RAJIV GANDHI UNIVERSITY OF HEALTH SCIUENCES

BANGALORE.KARNATAKA.

ANNEXURE II

SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1 / NAME OF THE CANDIDATE / Dr LAKSHMIDEVI. M.
AND ADRESS / PG STUDENT
DEPARTMENT OF OBSTETRICS
AND GYNECOLOGY
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE
BANGALORE-560002
2 / NAME OF THE INSTITUTION / BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE
BANGALORE-560002
3 / COURSE OF THE STUDY / M.S. IN OBSTETRICS AND
AND SUBJECT / GYNECOLOGY.
4 / DATE OF ADMISSION TO / 13-04-2007.
THE COURSE
5 / TITLE OF THE TOPIC / P ARTOGRAPHIC ANALYSIS OF THE
LABOUR IN PRIMIGRAVIDA AND
ACTIVE MANAGEMENT OF THIRD
S1' AGE OF LABOUR WITH
INTRMUSCULAR 10UNITS
OXYTOCIN.

6 BRIEF RESUME OFTHE INTENDED WORK:

6.1 NEED FOR THE STUDY:

  • Partogram is a valuable tool in the improvement of maternity care by allowing midwives and obstetricians to record intrapartum details graphically.
  • Partogram use is not affected by racial, cultural and socioeconomic differences and hence useful for universal application.

• WHO has introduced partogram both for developed and developing countries.

  • Partographic analysis of labour helps in early identification of any deviation from normal labour and active management of labour.
  • The use of partogram for the management of labour has shown to be beneficial in differentiating normal and abnormal progress of labour and identifies the women likely to require intervention.
  • Oxytocin induces strong rhythmic uterine contractions and promotes the separation of placenta from the upper segment and hence more physiological. It does not have any deleterious effect when administered in case of preecclampsia and undiagnosed twin pregnancy compared to ergometrine.
  • The need for this study is to know the effect of use of partogram for the management oflabour and active management of third stage with 10 units of oxytocin.

6.2 REVIEW OF LITERATURE:

  • Partogram was introduced by WHO for both developed and developing countries. Here labour is graphed and analysed using alert and action lines which helps in active management of labour.
  • Active phase abnormalities can be documented and easier to audit with the use of partogram which provides a graphic representation of the progress of cervical dilatation and descent as well as maternal and fetal vital parameters. 2
  • In a study (1955) 500 primigravid parturients with detailed, accurate, and complete records were analysed from solane hospital for women of Columbia Presbyterian medical center in Newyork city and concluded that partogram is helpful in early detection of deviations from the normal labour and helps in its management3.
  • Some authors have retrospectively analysed partograms of 500 parturient women in spontaneous labour at term with a singleton fetus with cephalic presentation and concluded that active management of labour using partogram helps in reducing the duration of first stage of the labour.4
  • In an article they have analysed the use of partogrm in preventing prolonged labour in developing countries and preventing its complications and concluded that partogram is useful in assessing progress of the labour and helps in active management of the labour. They also concluded that highly effective in reducing complications related to prolonged labour.5
  • In a study (1975) 1513 women were included and they have done a comparison study on use of oxytocin(506 women) and ergometrine(543 women) for the active management of third stage of labour and concluded that active management of third stage using oxytocin produces optimum uterotonic effect and reduces the incidences of postpartum hemorrhage and produces more physiological method of separation of placenta.6

  • In a study (2006) a total of 3607 women 1236 study group and 2371 control group were included, and analysed the use of 10 units of oxytocin intramuscularly for the active management of third stage of labour and concluded that use of oxytocin reduces the incidence of postpartum hemorrhage by reducing the duration of the third stage ~f the labour. 7
  • In a study(2003) they have analysed the effect of partogram use on outcomes for women with singleton pregnancy with spontaneous labor at term and concluded that use of partogram is helpful in preventing perinatal and maternal morbidity and mortality. 8

6.3 OBJECTIVES OF THE STUDY:

  • To study the use of Partogram in the analysis of spontaneous labour at term in primigravida with cephalic presentation .
  • To study the use of intramuscular 10units of oxytocin in the active management of third stage of labour.

