Rajiv Gandhi University of Health
Sciences Bangalore, Karnataka
Synopsis Profoma for Registration of
subjects for dissertation
1. Name of the Candidate : Miss S. Lylin
And Address 1 year Msc. Nursing
Gold Finch College of Nursing
Kodigehalli Main Road,
Maruthinagar,
Bangalore.
2. Name of the Institution : Gold Finch College of Nursing
3. Course of Study and Subject : I year M Sc Nursing obstetrics and Gynaecological Nursing.
4. Date of Admission of Course : 10-07-2008
5. Title of the Topic : A Study to Assess the Relationship Between the Placental Characteristics with selected new born characteristic in KCG Hospital at Bangalore.
6. INTRODUCTION
“Babies are an heritage of the Lord, and
the fruit of the Womb is his reward.” - Psalm. 127:3
Child Birth is an intense and exhausting physiologic and emotional experience for mother’s and new born. As a nurse those who are working in the labor room their responsibility to examine the placenta and for any abnormality, and new born for any distress and congenital deformity.1
A well developed healthy placenta ensures to a large extend a healthy fetus “behind every healthy baby is a healthy placenta” 9
Placenta the wonderful organ developed as a part of conceptus is unique for its multiplicity of functions in spite of simplicity in structure and brevity of life span. It grows along with the fetus to maintain adequate channels of oxygen, nutrition’s and protects fetus from noxious agent. 13
Placenta is the organ of metabolic interchange between the factors and the mothers. The human placenta at term averages 1/6 -1/4 the weight of the fetus. It is an disc shaped, spongy structure having a diameter of about 185mm. it is thickest in the centre with a maximum thickness of about 25mm and this diminishes towards the periphery which is the thinnest.2
The average term newborn at birth weight about 3000-3600g depending upon race. 17
The most profound physiologic change required of the newborn is transition from fetal or placental circulation to independent respiration. The loss of the placental connection means the loss of complete metabolic support, the most important and essential function being the supply of oxygen and the removal of co2. 4
6.1 NEED FOR THE STUDY
Every problem in human life having a quest for an answer until it is resolved reiterates a “Need for Study” to find a solution to solve the problem.3
In India there was only less number of literature available on placental and newborn characteristics. Hence the researcher were motivated to select the problem for investigation to identify newborn placental characteristics for the theoretical educational purpose and reduce mortality and morbidity rate. 11
The sample registration survey 1997 has recorded the following: for MMR 1,00,000 live births. In India 408 around 1 in 37 maternal/ deaths. States with MMR >400 are Up=707. Rajesthan=667 MP=498 Assam=491 Bihar=451. States with MMM around 200 Kerala, Punjab and Karnataka have similar figure f 195. States with MMR < 100 Gujarath 29 Tamilnadu=76.
Indian council medical researches (KM) 2001 date from 11 states -10 districts gave prevalence of maternal anemia of 84.9%
Nutrition foundation of India (NH) 2002-2003. 7 states survey showed pregnancy anemia 86.1%
Fetal growth retardation in later life (with small /large placenta) is known to be associated with H7, coronary heart disease, DM . 5
The national neonatology journal of India has defined perinatal asphyxia as an Apgar score of less than 7 at one minute after birth (UCMS and G7BH Delhi) the incidence of perinatal asphyxia was 5.1% in babies born without meconium stained liquor. Among meconium stained babies the incidence was 39.1%. 5
A malformation is an defect of embryogenesis. It occurs due to error in normal development and differentiation. All malformations are the congenital 14% newborns have a single minor malformation & 0.7% multiple malformations.5
There is diagnostic, prognostic investigative educational and legal reason for examining the placenta. The placenta should be examined for maternal abnormalities like substance abuse, maternal anemia, hypertension, Diabetes Mellitus. Fetal diseases such as still birth, fetal growth retardation, meconium in amniotic fluid etc. Severe maternal anemia may lead to historical and vascular changes in the placenta such as placentomegaly and fetal growth restriction & increased risk of H7 in childhood and adult life.14
An increase in thickness of the placenta may be a normal pregnancy findings chronic infection has also been reported as a case of thickening of placenta so the examination of the placenta, and newborn characteristics is an important responsibility of the attendant midwives.16
6.2 REVIEW OF LITERATURE
1. N. Kabir et. al. (2007) 8 conducted a study on relationship of placental weight with birth weight to assess the relationship between placental weight and birth weight, 246 pregnant mothers, who were otherwise healthy, were prospectively followed in a city hospital during antenatal period until delivery and immediate post-partum period. Placental weight and birth weight of babies were measured by one of the authors immediately after delivery by a weighing scale. It was observed that a very strong co-relation existed between placental weight and birth weight (r=0.391, p<0.001). Even this co-relation was stronger in small for gestational age babies. Increment of birth weight occurs with increase of placental weight.
