RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE
AND ADDRESS (IN BLOCK LETTERS) / Dr. RANGANATH S. VAIDYA
POST-GRADUATE IN OBSTETRICS AND GYNAECOLOGY
CHELUVAMBA HOSPITAL
MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE,
MYSORE
2. / NAME OF THE INSTITUTION / MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE,
MYSORE
3. / COURSE OF STUDY AND SUBJECT / M.S.
(OBSTETRICS AND GYNAECOLOGY)
4. / DATE OF ADMISSION TO COURSE / 24th May 2007
5. / TITLE OF TOPIC / “FETOMATERNAL OUTCOME IN POSTDATED PREGNANCY”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 Need for the Study

Last menstrual period and early ultrasound is the best landmark to assess the gestational period in pregnancy. However a few women are sure to their dates and often cause anxiety when they come with postdated period. A post-term or prolonged pregnancy is the one which extends to or beyond 42 weeks or 294 days from the first day of the last menstrual period with incidence of 5 to 10%.

Postdated pregnancy always posses a high risk, as there is a possibility of fetal distress and fetal death due to progressive fetal hypoxia following placental insufficiency.

Maternal risks due to postterm pregnancy includes labour dystocia, increase in severe perineal injury due to macrosomia, doubling in the rate of caesarean delivery and cause anxiety.

Postdated pregnancy remains an unresolved clinical problem with the threat of medicolegal consequences in cases of unfavourable outcome.

Management of pregnancy beyond 40 weeks gestation relies on an accurate assessment of the gestational age.

So, the need for the present study are to find out the maternal and fetal risk associated with pregnancy beyond expected date of delivery.

6.2 Review of Literature

1.  In 2007, Chhabra S, Dargan R, Nasare M1 in their study of “Postdate pregnancies: Management options” concluded that in women with postdated pregnancy an individualised approach with induction of labour when necessary is the proper line of management.1

2.  In 2005, Donald Briscoe2 in his article of “Management of pregnancies beyond 40 weeks gestation”, concluded that the number of pregnancies considered post-term will be decreased when early USG dating is performed. Maternal and fetal risks increase with gestational age, but the management otherwise in low risk prolonged pregnancies is controversial. There will be reduction in rate of cesarean section and possibly neonatal mortality with policy of routine induction at 41 weeks gestation.

3.  In 2004, Neff MJ3 in his article “ACOG releases guidelines on management of post-term pregnancy” states that most cases of post-term pregnancies results from prolongation of gestation. Other cases due to inability to correctly define EDD. The adverse sequele can be reduced by making accurate gestational age and diagnosis of post-term gestation as well as recognition and management of risk factors. Antenatal surveillance and induction of labour are the two strategies that may decrease the adverse fetal outcome.

4.  In 2003, Olesen AW, Westergaard TG, Olesen J4 in their study of “Perinatal and maternal complications related to post-term delivery: A national register-based study 1978-1993” concluded that post-term delivery was associated with significantly increased risks of perinatal and maternal complications like meconium aspiration, asphyxia before, during and after delivery. There was a significantly increased risk of obstetric complications, such as postpartum hemorrhage, cephalopelvic disproportion, cervical rupture, dystocia, fetal death during delivery, cesarean section, and puerperal infection.

5.  Post-term pregnancy is one that extended to or beyond 42 weeks completion and patient with unfavourable cervix can either undergo induction or managed expectantly. It is reasonable to initiate antenatal surveillance between 41-42 weeks of gestation despite lack of evidences it improves the outcome. No single method has been recommended as superior in making of fetomaternal outcome.5

6.  Prolonged pregnancy has uncertain definition and uncertain pathophysiology. More basic research into the pathophysiology is needed if prolonged pregnancy taken as more than 41 weeks about one quarter will be prolonged pregnancy, it will be decreased to 11% if it taken as more than 42 weeks. Meta analysis of randomized control trial in induction of labour for prolonged pregnancy shows that decrease in the perinatal mortality and cesarean section, but randomized control trial (RCT) are clinically so variable that conclusions cannot be justified. But observation data that routine induction for prolonged pregnancies increases cesarean deliveries and great chances of vaginal delivery.6

6.3 Objectives of the Study

1.  To study the situational analysis of postdated pregnancy.

2.  To study the maternal outcome in pregnancies beyond expected date of delivery (EDD).

3.  To know the fetal morbidity and mortality.

7. MATERIALS AND METHODS

7.1 Source of Data

The postdated pregnancies admitted to Cheluvamba Hospital from November 2007 to May 2009.

7.2 Method of Collection of Data

Sample size: A minimum of 200 cases.

Sampling method: Simple random sampling.

The data will be collected using a piloted proforma meeting the objectives of the study by means of personal interview with the patients after taking informed consent. The data will be collected from the aforementioned sources using the following inclusion and exclusion criteria.

Inclusion Criteria

(i)  Lady with regular menstrual cycles and known LMP.

(ii)  Singleton pregnancy with vertex presentation.

(iii)  Gestational age beyond 40 weeks of pregnancy upto 44 weeks.

