RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA,BANGALORE.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / DR.PRASANTHI SINGITHAM N.S
POST GRADUATE 1ST YEAR, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY,
PG WOMENS HOSTEL, ROOM NO.9,
NAVODAYA MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTRE, RAICHUR-584103.
2. /
NAME OF THE INSTITUTION
/ NAVODAYA MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTRE, RAICHUR-584103.
3. / COURSE OF THE STUDY AND SUBJECT / M.S OBSTETRICS AND GYNAECOLOGY,
3 YEARS.
4. / DATE OF ADMISSION TO COURSE / 15th April, 2011
5. /

TITLE OF THE TOPIC

/ CORRELATION OF ABNORMAL CARDIOTOCOGRAPHY AND ITS PERINATAL OUTCOME
6. / BRIEF RESUME OF INTENDED WORK :
6.1 Need for the study :
Pregnancy and childbirth is normal physiological process with great pathological potential. Most of the pregnancies progress normally but some pregnancies are more complex. The antenatal and intra-partum conditions place the mother, or the developing fetus or both at a higher risk for complications1. some instances can lead to adverse outcome resulting in immediate and late neonatal and maternal problems. The obstetricians are more concerned with the early recognition of fetal distress during labour in order to avoid such adverse outcomes. Such an adverse outcome should be detected at the earliest point of time by an effective surveillance method. Intermittent auscultation, continuous electronic fetal heart rate (FHR) monitoring and invasive techniques like fetal blood gas analysis are the available methods for such a surveillance2. Cardiotocography is most diffused, non invasive pre-natal diagnostic technique to monitor foetal health during labour.. The intermittent auscultation by cardiotocography helps in assessment of the Foetal heart rate to prevent the adverse pregnancy outcome3. The studies related to the use of cardiotocography in preventing the adverse outcome are scarce in India. So this study was undertaken with the aim to correlate abnormal cardiotocography and its perinatal outcome.
6.2 Review of Literature :
In a study by Sandhu et al2 in Bangalore, they screened about high risk obstetric patients at admission. They found that the test was normal in 67% of the patients, Equivocal in 23% of the patients and Abnormal in 10% of the patients. The rate of admission of the babies born to mothers with abnormal test was around 33% and most of them had Apgar score between 4 – 5. They have also shown that the positive predictive value of the CTG test to predict development of foetal distress was 73.3%, Predicting lower Apgar score was 53.3% and admission to NICU was 33.3%.
In a comparative study of normal and abnormal cardiotocography with pregnancy outcomes at Dhaka, Sultana et al4 have shown that there were significant differences between normal and abnormal groups especially in mode of delivery, indications of caesarean section, percentage requiring caesarean section for foetal distress, oligohydramnios, meconium stained liquor, small placenta and cord around the neck. Early neonatal outcome included apgar score, birth weight, admission into neonatal intensive care unit (NICU), duration of stay in NICU and perinatal mortality. They also concluded that CTG is an important test to assess the fetal condition during ante partum and intrapartum period.
In a study in Lahore, Noreen et al5 who studied two hundred women with abnormal CTG. Of them 68% had tachycardia, 76% had absent or reduced variability, 59% had decelerations and 29% had fetal bradycardia. Majority of the pregnant women with decelerations had most of the abnormal outcomes where 10% of the babies were admitted to NICU. Nine percent of the fetus developed complications like meconium aspiration syndrome, early onset sepsis and neonatal encephalopathy.
A study by Breuker et al6, where they studied 1,463 women and correlated it with their outcome of the delivery. They observed 50 suspect/prepathologic heart recordings. Fetuses born to pregnant women had birth weight less than 1500 grams in 30% of the cases, they also had poorer Apgar scores and umbilical artery pH values than neonates with normal ante partum cardiotocograms. They also concluded that recognition of abnormal CTG characteristics requires technically adequate recording and accurate analysis.
6.3 Objectives of Study:
1.  To study the cardiotocographic pattern during labour in all pregnant women and correlate it with pregnancy outcome.
2.  To correlate abnormal cardiotocographic pattern with its pregnancy outcome.
3.  To compare the perinatal outcome of normal and abnormal cardiotocography
7. / MATERIALS AND METHODS :
7.1 Source of Data :
The study includes 500 pregnant women admitted for labour attending Department of Obstetrics and Gynecology, at Navodaya Hospital, Raichur.