2. Langley - Evans et al 2003 10 conducted a experimental study on relationship between maternal placental weight with newborn weight. The study was conducted in District General Hospital in the east Midlands of England. 300 women’s were recruited from an antenatal ultrasound dating scan clinic. Birth weight and infant head circumference at birth related to the placental weight. Thinness at birth was associated with low contribution of carbohydrate to dietary energy (p=0.036). The present study shows that maternal nutrition exert a strong influence upon fetal growth. These data suggest that association between low weight, thinness or greater head circumference at birth and disease in later life attributable to the effects of maternal under nutrition.
3. Karger, et. al., (2001) 9 conducted study to determine the relationship between the placental weight to birth ratio with maternal prepregnancy weight gestational weight gain, and neonatal out come in Australia (450) non – diabetic pregnancies resulting in appropriate for gestation age infants. Their findings suggest that a high placental ratio can identify AGA newborns who are disproportionately small relative to maternal size and may reflect some from of fetal growth impairment.
4. Drs. Olivar.C. Casterions et. al., (2000) 12 Conducted a co-relational study to assess the foetal and placental weight with their parameter on 3rd trimester from middle class. It was reported that there is a significant high variability in birth weight, placental weight, cord length and foetal placental index without differences statistic significant related with fetal sex. It was concluded that, there is direct positive of relationship between cord length and placental weight, or birth weight & placental weight and this later with mothers age or gestational age.
5. Bazaz .G. et. al., (1999) 6 conducted a study on under nutrition and toxemia of pregnancy are considered to be important maternal causes for the fact that 15-30% of infants born at term in India are “small for date”. Placenta was studied in 100 term parturient admitted to the labour ward of the lady Hardinge medical college and hospital in New Delhi, India. The placental histology is found in toxemia of pregnancy and the same is true in cases of unexplained intrauterine growth retardation. Decrease in size and weight of placenta in the IUGR group. Mean diameter was 15.3 cm compared to 17.54 in control cases, mean weight was 288.0 gms compared to 466.8 in control cases.
6. K.M.Godfrey, et. al., (1989), 7 conducted a study on “Effect of early maternal iron stores on placental weight and structure” among 350 mothers in USA. K.M. Godfrey reported that large placental weight was associated with low maternal hemoglobin and fall in maternal RBC during pregnancy.
7. Ryu HS, et., al., (1996) 15 conducted a study on low-birth-weight among the new-born infants in hospitals, Korea. This paper reviews 30 articles published between 1955 and 1986 on the incidence, mortality, and causes of death for premature and low birth weight infants in Korea. Prematurity is caused by premature rupture of the membranes, preeclampsia, toxemia, and abnormal placenta and that low birth weight is caused by toxemia, twin pregnancies, premature rupture of the membranes, and abnormal placenta.
8. Meyberg R, et., al., (2000) 11 conducted a study on perinatal mortality and postnatal morbidity among 50 samples in Mysore. The objectives of the study intrauterine growth retardation (IUGR) contributes specially to perinatal mortality and morbidity. Placental site the most noticeable conditions have been placental insufficiency (40.6%) and placental infarction (28.7%). The Study concluded that Children with IUGR are exposed to high perinatal mortality and postnatal morbidity. Premature babies in association with an IUGR are at high risk. The surveillance of the pregnant women and the new-born children should be performed in a perinatal centre.
6.3 STATEMENT OF THE PROBLEM
A study to assess the relationship between the placental characteristics with selected newborn characteristics at KCG Hospital, Bangalore.
OBJECTIVES
· To assess the placental characteristics.
· To assess the newborn characteristics.
· To correlate the placental characteristics with newborn characteristics.
· To associate newborn characteristics with selected demographic variables.
· To associate placental characteristics with selected demographic variables.
6.4 OPERATIONAL DEFINITIONS :
· Placenta:
It is an special vital organ to exchange the materials from maternal to fetus Circulation for the growth and development of fetus.
· Newborn:
Baby born under normal vaginal delivery.
· Characteristics:
It is an special features like observation and measurements of the placenta and newborn.
6.5 HYPOTHESIS:
· H1: There will be significant co relation between the placental characteristics and newborn characteristics.
· H2: There will be a significant association between the placental characteristics with selected demographic variables.
· H3: There will be a significant association between the newborn characteristics with selected demographic variables.
7. MATERIAL AND METHODS:
This chapter explain the research methodology adapted to assess the relationship between placental characteristics and new born characteristic with selected demographic variable at KCG Hospital, Bangalore.
