KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE & ADDRESS / DR. SHILPA T
POST GRADUATE STUDENT
MS, OBSTETRICS AND GYNAECOLOGY SRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF MEDICAL SCIENCES AND HOSPITAL, MANJUSHREE NAGAR, SATTUR, DHARWAD – 580009
2. / NAME OF THE INSTITUTION / SRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF MEDICAL SCIENCES AND HOSPITAL, MANJUSHREE NAGAR, SATTUR, DHARWAD – 580009
3. / COURSE OF STUDY AND SUBJECT / MS OBSTETRICS AND GYNAECOLOGY
4. / DATE OF ADMISSION TO THE COURSE / 31-05-2013
5. / TITLE OF DISSERTATION / CLINICAL STUDY OF MATERNAL AND PERINATAL OUTCOME IN ABRUPTIO PLACENTAE PATIENTS.
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR STUDY:
Placental separation from its implantation site before delivery has been variously called placental abruption, abruptio placentae, and in Great Britain, accidental hemorrhage. The Latin term abruption placentae means "rending asunder of the placenta" and denotes a sudden accident, which is a clinical characteristic of most cases. The cumbersome term premature separation of the normally implanted placenta is most descriptive.1
Massive obstetric haemorrhage is a major contributor towards maternal morbidity and mortality. The main causes are abruptio placentae, placenta praevia and postpartum haemorrhage. Clinicians managing pregnant women should be equipped with the knowledge and skills for managing massive obstetric haemorrhage to institute timely and appropriate life-saving treatment. Prompt resuscitation and reversal of coagulopathy are critical while definitive measures are carried out to arrest the bleeding.2
Therefore this study is planned to study maternal and perinatal outcome in patients of abruptio placentae so as to outline the important causes, ways to earlier diagnosis, proper management of the patient so as to improve both the maternal and perinatal morbidity and mortality and specify as to what requires improvement in developing country like ours to improvise the same.
6.2 REVIEW OF LITERATURE:
1. Carl A Narl, Cande V Ananth et al conducted a population based case control study for association between abruption placentae and low birth weight. They concluded that there is no association between abruption and low birth weight. Their result indicated, preterm birth is intermediary between placental abruption and low birth weight.3
2. A Yla Outinen, M Palalder, P K Heinonen studied retrospectively, a total of 180 (0.21%) out of 85.177 deliveries were complicated by abruptio placentae (AP) during the period 1962–1981. Of these the obstetric records of 130 deliveries were retrospectively studied in order to elucidate risk factors for the occurrence of abruptio placentae as well as to find out factors influencing the outcome of the newborn. A history of abruptio placentae revealed an 11-fold risk of premature separation of placentae in subsequent pregnancy. The factors most significantly associated with favorable prognosis of the newborn were: duration of gestation, birth weight and the degree of separation of the placenta.4
3. Amornrath Pitaphrom and Nares Sukcharoen conducted retrospective study between 1994 to 2004 at King Chulalongkorn Memorial Hospital, studied 11375 singleton deliveries and found 103 cases were complicated by abruption. Placental abruption attributed to maternal complications including hemorrhagic shock (19.4%), Couvelaire uterus (16.5%) and DIC (5.8%). The perinatal outcomes included low birth weight (65.0%), preterm (56.3%), severe birth asphyxia (16.5%) and perinatal death (16.5%). Placental abruption with pregnancy induced hypertension (PIH), DIC and blood transfusion had a significantly higher incidence of perinatal mortality than the remainder.5
4. Gunnar Ceiksen, Mognes Wohlet Vibeke in the year 1991, conducted a case control investigation in which course of pregnancy and labour, neonatal out come and social circumstances were compared between 87 women with placental abruption and control group of 5697 women. It was found that, amniocentesis, congenital malformation, maternal smoking and a job involving much standing or walking were associated with placental abruption6
5. Lam CM / Won SF – 2002 – A retrospective study was carried out to identify risk factors for preterm delivery in women with placenta previa and ante partum haemorrhage and found that preterm delivery was increased with placenta previa and APH and who have 2nd trimester vaginal bleeding or presence of uterine contractions.7
6. Dohetry DA, Newnham JP, Magann EF 2008 – a study was carried to evaluate factors associated with unexplained antepartum bleeding of unknown origin after 24 weeks of pregnancy and correlate Unexplained hemorrhage with maternal and perinatal outcome – women with ABUO (Antepartum Bleeding of Unknown Origin) are at greater risk of preterm delivery, and their neonates are at a greater risk for NICU admission, hyperbilirubinemia. 8