Exclusion Criteria

(i)  Gestational age > 44 weeks

(ii)  Previous cesarean section cases

(iii)  High risk pregnancies like diabetes, antepartum haemorrhage (APH), premature rupture of membranes (PROM) and pregnancy induced hypertension (PIH)

(iv)  Congenital anomalies

Statistical method used: Chi-square test.

7.3 Does the study requires any investigation or intervention to be conducted on

patients or humans or animals ? If so, please describe briefly.

Blood and urine investigations

USG

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

Yes (copy enclosed)

8. REFERENCES

  1. Chhabra S, Dargan R, Nasare M. Postdated pregnancies: Management options. Journal of Obstetrics and Gynaecology India 2007;57(4):307-10.
  2. Briscoe D. Management of pregnancy beyond 40 weeks gestation. American Family Physician; 2005 May 15. pp. 1-8. (http://findarticles.com/p/articles/ mi_m3225/is_10_71/ai_n13795619/print)
  3. Neff MJJ. ACOG releases guidelines on management of post-term pregnancy. American Family Physician; 2004 Dec 1. pp. 1-3. (http://findarticles.com/p/ articles/mi_m3225/is_11_70/ai_n8570506/print)
  4. Olesen AW,Westergaard JG, Olesen J. Perinatal and maternal complications related to post-term delivery; a national register based study. Am Journal Obst Gynecology 1978-1993;189:222-7.
  5. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Larry CG III, Wenstrom KD. Post-term pregnancy. 22nd ed. In: William’s Obstetrics. New York: McGraw-Hill Companies; 2005. pp. 881-92.
  6. Grant JM. Prolonged pregnancy. 3rd ed. In: James DK, Steer PT, Weiner CP, Gonik B, High risk pregnancy management options; New Delhi: Elsevier. pp. 1376-82.
  7. Karande VC, Deshmukh MA, Virkud AA. Management of post-term pregnancy. J Postgraduate Medicine 1985;31:98-101.
  8. Sanchez-Ramos L, Oliver F, Delke I, Kaunitz AM. Labour induction versus expectant management for post-term pregnancies: a systemic review with meta-analysis. Obstet Gynecology 2003;101:1312-8.

9. SIGNATURE OF CANDIDATE

[Dr. RANGANATH S. VAIDYA]

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION OF (in block letters)

11.1 Guide : Dr. S. RADHAMANI,M.S.

PROFESSOR

DEPARTMENT OF OBSTETRICS

AND GYNAECOLOGY

CHELUVAMBA HOSPITAL

MYSORE MEDICAL COLLEGE

AND RESEARCH INSTITUTE

MYSORE

11.2 Signature :

11.3 Head of the Department : Dr. H.C. LOKESHCHANDRA,M.S.

PROFESSOR AND HEAD

DEPARTMENT OF OBSTETRICS

AND GYNAECOLOGY

CHELUVAMBA HOSPITAL

MYSORE MEDICAL COLLEGE

AND RESEARCH INSTITUTE

MYSORE

11.4 Signature :

12. 12.1 Remarks of the :

Dean and Director

12.2 Signature :

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ETHICAL COMMITTEE CLEARANCE

1. / TITLE OF DISSERTATION / : / “FETOMATERNAL OUTCOME IN POSTDATED PREGNANCY”
2. / NAME OF THE CANDIDATE / : / Dr. RANGANATH S. VAIDYA
3. / NAME OF THE GUIDE / : /

Dr. S. RADHAMANI,M.S.

PROFESSOR
DEPARTMENT OF OBSTETRICS
AND GYNAECOLOGY
CHELUVAMBA HOSPITAL
MYSORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE
MYSORE
4. / APPROVED/NOT APPROVED / :

SUPERINTENDENT SUPERINTENDENT

K.R. Hospital Cheluvamba Hospital

Mysore Mysore

PROFESSOR & HOD PROFESSOR AND HOD

Department of Medicine Department of Surgery

Mysore Medical College Mysore Medical College

and Research Institute and Research Institute

Mysore Mysore

SUPERINTENDENT LAW EXPERT

PKTB Hospital

Mysore

DEAN AND DIRECTOR

Mysore Medical College and Research Institute, Mysore

From

Dr. Ranganath S. Vaidya

Post-Graduate in Obstetrics and Gynaecology

Department of Obstetrics and Gynaecology

Mysore Medical College and Research Institute

Mysore

To

Registrar (Evaluation)

Rajiv Gandhi University of Health Sciences

Bangalore

THROUGH PROPER CHANNEL

Respected Sir,

Subject: Submission of Synopsis titled “Fetomaternal Outcome

in Postdated Pregnancy”

I am hereby submitting the above titled synopsis (4 copies) as mentioned above, so kindly accept my application and do the needful.

Thanking you,

Yours faithfully,

(Dr. RANGANATH S. VAIDYA)

Forwarded to Dean and Director, MMC & RI, Mysore for further needful action.

PROFESSOR AND HEAD

Date : Department of Obstetrics and Gynaecology

Mysore Medical College and

Place: Mysore Research Institute

Mysore

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