Rajiv Gandhi university of Health Sciences
karnataka, Bangalore
M. S (OBSTETRICS & GYNAECOLOGY)
YENEPOYA Medical College
DERALAKATTE, MANGALORE – 18
A CLINICAL STUDY ON PREGNANCY OUTCOME BEYOND 40 WEEKS OF GESTATION IN YENEPOYA MEDICAL COLLEGE HOSPITAL.
By
Dr. KADEEJATH REZANA
Department of OBSTETRICS & GYNAECOLOGY
YENEPOYA Medical College
DERALAKATTE, MANGALORE – 18
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / NAME OF THE CANDIDATE & ADDRESS / DR. KADEEJATH REZANANo.F4, DELUXE APARTMENTS,
BEHIND YENEPOYA HOSPITAL,
DERALAKATTE, MANGALORE-18.
2 / NAME OF THE INSTITUTION / YENEPOYA MEDICAL COLLEGE
DERALAKATTE, MANGALORE-18.
3 / COURSE OF STUDY AND SUBJECT / M.S, OBSTETRICS & GYNAECOLOGY.
4 / DATE OF ADMISSION TO COURSE / 31. 05. 2008
5 / TITLE OF TOPIC / A CLINICAL STUDY ON PREGNANCY OUTCOME BEYOND 40 WEEKS OF GESTATION IN YENEPOYA MEDICAL COLLEGE HOSPITAL.
6. BRIEF RESUME OF THE INTENDED WORK
6.1. NEED FOR THE STUDY
The historical basis for the concept of an upper limit of human pregnancy duration was the observation that peri natal mortality increased after the expected due date was passed.
Reported frequency of post term pregnancy range from 4% to 14% with an average of 10%. Abnormalities such as congenital anomalies, placental insufficiency, oligohydramnios, meconium aspiration, foetal asphyxia, foetal dysmaturity, macrosomia and shoulder dystosia are commonly observed in these pregnancies.
Pregnancy beyond dates is one of the most frequent clinical dilemma faced by the obstetricians, whether to choose expected management with ante partum foetal surveillance or to prescribe induction of labour remains controversial.
6.2. REVIEW OF LITERATURE
· Aaron.B, Naomi.E, Eugene.A, et al1. Conducted study to estimate when the rates of maternal pregnancy complications increase beyond 37 weeks of gestation and found that among the 1,19,254 women who delivered at 37 completed weeks and beyond, the rates of operative vaginal delivery (OR 1.15, 95% CI), 3rd- or 4th-degree perineal laceration (OR 1.15, 95% CI), and chorioamnionitis (OR 1.32, 95% CI) all increased at 40 weeks as compared to 39 weeks of gestation and rates of postpartum hemorrhage (OR 1.21, 95% CI), endomyometritis (OR 1.46, 95% CI), and primary cesarean delivery (1.28, 95% CI) increased at 41 weeks of gestation. The caesarean indications of non reassuring foetal heart rate (OR 1.81, 95% CI) and cephalo-pelvic disproportion (OR 1.64, 95% CI) increased at 40 weeks of gestation.
· Alexander, James.M, Donald.D, et al2. conducted study to assess pregnancy outcomes at 40, 41, and 42 weeks' gestation when labour induction is done routinely at 42 but not 41 weeks and found that of total 56,317 pregnancies studied: 29,136 at 40 weeks, 16,386 at 41 weeks, and 10,795 at 42 weeks. Labour complications increased from 40 to 42 weeks, including oxytocin induction (2% vs 35%), length of labour (5.5±4.9 vs 8.8±6.5 hours), prolonged second stage of labour (2% vs 4%), forceps use (6% vs 9%), and caesarean delivery (7% vs 14%). Neonatal outcomes were similar in the three groups, including 5-minute Apgar score less than 4, admission to the neonatal intensive care unit (NICU), umbilical artery pH less than 7, seizures, and perinatal mortality. Sepsis was more frequent in the 42-week group than the other groups (0.1 vs 0.3%), as was admission to the NICU (0.4 vs 0.6%).
· Donald M, Arnold L, Sarah F, et al3. Conducted a clinical Trial of Induction of Labour Versus Expectant Management in Post term Pregnancy and found that the incidence of adverse perinatal outcome (neonatal seizures, intracranial haemorrhage, the need for mechanical ventilation, or nerve injury) was 1.5% in the induction group and 1% in the expectant management group. There were no foetal deaths in either group. There were no differences in mean birth weight or the frequency of macrosomia (birth weight >= 4000 gm) between the two groups. Regardless of parity, prostaglandin E2 intracervical gel was not more effective than placebo in ripening the cervix. The caesarean delivery rate was not significantly different in the expectant (18%), prostaglandin E2 gel (23%), or placebo gel (18%) groups.