6.3 OBJECTIVES OF STUDY:
1. To study the incidence, risk factors and clinical profile of abruptio placentae patients.
2. To study the maternal and perinatal morbidity and mortality in abruptio placentae.
7. / MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
Study subjects:
All patients diagnosed as abruptio placentae by clinical examination and investigations.
Inclusion Criteria: All women diagnosed as abruptio placentae.
Exclusion Criteria: No exclusion criteria.
Study area: Sri Dharmasthala Manjunatheshwara College Of Medical Sciences and Hospital, Dharwad.
Study period: One year, 1st November,2013 to 31st October,2014.
Study design: Hospital based, Time bound, Cross-Sectional study.
Sample size: All cases admitted and diagnosed with abruptio placenta during the study will be included
Study instrument: Pre-structured, pre-tested questionnaire, clinical examination, and laboratory investigation will be used.
7.2 DATA COLLECTION:
After obtaining written informed consent, data will be collected from the study subjects by the investigator regarding their socio demographic profile, clinical symptoms.
Investigator will do detailed general physical examination and gynaecological examination and necessary investigation will be done and reports collected.
Study analysis:
Descriptive statistics like percentages, proportions will be used.
7.3 Does the study require any investigation/ intervention to be conducted on patients or animals? If so please describe briefly.
Investigation reports done for the management of patient are collected.
7.4 Has ethical clearances been obtained from ethical committee of your institution in case of 7.3?
8 / 8.1 List Of References-
1. Cunningham FG, Gant NF Leveno KJ Hauth JC Wenstrom KD. Obstetrical haemorrhage, Williams Obstetrical, 23rd edition. New York, Mcgraw Hill,2001 P-619-69.
2. Lin Lin Su, Yap Seng Chong. Haematological Disorders in Pregnancy.
Best Practice & Research Clinical Obstetrics & Gynaecology 2012;26( 1):77–90.
3. Cande.V.Ananth, Celeste DeMarco, Anthony M. Vintzileos. American Journal of Obstetrics and GynecologyMarch 2008. 198(3)
4. A.Yla-Outinen, M.Palander, P.K.Heinoney. European Journal of Obstetrics & Gynecology and Reproductive Biology, May1987; 25(1) :23–8
5. Amornath Pitaphrom, Nares Sukcharoen, J Med Assoc Thai 2006; 89 (10): 1572-8
6. Gunnar Ceiksen, Mognes Wohlet Vibeke. Br J Obst Gynecol 1991 May;98:448-52.
7. Lam CM, Won SF. Risk factors for preterm delivery are women with placenta previa and antepartums hemorrhage retrospective study. Hong Kong Med J 2002;8(3):163-6.
8. Dohetry DA, Newnham JP, Magann EF. Antepartum bleeding of unknown origin in 2nd half of pregnancy and pregnancy outcome. BJOG 2008;115(11):1451-7.
