FROM Place:Bellary.
Dr.suma .H.R Date:16/11/2009
Post Graduate student in MS OBG
Department of OBG
Vijayanagara institute of medical sciences
Bellary.
To,
The Principal
Vijayanagara institute of medical sciences.
Through Proper Channel
Respected Sir,
Subject : Submission and Forwarding of Synopsis for
Registration Of Dissertation topic
********************
In accordance with subject cited above, I the undersigned studying in PG course in MS – OBG have been allotted the dissertation topic “The Study of Maternal and Perinatal outcome in term singleton breech Presentation.” in patients admitted in OBG Department, VIMS Hospital, Bellary under the guidance of Dr.Vijaya Harsoor, Professor, Department of OBG, VIMS, Bellary.
I request you to kindly forward the dissertation topic in prescribed form to the Registrar Rajiv Gandhi University of Health Sciences Bangalore, Karnataka for approval.
Thanking you,
Signature of guide
DR. VIJAYA HARSOOR
Professor, Dept of OBG,
VIMS, Bellary.
Yours faithfully
DR.SUMA H.R
From, Place : Bellary
The Professor and Head, Date : 16/11/2009
Department of OBG,
Vijayanagara institute of medical sciences.
Bellary.
TO,
The Registrar,
Rajiv Gandhi University of Health Sciences
Bangalore,
Through proper channel
Respected sir,
As per the Regulations of the university for Registration of Dissertation Topic, the following post graduate student in MS – OBG has been allotted the dissertation topic as follows by the official Registration
committee of all qualified and eligible guides of the department of OBG.
Name / Topic / GuideDr. Suma H.R
Post Graduate student in MS OBG
Department of OBG
VIMS,Bellary. / “The Study of Maternal and Perinatal outcome in term singleton breech Presentation.” / DR. VIJAYA HARSOOR
Professor Dept. of OBG,
VIMS, Bellary.
Therefore, I kindly request you to communicate the acceptance of
Dissertation topic allotted to the PG student at an early date.
Thanking you,
Signature of Guide Yours Faithfully
DR. VIJAYA HARSOOR Dr. A.A. KHAZI
Professor Dept. of OBG, Professor and Head
VIMS, Bellary Dept, of OBG.
VIMS, Bellary.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
ANNEXURE- II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE& ADDRESS (IN BLOCK LETTERS ) / DR. SUMA H.R
POST GRADUATE STUDENT
IN MS OBG
DEPT OF OBG
VIMS, BELLARY
2 / NAME OF THE
INSTITUTION / VIJAYANAGARA INSTITUTE OF MEDICAL SCIENCES
BELLARY
3 / COURSE OF STUDY &
SUBJECT / MS IN OBSTETRICS & GYNAECOLOGY
4 / DATE OF ADMISSION TO THE COURSE / 17-4-2009
5 / TITLE OF THE TOPIC / “THE STUDY OF MATERNAL & PERINATAL OUTCOME IN TERM SINGLETON BREECH PRESENTATION”
6 / BRIEF RESUME OF THE INTENDED WORK
6. Brief Resume of the Intended Work
6.1 NEED FOR THE STUDY
Breech presentation, the common obstetric malpresentation, complicates approximately 4 % of deliveries.1a
Perinatal mortality in breech presentation is higher than vertex, being 4 fold greater among term infants.1b
1/3 of perinatal deaths among breech infants are due to potentially preventable factors.These basically fall into two categories-1.Trauma and 2.Asphyxia.1c
The incidence of caesarean section for breech presention steadily increased from approximately 30 % in 1970 to 85 % in 1999. A
recent review of breech deliveries in California revealed 88% caesarean section rate.2
Significant long term major abnormalities of CNS are increased in fetus with breech presentation born per vagina. These include cerebral palsy, epilepsy, mental retardation and hemiplegia.3
Term breech fetuses delivered by vaginal route had almost 9 times increased risk of perinatal mortality.4
According to study by AM Abasiatti , the incidence of singleton breech delivery was 1.41% and perinatal mortality was 158/1000.5
Febrile morbidity and length of hospitalization were significantly higher in the women with caesarean section compared with those delivered vaginaly.6
The present study is done to know the outcomes of term singleton breech pregnancies so that the problem can be tackled in a better way and steps can be taken to minimize the maternal and perinatal mortality and morbidity.
6.2 REVIEW OF LITERATURE
Breech presentation is when the buttocks of the fetus enter the pelvis first.
Breech presentation seen in 3-4% of singleton deliveries.7
Incidence – Frank breech 65-70%
Complete breech 5-10%
Footling presentation 20-30% 8a
The main causes of perinatal mortality and morbidity are intracranial hemorrhage, asphyxia and fracture of the humerus, femur or clavicle.8b
Mothers of breech presentation infants who did not receive prenatal care were more likely to experience perinatal loss.9
Meta-analysis by cheng and Hannah , found significantly higher perinatal mortality and neonatal morbidity with planned vaginal delivery compared with planned caesarean section.10.