7.2 Method of Collection of Data :
All the patients admitted for labour in this hospital will be observed after obtaining consent with full explanation of benefits during the study. These cases are followed up during labour and for perinatal outcome after labour. The data will be collected in predesigned and pre tested proforma from 500 patients. Equal number of cases with normal CTG will be taken as control in order to compare the perinatal outcome of normal and abnormal CTG.
Study Design : Prospective study.
Study Period : one year
Inclusion Criteria :
1.  All pregnant women admitted for delivery irrespective of gravidity and parity .
2.  Cases with previous history of caesarean section, Instrumental vaginal Delivery, and delivery of abnormal presentation are included.
3.  Previous caesarean section considered for vaginal delivery.
Exclusion Criteria :
1.  Women with associated medical disorders of pregnancy ( heart disease, liver disorders, renal disease)
2.  Preterm deliveries
3.  Those with premature rupture of membranes , multiple pregnancy , severe pregnancy induced hypertension.
4.  Cases decided for caesarean section immediately after admission.
7.3 Does the study require any investigations or intervention to be conducted on patients or other humans or animals? If so, please describe briefly.
The study will use Cardiotocography, which is a simple, non invasive procedure to monitor the fetal heart rate and uterine contractions simultaneously. The machine is known as cardiotocograph, commonly called as electronic fetal monitor (EFM). Simultaneous recording of fetal heart rate and uterine contractions is done by placing two external transducers on maternal abdomen. One over the fundus and the other at the site where FHS is best heard. The intrauterine pressure is recorded by a pressure transducer (toco). The numbers are represented on a time scale of 20 minutes with the help of a running piece of paper, producing graphical representation. If no changes, it is extended for 10 more minutes. Acceleration is a visually apparent abrupt increase in FHR. Visually apparent, symmetrical, gradual decrease and return of FHR associated with uterine contraction is called deceleration. The CTG is said to be abnormal when there is absence of baseline variability with recurrent late or variable decelerations or bradycardia.
7.4 Has ethical clearance been obtained from your institution in case of 7.3
Yes,ethical clearance has been obtained from the institution.
8. / LIST OF REFERENCES :
1.  Haws RA, Yakoob MY, Soomro T, Menezes EV, Darmstadt GL, Bhutta ZA, ‘‘Reducing stillbirths: screening and monitoring during pregnancy and labour” BMC Pregnancy and Childbirth 2009, 9 (Suppl 1):S5 doi:10.1186/1471-2393-9-S1-S5.
2.  Sandhu, VSM, Raju R, Bhattacharyya TK, Shaktivardhan, ‘‘Admission Cardiotocography Screening of High Risk Obstetric Patients” MJAFI 2008; 64 : 43-45.
3.  Cesarelli M, Romano M, Bifulco P, Fedele F, Bracale M, ‘‘An algorithm for the recovery of fetal heart rate series from CTG data” Computers in Biology and Medicine 2007; 37 : 663 – 669.
4.  Sultana J,Chowdhury TA,Begum K,Khan MH, ‘‘Comparison of normal and abnormal cardiotocography with pregnancy outcomes and early neonatal outcomes” Mymensingh Med J 2009 jan,18( Suppl 1):S103-107.
5.  Noreen R, Saleem ST, Zaman MF, Saleem T, ‘‘Fetal out come in Caesarean Section after Abnormal Cardiotocography” Med. Forum, August 2010, 21( 8).
6.  Breuker KH,Kusche M, Muller U,Bolte A, ‘‘The importance of antepartum cardiotocography” Journal of Perinatal Medicine1986, 14:(3);171-179.
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12. / signature of candidate
Remarks of the Guide
Name and Designation of
11.1 Guide
11.2 Signature
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 Head of Department
11.6 Signature
12.1 Remarks of Chairman and Principal
12.2 Signature / Recommended and forwarded.
DR.K.V. GANESH RAO,
PROFESSOR AND UNIT CHIEF,
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY,
NAVODAYA MEDICAL COLLEGE,
RAICHUR-584103.
DR.SHEELA. M. KODLIWADMATH,
PROFESSOR AND H.O.D,
DEPT OF OBSTETRICS AND GYNAECOLOGY,
NAVODAYA MEDICAL COLLEGE, RAICHUR-584103.