pain AbdomenYes / No______Hrs.

PV LeakYes / No______Hrs.

Bleeding PVYes / No______Hrs.

History ofConvulsionsYes / No ______Hrs.

Loss of Foetal MovementsYes / No______Hrs.

3. Obstetric History:

H/O Consanguinity:

Married Life:

Obstetric Score:

Details of Previous Deliveries:

4. Menstrual History:

Attainment of Menarche:

Last Menstrual Period:

Expected Date of Delivery:

Previous Menstrual Cycles:

5. Past History:

With special reference to

Tuberculosis/Asthma/DM/Epilepsy/Cardiac disease/Hypertension.

6. Family History:

7. Personal History:

Diet:

Appetite:

Sleep:

Bowel & Bladder:

Habits if any:

8. General Physical Examination:

Built / Height
Nutrition / Weight

9. Vitals:

Pallor:+ / -Pulse Rate:

Icterus:+ / -Blood Pressure:

Cyanosis:+ / -Respiratory Rate:

Clubbing:+ / -Temperature:

Edema:+ / -

Lymph Nodes + / -

Spine / Breasts / Thyroid.

10. Systemic Examination:

Cardiovascular System:

Respiratory System:

Central Nervous System:

11. per Abdomen:

Height of Uterus:

Abdominal Girth:

Uterus Acting:Yes / No

If yes Contraction / 10 Min.

Stretching of lower segment:Yes / No

Bladder Distention:Yes / No

Any other finding:Yes / No

Foetus:Lie

Presentation.

FHS

Uterus well contracted / retracted:Yes / No

(in cases of PPH).

12. per Speculum:

Leaking PV:+ / -

Bleeding PV:+ / -

13. per Vaginum:

Examination of External Genitilia:

Vulval condition:Edema / Injury

Vaginal tear:Yes / No

Cervix:Effacement / Dilatation

Membranes:+ / -

Liquor:

Station:

Pelvis:Adequate / CPD

14. Provisional Diagnosis:

15. Investigations:

HB %

Blood Group:

Urine:

RBS:

HIV:

HBsAg:

VDRL:

Others: Special Investigations depending upon individual cases.

USG:

1st Trimester

2nd Trimester

3rd Trimester

17. Management:

Medical:

(Antihypertensive, Mgso4, Blood transfusion)

Obstetric:

Mode of Delivery: Vaginal

Assisted

Forceps/Ventouse

Destructive Procedure

LSCS

Hysterectomy

18. Maternal Outcome:

19. Foetal Outcome:

20. Condition at discharge:

Sree Siddhartha Institute of post GraduationHospital and Research Centre

Agalkote, B.H.Road, Tumkur – 572101

(Recognized by the Medical Council of India and Affiliated to BangaloreUniversity / R.G.U.H.S)

Ph: 0816-278867 Fax: 0816-2752110.

______

Ref No. SSMC/PRI/ /2007-2008.

From,Tumkur

Date:

Dr: Srividya T.V. P.G. in M.S.OBG

SSMC

Tumkur.

To,

The Chairman,

Ethical Clearance Committee

SSMC,

Tumkur

Karnataka.

Respected Sir,.

Sub: Clearance from Ethical Committee.

************

With regard to subject mentioned above the dissertation subject titled

“STUDY OF THE OUTCOME OF OBSTETRIC EMERGENCIES OF

REFERRAL CASES IN TERTIARY CENTRE”is to be justified and has to be given

the ethical clearance from the department. I request you to kindly do the needful and

oblige.

Thanking You,

Yours Faithfully,

Dr. Srividya T.V.

From,Tumkur

Date:

Dr: Srividya T.V. P.G. in M.S.OBG

SSMC

Tumkur.

To,

The Chairman,

Ethical Clearance Committee

SSMC,

Tumkur

Karnataka.

Respected Sir,.

Sub: Clearance from Ethical Committee.

************

With regard to subject mentioned above the dissertation subject titled

“STUDY OF THE OUTCOME OF OBSTETRIC EMERGENCIES OF

REFERRAL CASES IN TERTIARY CENTRE”is to be justified and has to be given

the ethical clearance from thedepartment. I request you to kindly do the needful and

oblige.

Thanking You,

Yours Faithfully,

Dr. Srividya T.V.