According to Mary E, Hannah et. al planned caesarean delivery for pregnancies with breech presentation at term may lower the risk of incontinence and is not associated with an increased risk of other problems, although the effect on long term outcomes is uncertain.11
According to louis Jacques & Asha misra ,breech presentation is not coincidental but a consequence of poor fetal quality.12
5-15% of breech fetuses have a congenital malformation .In breech presentation whatever the mode of delivery is a signal for potential fetal handicap..13
6.3 OBJECTIVES OF THE STUDY
The present study is undertaken,
1.To study the maternal outcome in singleton term breech presentation.
2. To study the perinatal outcome in singleton term breech presentation.
7. MATERIALS AND METHODS
7.1. Source of data:
This study will be conducted in 100 pregnant women with singleton breech presentation at term, who are admitted in OBG department, VIMS, Bellary.This is a prospective study during the period of December 2009-december 2011. A detailed clinical evaluation and relevant labouratory investigations will be done for all subjects as per proforma. The relevant cases will be followed until delivery and discharge of the patient from the hospital for maternal outcome and the newborn will be followed up to the 7th day of delivery for perinatal outcome.
7.2. Method of collection of data
Inclusion criteria
Pregnant women,both primigravida and multigravida, with singleton breech presentation >37 weeks of gestation.
Exclusion criteria
1.Breech presentation in twin pregnancy.
2.Breech presentation < 37 weeks gestation.
7.3. Does the study require any investigations to be conducted on patients ? if so describe briefly.
Yes, the study requires routine investigations like Hb% ,Urine-Sugar, albumin & microscopy, HIV test, HbsAg test, blood grouping , USG, & cord blood PH.
All investigations and interventions will be done under the guidance and supervision of the guide.
7.4 Has ethical clearance obtained from your institution in case of 7.3?
Yes ethical clearence has been obtained from the VIMS institutional
ethics committee, Bellary.
8. LIST OF REFERENCES;
1. Ronald s.Gibbs, Beth Y.karlan, Arthur F.Haney, Ingrid Nygaard; Danforth s obstetric and gynaecology,Lippincott Williams & wilkins,10th edition, 2008,a. page 400
b.page 402
2. Alan H, Decherney, Lauren Nathan, T. Murphy goodwin, Neri laufer; LANGE current diagnosis and treatment, MCGraw Hill , 10th edition 2007,page 351.
3. Harry oxorn, OXORNE-FOOTE Human labour & birth, MC GrawHill, 5th edition,2000, page 238.
4. Conde-agudelo A. planned caesarean section for term breech delivery. RHL(WHO reproductive health libraury) 8TH September 2003.
5. AM abasiattai, SJ Etuk, EEJ Asuquo, CO iklaki, mary slessor journal of medicine >volume.4(1)2004;81-85. African journal online.(AJOL)
6. E.S.cliff et.al; AJOG( American journal of obstetrics & gynaeoology) vol 175 maternal and neonatal outcome of 846 term singleton breech deliveries.
7. Cunningham. F.G.,et.al; William obstetrics ,MCGraw Hill,22nd edition 2005, page 510
8. Jhon T. Queenan,Catherine Y spong, charles J lockwood ;Management of high risk pregnancy, An evidence based approach, Blackwell publishing limited,5th edition ,2007,a.page 397
b.page397
9. Derek lewellyn-Jhones,Fundamentals of obstetrics & gynaecology,Mosby publishers,7th edition,1999, page 164
10. Mekbib TA,breech delivery & fetal outcome, Ethiopian medical journal, 1995 july;33(3)175-82
11. Mary E , Hannah et al the international randamised term breech trial. Journal of the American medical association(JAMA) Vol 287 no 14,april 10, 2002.
12. Louis Jacques van bogaert, Asha misra, SOUTH AFRICAN MEDICAL JOURNAL, October 2007.
13. David M. Luesley & Philip N baker, LUESLEY & BAKER text book of obstetric & gynaecology. Arnold publisher, 1st edition,2004, page 425.
9 / SIGNATURE OF THE CANDIDATE / Dr. SUMA H.R.
10 / REMARKS OF THE GUIDE / RECOMMENDED AND FORWARDED
11 / NAME OF THE DISGNATION OF
11.1. GUIDE / Dr. VIJAYA HARSOOR
Professor, Department of OBG
VIMS, Bellary
11.2. SIGNATURE
11.3. HEAD OF THE DEPARTMENT / Dr. A.A. KHAZI
Professor and head
Dept. of OBG
VIMS, Bellary
11.4. SIGNATURE
12 / 12.1. REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2. SIGNATURE