POBLACIÓN TOTAL RODEO: 1
SISTEMA ADMINISTRATIVO
7.2. MARCO CONCEPTUAL
7.2.13. GRUPO PROGRAMÁTICO
7.2.13.3. PERFILES DE MORBILIDAD Y MORTALIDAD EN ADOLESCENTES TEMPRANOS Y TARDÍOS
Foetal macrosomia and intrauterine growth retardation (IUGR) are both known to increase the risk of perinatal morbidity and mortality and of long term neurologic and developmental disorders.2 Diagnosis of both foetal macrosomia and IUGR by either clinical or sonographic estimation will lead to prompt delivery for IUGR and caesarean delivery for foetal macrosomia with failed vaginal delivery thereby reducing perinatal morbidity.3
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This study is relevant to family medicine in that a family physician is a doctor of first contact providing primary care and a six-star doctor (communicator, care giver, community leader, manager, researcher and a decision maker). Family physicians provide comprehensive, continuing and coordinated care to individuals and their families irrespective of sex, age and disease entity. As such family physicians are also involved in obstetric care.
The Family physician as a decision maker, chooses which technologies to apply ethically and cost effectively. Family physicians manage resources of their clients by use of inexpensive investigations. Requesting for costly ultrasound estimation is hardly justifiable when clinical estimates are equally accurate and can be done quickly at no cost. This study demonstrated the practicality of clinical estimation of foetal weight.
Health problems in sub-saharan Africa are largely preventable. There are efforts to improve delivery of health care by introducing Family medicine in the entire region.80
The Family physician, who is an educator, can teach other health care workers involved in obstetric care, working in primary health care centres where there are no ultrasound machines or skilled personnel to operate them. The teaching can be done through workshops, provision of teaching aids and handouts.
The use of this simple and inexpensive clinical method of estimating foetal weight can be used to identify foetal macrosomia and refer suspected cases of foetal macrosomia and IUGR to better equipped facilities where interventions can be done to avoid complications like obstructed labour. This will reduce the rate of perinatal mortality and maternal morbidity thereby improving the health of Nigerians.
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5.13 STRENGTHS AND LIMITATIONS OF THE STUDY
A major strength of this study is that there was no participant that dropped out. The entire participants recruited were studied and their results were analyzed.
Also there was no industrial strike action during the study period that would have interrupted the recruitment and follow up of patients. This is one of the advantages of studies done in faith based organization where no industrial actions take place.
The other major strength is that bias was removed by having independent assessment of both clinical and sonographic estimation of weight.
The limitations of the study included;
1. Use of only one method of clinical assessment( Dare’s formula) 2. Use of only one formula of ultrasound estimation (Hadlock formula) 3. Inclusion of obese women in the study.
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102 INFORMED CONSENT FORM
Study Title: COMPARISON OF CLINICAL AND SONOGRAPHIC ESTIMATION OF INTRAUTERINE FOETAL WEIGHT WITH BIRTH WEIGHT IN BINGHAM UNIVERSITY TEACHING HOSPITAL, JOS.
Dr Agyema P.A Jemimah TEL: 08035040488 e-mail: [email protected] Subject Identification: ____ ERB Research approval number: _____
What is consent?
Consent means agreeing to let you take part in this research study of clinical vs sonographic estimation of foetal weight. You have the right to decide if you want to take part in the study or not. This document is to inform you about the study. Ask us if there is anything that is not clear or if you would like more information. If you agree to participate in this study, we will ask you to sign the page at the end of this document.
Why is this study being done?
Obstetric management is often influenced by clinical and ultrasound estimations of foetal weight. Estimated foetal weight (EFW) is a consideration when planning the mode of delivery for a suspected macrosomic or small foetus. It has long been established that birth weight is a major determinant of infant mortality in the first year of life, and that mortality rates are more sensitive to birth weight than gestational age. Hence the importance attached to antenatal Birth weight determination.
The study examines whether there is a difference between Clinical and Sonographic Estimation of Foetal Weight in pregnant women at term compared with their actual birth weight.
How many subjects will be in the study?
52 women who meet the inclusion criteria will be selected from the study population (antenatal care women who meet the inclusion criteria.)
What does this study involve?
You can only take part in this study if you have given your consent, and if you agree to participate in this study the following will happen:
We will clinically estimate the foetal weight followed by ultrasound estimation at term 37-42 weeks serially till delivery then the actual weight of the neonate will be taken within 24hours of delivery.
Consent statement
We/I...
Printed name of subject/guardian(s)
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Confirm that we/I have had the opportunity to ask questions about this study and we/I are/am satisfied with the answers and explanations that have been provided.
Understand that participation in this study is voluntary and that we/I may freely stop being part of this study at any time.
Statement of person obtaining informed consent:
I have fully explained this research to ____________________________________ and have given sufficient information, to make an informed decision.
DATE: _____________________ SIGNATURE: _______________________________
NAME: ___________________________________
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COMPARISON OF CLINICAL AND SONOGRAPHIC ESTIMATION OF INTRAUTERINE FOETAL WEIGHT WITH ACTUAL BIRTH WEIGHT IN BINGHAM UNIVERSITY TEACHING HOSPITAL JOS.
Dear respondent,
I am Dr Agyema P.A Jemimah a resident of family medicine in Bingham University Teaching Hospital Jos. This questionnaire is designed for research purpose, and aimed at assessing the foetal birth weight in partial fulfillment of the requirement for the part II fellowship examination of the faculty of family medicine of the National Postgraduate Medical College of Nigeria. Your responses shall be treated confidentially, and your name is not required in this questionnaire.
Questionnaire No ……….
Please tick the appropriate box
SECTION A; Socio-demographic characteristics 1. Age………(in years)
2. LMP ………
3. Gestational Age 37weeks: Early ultrasound scan ( ) LMP ( ) 4. Weight in kg ……..
5. Height in m …….
6. BMI: ………
7. Religion: Islam ( ) Christianity ( ) others specify ( ) 8. Type of family: Monogamous ( ) Polygamous ( )
9. Marital status: Married ( ) Divorced ( ) Single ( ) Widow ( ) Separated ( ) 10. Occupation ………
11. Educational status: None ( ) Primary ( ) Secondary ( ) Tertiary ( ).
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SECTION B: CLINICAL ESTIMATION OF FOETAL WEIGHT.
S/N Gestational age by LMP/USS (weeks)
37 38 39 40 41
1 Symphysio-fundal height(cm)
2 Abdominal girth(cm)
3 Estimated foetal weight(gm)
Mean estimated foetal weight (gm):...
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SECTION C: SONOGRAPHIC ESTIMATION OF FOETAL WEIGHT
S/N
Gestational age by LMP/USS (weeks)
37 38 39 40 41
1 Biparietal diameter (BPD) mm 2 Head Circumference (HC) mm 3 Femur length (FL) mm
4 Abdominal circumference (AC) mm 5 Estimated foetal weight (EFW) gm 6 Placenta location:
7 Amniotic Fluid Index (AFI) 8 Estimated gestational age (EGA)
Mean estimated foetal weight by USS (gm)...
107 SECTION D: DELIVERY SUMMARY 1. Route of delivery: ……….
2. Length of the neonate ………..
3. Actual Birth Weight (ABW)……..
4. Sex……..a. Male b. Female C. Bisexual 5. Apgar Score: 1st minute…….., 5th minute…….
6. Birth trauma neonate…… a. Yes b. no.
7. Vaginal laceration …….. a. yes b. no.
8. Estimated Blood loss (ml): a. 100 b. 200 c.300 d.400 e.500 f.>500
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