· Michael. Y, Bengt.H, Henry. N, et al4. Conducted study on fetal and neonatal mortality in postterm pregnancy and found that a small but significant increase in fetal mortality in accurately dated pregnancies that extend beyond 41 weeks of gestation. This study also demonstrates that fetal growth restriction is independently associated with increased perinatal mortality in these pregnancies.
· Norwitz, Errol. R, Snegovskikh, et al5. Conducted a study on when to intervene in prolonged pregnancy and found that the risks of routine induction of labor (specifically failed induction leading to caesarean delivery) in the era of cervical ripening agents are lower than previously reported. The risk of fetal death is also low, but not 0, with expectantly managed, carefully monitored postterm pregnancies. For these reasons, the authors favour a policy of routine induction of labour for low-risk pregnancies at 41 weeks of gestation.
· Zachary. A, Lisanne. P, Sarah. E, et al6 studied risk of post term delivery after previous post term delivery and observed that among mothers who deliver post term, there is a significant risk for subsequent post term births. This increased risk suggests that common factors (genetic or other) influence the likelihood of abnormal parturition timing.
· Top of Form
6.3. OBJECTIVE OF THE STUDY
To evaluate: 1) Spontaneous labour rate.
2) Induction rate.
3) Caesarean rate.
4) Perinatal mortality and morbidity in uncomplicated pregnancies beyond 40 weeks of gestation and to compare the outcome in 3 gestational age groups: 40 – 41 weeks
41 – 42 weeks
Beyond 42 weeks.
7. MATERIALS AND METHODS
7.1. SOURCE OF DATA
This study include pregnant women both primigravida and multigravida beyond 40 weeks of gestation admitted in Dept. Of OBG, Yenepoya Medical College, Deralakatte, Mangalore during a period from November 2008 to May 2010.
7.2. METHOD OF COLLECTION OF DATA
STUDY DESIGN: Prospective clinical study.
SETTING: Dept. Of OBG, Yenepoya Medical College, Deralakatte
DURATION OF STUDY: One and half years from Nov.2008 to
May 2010.
SAMPLE SIZE: 50 Cases including primigravida and multigravida.
SAMPLING TECHNIQUE: Random selection of subjects meeting the Inclusion and exclusion criteria.
SAMPLE SELECTION:
A) INCLUSION CRITERIA:
· Pregnant women beyond 40 weeks of gestation with dependable dates (last 3 menstrual cycles regular, not used contraceptive pills for past 3 months, not conceived during lactational amenorrhea).
B) EXCLUSION CRITERIA:
· Any associated complications like previous LSCS, malpresentations, PIH, Placenta previa and other medical complications.
7.3. HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION?
YES
8. REFERENCE’S AND CITATION’S
1. Aaron B, Naomi E, Eugene A et al., “ Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term”. American Journal of Obstetrics and Gynaecology, Feb 2007, 196(2): 155.
2. Alexander, James M, Donald D et al., “ Forty Weeks and Beyond: Pregnancy Outcomes by Week of Gestation”. Obstetrics and Gynaecology, August 2000, 96(2) : 291-294.
3. Donald M, Arnold L, Sarah F et al., “ A Clinical Trial of Induction of Labor Versus Expectant Management in Postterm Pregnancy”. American Journal of Obstetrics and Gynaecology, March 1994, 170(3) : 716-723.
4. Michael Y, Bengt H, Henry N et al., “ Foetal and neonatal mortality in the post term pregnancy : The impact of gestational age and foetal growth restriction”. American Journal Of Obstetrics & Gynaecology, April 1998, 178(4) : 726-731.
5. Norwitz, Errol R, Snegovskikh et al., “ Prolonged pregnancy: when should we intervene?”. Clinical Obstetrics and Gynaecology, June 2007, 50(2) : 547-557.
6. Zachary A, Lisanne P, Sarah E et al., “ Risk of post term delivery after previous post term delivery”. American Journal of Obstetrics and Gynaecology, March 2007, 196(3) : 241.
9. SIGNATURE OF THE CANDIDATE :
10. REMARKS OF THE GUIDE :
11. NAME AND DESIGNATION
11.1 . GUIDE : Dr. P.K. SHYAMALA DEVI
PROFESSOR; DEPT. Of OBG
YMCH, MANGALORE.
11.2. SIGNATURE :
11.3. CO-GUIDE :
11.4. SIGNATURE :
11.5. HEAD OF THE DEPARTMENT : Dr. BHARATHI.V.BALIGA
PROF. & HOD; DEPT. Of OBG
YMCH, MANGALORE.
11.6. SIGNATURE :
12. PRINCIPAL : Dr. R.N.SUJEER
PROFESSOR; DEPT. Of SURGERY
YMCH, MANGALORE.
12.1. REMARKS OF PRINCIPAL :
12.2. SIGNATURE :