7 MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

Present study will be carried out on 200 primigravidas with spontaneous labour at term with cephalic presentation in vani vilas hospital and Bowring and Lady curzon hospital Bangalore.

7.2 METHOD OF COLLECTION OF DATA:

Data will be collected from labour wards of vani vilas hospital and Bowring and Lady curzon hospital Bangalore.

Partogram is a single sheet of paper in which various events during labour can be represented graphically. It includes fallowing detail.

a) Patients details.

b)Time - zero time is when the cervix is 4 cm dilated.

c)Fetal heart rate half hourly.

d) State of membranes and colour of amniotic fluid.

I for intact membranes.

C for clear amniotic fluid.

M for meconium stained amniotic fluid. e) Cervical dilatation 4 hourly.

f ) Descent of the head 2 hourly.

g) Uterine contractions half hourly,

Dots for contractions lasting for 20 seconds.

Bars for contractions lasting for 20 to 40seconds.

Shaded area for contractions lasting for more than 40seconds.

Number of contractions will be marked on number of squares. h) Oxytocin infusion and drops per minute.

i)Drugs given and intra venous fluids.

j) Pulse rate every half hourly.

k) Blood pressure every 2 hourly.

1) Temperature every 2 hourly.

m) Urine output and test for proteins and acetone every 4 hourly.

7.3 INCLUSION CRITERIA:

Pimigravida with the spontaneous labour at term with cephalic presentation.

7.4 EXCLUSION CRITERIA:

  • Primigravida other than cephalic presentation .
  • Multigravida.

7.5Does the study any investigations or interventions to be conducted on the

patient or other animals? If so please describe briefly Investigations required are - nil.

7.6Has the ethical clearance obtained from your institution?

Yes.

8. LIST OF REFERENCES:

1.GaryCunningham,KennethJ.Levenoand Steven.l.Bloom. Williams obstetrics.22l1d edition. McGraw Hill Publishers 2005;438-439.

2.RenuMisra.Management of labour.Ian Donald's6th edition.BI Publishers2007 ;513517.

3.Pitkin,Roy.Primigravidlabour:A graphicostatistical analysis. Journal of Obstetrics and Gynecology February 2003;101(2):216.

4.Impey,Lawrence,Hobson.Graphicanalysis of actively managed labour;prospective computation of labor progress in 500 consecutive nulliparous women in spontaneous labor at term.American journal of Obstetrics and Gynecology august 2000; 183(2):438-443.

5.Ganesh Dangal.Preventing prolonged labor by using partograph.The internet journal of Gynecology and Obstetrics;2007 V olume7 (1)

6.Bengt Sorbe.Active pharmacologic management of the third stage of labor - A comparison of oxytocin and ergometrine.American journal of Obstetrics and Gynecology 1978;52(6):694-697.

7.VivienD,Tsu,TranTPMai.Reducing postpartum hemorrhage in Vietnam:Assessing the effectiveness of active management of third stage of labor Journal of obstetrics and gynecology research October 2006 ;32(5):489-496.

8.T Lavender,P O'Brien,A Hart. Effect of partogram use on outcome for women in Spontaneous labour at term.Cochrane Database of systematic reviews;2005(3).

9. SIGNATURE OF THE CANDIDATE

Dr.LAKSHMIDEVI.M.

10. REMARKS OF THE GUIDE : Partogram is an essential tool to asses the progress of labour and thereby helps us to prevent maternal morbidity and mortality in

some cases.

l1.NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3 COGUIDE

11.4 SIGNATURE

:Dr. MALINI.K. V. PROFESSOR, DEPARTMENT OF OBSTETRICS AND GYNECOLOGY.

BANGALORE MEDICAL COLLEGE.

BANGALORE

: NO.

d)

11.6 SIGNATURE

11.5 HEAD OF THE DEPARTMENT :Dr.SOMEGOWDA.

PROF. AND HEAD OF THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY.

BANGALORE MEDICAL

BANGALORE.

:

12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL :

12.2 SIGNATURE :