7.1 SOURCES OF DATA:
The population of the study comprises of term mothers who had undergone normal vaginal delivery at KCG Hospital, Bangalore.
7.2 METHODS OF DATA COLLECTION:
The study will be conducted in bangalore from 15-12-08 to 17-01-09 per schedule permission to be obtain from medical director and nursing supervisor to labour room staffs. Term mother who met in inclusive criteria are selected by use in convenient sampling technique the timing of data collection is 7.00 a.m to 6.p.m. The duration of examining the placenta and newborn in 15 to 20 mins.
7.2.1 TYPES OF STUDY:
In view of the nature of the problem and to accomplish objective of the study a descriptive approach.
7.2.2 RESEARCH DESIGN:
Co relational design
7.2.3 VARIABLES UNDER STUDY:
Independent- Placental characteristics.
Dependent- New born characteristics.
7.2.4 SAMPLING TECHNIQUES:
Non probability convenient technique
7.2.5 SAMPLE SIZE:
50 Samples.
7.2.6 DURATION OF STUDY:
6 Weeks.
7.2.7 INCLUSION CRITERIA AND EXCLUSION CRITERIA:
Inclusion Criteria
Mothers with spontaneous normal vaginal delivery.
Mothers having complaints of disease like Diabetes Mellitus, Hypertension, Heart disease, Maternal abuse, Maternal anemia.
Exclusion Criteria
Mothers who are not willing to participate in the study.
Mothers with manual removal of the placenta.
7.2.8 INSTRUMENTS:
Observation
7.2.9 DATA COLLECTION PROCEDURE:
Permission to be obtain from medical director and nursing supervisor to labour room staffs. Term mother who met the inclusive criteria are selected by use in convenient sampling technique. The timing of Data collection is 7.00 am to 6 pm. The duration of examining the placenta 15 to 20 mins and newborn is 20 to 30 mins.
7.2.10 STATISTICAL METHOD USED
Descriptive
Frequency distribution
To describe the demographic variable
Inferential
Karl pearson correlation and coefficient.
To correlate the placental characteristics with new born characteristics.
Chi square Test
To find the association between placenta and newborn characteristics with selected demographic variables.
7.3 DOES STUDY REQUIRE ANY INVESTIGATION / INTERVENTION TO BE CONDUCTED ON PATIENTS / HUMAN / ANIMALS.
Non experimental.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM INSTITUTION.
The study is going to conduct after approval of the dissertation committee of gold finch college of nursing obtained from the selected hospitals after explaining the purpose of the study the written consent is obtained from each mothers of the study
8. BIBLIOGRAPHY
BOOKS :-
1. Bennet Ruth, & Brown, K. Linda (2000). Myles text book of midwifery. (13th ed). Churchill livingstone publications.
2. Lowdermilk A. (1999). Maternity nursing. (5th ed). London: Mosby publications.
3. Reeder, J.S. (1997). Maternity nursing family newborn and women’s health care. (8th ed). Philadelphia: Lippincott Company.
4. Wong’s (2007). Nursing care of infants and children: Philadelphia: Mosby publications.
5. Dr.K.N. Agarwal. (1999). All India institute of medical sciences. NewDelhi.
JOURNALS :-
6. Bazaz, G. (1979). Placenta in intrauterine growth retardation. Journal of obstetrics and gynecology in India, 29(4), 805-810.
7. Godfrey, K.M. (1989). Effect of early maternal iron stores on placental weight and structure. American journal of obstetrics & gynecology, 20(1), 100-105.
8. Kabir, M.L. (1999). Placenta & newborn weight. Journal of Anatomical society of India, 43(2), 180-188.
9. Karger, S. (2001). Biology of fetal and neonatal research. American Journal of Obstetric & Gynecology, 80(2), 108-110.
10. Langley, E. (2003). Relationship between placenta and newborn weight. Journal of the Royal Society for the promotion of health, 123(4), 210-216.
11. Meyberg, R. (2000). Perinatal mortality and morbidity. Journal of neonatology, 20496), 218-223.
12. Oliver, C.C. (2000).Co-relation of fetal & placental weight. Journal of obstetrics & gynecology, 60(3), 10-16.
13. Ramakrishna Raju, G. (1999). Importance of placenta. Journal of obstetrics and fetal medicine, 40(2), 23-27.
14. Reshetoninova, L. (1995). Placentomegaly and fetal growth restriction, 60(1), 100-105.
15. Ryu, H.S. (1986). Low birth weight infants in hospital. Journal of gynecology & obstetrics, 6(2), 131-149.