9. Dutta DC. Ante partum haemorrhage. In : Hiralal Konar, editor. Textbook of obstetrics. 6 th edition, New central Book agency Calcutta 2004. P-243-61
10. Arora K, Desi U. J Obstric Gynecol India 2001 May-June;51(3):102-4.
11. Sintra P, Kurban N. APH an update. J Obst Gynecol 2008 May;28(4):377-81.
9. / SIGNATURE OF THE CANDIDATE
10. / REMARKS OF THE GUIDE / Abruptio placentae can lead to life threatening complications like Disseminated intravascular coagulation, renal failure, haemorrhagic shock, increased perinatal morbidity and mortality. Early diagnosis and timely intervention can prevent all these complications.
11. / NAME & DESIGNATION
11.1 GUIDE / DR HEMALATHA S. MAHANTSHETTI.,
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
SRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF MEDICAL SCIENCES AND HOSPITAL, SATTUR, DHARWAD-580009
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT / DR. RATHNAMALA M DESAI, MD OBG.
PROFESSOR AND HEAD OF THE DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY,
SRI DHARMASTHALA MANJUNATHESHWARA COLLEGE OF MEDICAL SCIENCES & HOSPITAL, SATTUR, DHARWAD–580009.
11.6 SIGNATURE
12. / 12.1 REMARKS OF CHAIRMAN
AND PRINCIPAL
12.2 SIGNATURE
PROFORMA
Name- MR No:
Age- IP No:
Address-
Occupation- Husband’s name-
Education- Occupation-
Socio-economic status- Education-
HISTORY
CHIEF COMPLAINTS:
HISTORY OF PRESENTING ILLNESS: duration:
· H/o amenorrhea yes/no______
· H/o PV bleeding/PV spotting yes/no______
· H/o Pain abdomen yes/no______
· H/o imminent features of eclampsia yes/no______
(nausea, vomiting, heart burn, headache)
· H/o loss of consciousness or convulsions: yes/no______
· H/o drug intake: yes/no______
HISTORY OF PRESENT PREGNANCY
BOOKED/UNBOOKED
TRIMESTER 1-
TRIMESTER 2-
TRIMESTER 3-
OBSTETRICS HISTORY
G P L D A
Age at marriage: Married life:
MENSTRUAL HISTORY
Age of menarche:
Past menstrual cycles: regular/ irregular: duration of flow:
Duration of cycle: heavy/mod/less:
Dysmenorrhoea: Last menstrual period:
Expected date of delivery:
Gestational age:
PAST HISTORY
Previous history of abruptio :( Y/N, if yes take details):
H/o hypertension: Yes/no:
H/o diabetes: Yes/no:
Past history of medical illness/blood transfusion/surgeries:
Habits: smoking: alcohol: others:
PHYSICAL EXAMINATION
Conscious or not:
Temperature: Height:
Pulse rate: Weight:
Blood pressure: BMI:
Pallor: +/-
Icterus: +/-
Edema: +/-
B/L Breast, Spine, Thyroid :
R/S: CVS:
P/A:
Uterine height:
Uterine contractions:
Uterine tenderness:
Lie of fetus:
Presentation:
Position:
Engaged or unengaged:
FHS:
P/V:
PROVISIONAL DIAGNOSIS:
INVESTIGIONS:
Blood group & Rh type:
Hb: PCV:
Urine routine:
Liver function test: Bilirubin- Total-
Direct-
Indirect-
LDH-
SGOT-
SGPT-
Renal function test: Blood Urea-
Serum Creatinine-
Coagulation profile: PT-
aPTT-
INR-
Platelet count-
Serum Uric acid:
Obstetric Ultrasonography:
Doppler:
Non stress test:
Treatment:
Mode of delivery: Vaginal/ Caesarean section
Retroplacental clot: +/-
Materna outcome: Post partum maemorrhage: y/n
Need for blood transfusion: y/n
Renal failure: y/n
Disseminated intravascular coagulopathy: y/n
Puerpural sepsis: y/n
Couvelaire Uterus:+/-
Death: y/n
Fetal outcome: Preterm/ Term:
Live born/ still born/ macerated.
Sex:
Birth weight:
Apgar score:
If live born, mother side or NICU care-
Condition on discharge: