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  • FETAL OUTCOMES AMONG PREGNANT WOMEN PRESENTING

    WITH REDUCED FETAL MOVEMENTS AT KENYATTA

    NATIONAL HOSPITAL: A CROSS SECTIONAL STUDY

    A RESEARCH DISSERTATION IN PARTIAL FULFILMENT

    OF

    MASTERS OF MEDICINE IN OBSTETRICS AND GYNAECOLOGY

    UNIVERSITY OF NAIROBI

    November 2010.

    SUBMITTED BY

    DR. KIKWAI WILLEY KIBET

    Registrar, Obstetrics and Gynaecology, University of Nairobi

  • ii

    SUPERVISORS

    Dr. Anne Beatrice Kihara MBCHB, MMED

    Lecturer, Department of Obstetrics and Gynaecology

    University of Nairobi

    Dr. Guyo Jaldesa MBCHB, MMED, MSC

    Senior lecturer, Department of Obstetric and Gynaecology

    University of Nairobi

  • iii

    TABLE OF CONTENTS

    Table of content Page number

    LIST OF TABLES iv

    LIST OF ABBREVIATION v

    DEDICATION vi

    ACKNOwLEDGEMENT vii

    DECLARATION viii

    ABSTRACT Xi

    CHAPTER 1: LITERATURE REVIEW AND STUDY OBJECTIVES

    LITERATURE REVIEW 1

    STUDY JUSTIFICATION 8

    RESEARCH QUESTION 9

    STUDY OBJECTIVES 9

    CHAPTER 2: STUDY DESIGN AND METHODOLOGY

    study design 10

    study site and setting 10

    study participant recruitment 12

    study population 12

    inclusion criteria 12

    exclusion criteria 12

    sample size 12

    sampling procedure 13

    data collection and management 13

    study procedure 13

    quality control 15

    data analysis 16

    research ethics 16

    CHAPTER 3: RESULTS 17

    CHAPTER 4: DISCUSSION 28

    CHAPTER 5: REFERENCES 32

    APPENDIX 1: PATIENT INFORMATION AND CONSENT 35

    APPENDIX 2: DATA COLLECTION SHEET 37

    APPENDIX 3: TIME FRAME AND BUDGET 44

    APPENDIX 4: ETHICAL APPROVAL 45

  • iv

    LIST OF TABLES PAGE

    Table 1- age distribution 17

    Table2- drug habits/use 17

    Table3- gestational age 18

    Table 4-obstetric and medical condition 18

    Table 5- antenatal profile 19

    Table 6- fetal surveillance methods 20

    Table 7- mode of delivery 20

    Table 8- reasons for caesarian 21

    Table 9- fetal outcome 21

    Table 10- correlating gestational age/fetal outcome 23

    Table 11- correlating PIH/fetal outcome 24

    Table 12- correlating CTG/fetal outcome 25

    Table 13- correlating BPP SCORE/fetal outcome 26

    Table 14- correlate fetal outcome/mode of delivery 27

  • v

    LIST OF ABBREVIATION

    ACOG American college of Obstetric and

    Gynaecology

    AIDS Acquired immunodeficiency syndrome

    APH antepartum hemorrhage

    BPP Biophysical profile

    CNS Central nervous system

    CTG Cardiotocography

    DBP Diastolic blood pressure

    DFM Decreased fetal movements

    DM Diabetes mellitus

    GBD Gestation by dates

    GB U/S gestation by ultrasound

    HB Haemoglobin

    H.I.V Human immunodeficiency syndrome

    FKC fetal kick chart

    FM Fetal movements

    FHR fetal heart rate

    IUFD Intrauterine fetal death

    KMTC Kenya Medical Training College

    KNH Kenyatta National Hospital

    NBU Newborn Unit

    NICU Newborn intensive care unit

    NRFS Non reassuring fetal status

    P.I.H Pregnancy induced hypertension

    P02 Partial pressure of oxygen

    PTB Pulmonary tuberculosis

    PROM Premature rupture of membranes

    SVD Spontaneous vaginal delivery

    VDRL Venereal Disease Research Laboratory

  • vi

    DEDICATION

    This book is dedicated to my wife Jepkorir, my daughter Jepkosgei and my son Tali.

    To my mother Jerop whom I consider my first teacher in life

    To my late father Kikwai Tali for purchasing books for me early in life especially the

    encyclopedia in standard seven

  • vii

    ACKNOwLEDGEMENT

    I am grateful to the ministry of medical services for having granted me the scholarship to

    train in obstetrics and gynaecology at the University of Nairobi with the aim of

    improving the health of women in our community. I would also give thanks to Moi

    teaching and referral hospital and Thika district hospital for enabling me do my elective

    term in their institutions. The experience was worth while.

    Special thanks to my supervisors, Dr. Guyo Jaldesa and Dr. Beatrice Anne Kihara for

    their support and guidance. It is through their dedication that I have come this far. All

    members of staff of the department of obstetrics and gynaecology including the chairman

    Prof. Koigi Kamau, all the consultants for their words of wisdom enriched with

    experience. To Dr. Kinuthia, your input was of much help.

    I wish to appreciate the administration of Kenyatta National Hospital for allowing me to

    collect my Data in labour ward and antenatal wards. I also thank my research assistants,

    Jebet, Dome and Mwaniki for their good job. Special thanks to Francis Njiri for the data

    analysis.

    Thanks to all my colleagues, fellow postgraduate students and all staff of Kenyatta

    National Hospital for the good interaction we had during my entire training period.

  • viii

    DECLARATION

    This dissertation is my original work and has not been presented elsewhere. References to work

    done by others have been clearly indicated.

    Signature.. Date

    Dr. Kikwai Willey Kibet

    Approval:

    This dissertation has been submitted with our approval as University of Nairobi

    supervisors:

    Signature.. Date

    Dr. Anne Beatrice Kihara MBCHB, MMED

    Lecturer, Department of Obstetrics and Gynaecology

    University of Nairobi

    Signature.. Date

    Dr. Guyo Jaldesa MBCHB, MMED, MSC

    Senior lecturer, Department of Obstetric and Gynaecology

    University of Nairobi

  • ix

    CERTIFICATE OF AUTHENTICITY

    This is to certify that this dissertation is the original work of Dr Kikwai Willey Kibet

    Master of Medicine student in Department of obstetrics and Gynaecology, Registration number

    H58/70975/2007 University of Nairobi (2007-2011). The research was carried out in the

    department of obstetrics and Gynaecology, School of Medicine, College of Health Sciences. It

    has not been presented in any other university for award of a degree.

    Signature...........................................................................................................................

    Date...................................................................................................................................

    Prof. Koigi Kamau,

    Associate Professor of Obstetrics and Gynaecology

    Consultant Obstetrics and Gynaecology,

    Chairman,

    Department of Obstetrics and Gynaecology,

    University of Nairobi

  • x

    ABSTRACT

    Background: Reduced fetal movement in pregnancy is a common cause of anxiety and

    admission of pregnant women. It is considered a high risk pregnancy with the fetus at risk

    of hypoxia and sudden death. Fetal surveillance is always indicated to assess the fetal

    wellbeing and to aid in opportune time of delivery.

    Objectives: This study was undertaken to examine fetal outcome of mothers who

    presented with decreased fetal movements

    Design: The study was hospital based descriptive cross-sectional study.

    Study population: women presenting with reduced fetal movements at 34 weeks

    gestation formed the study group. Those who met eligibility criteria were consented and

    standardized structured questionnaire administered. The study subjects followed the

    standard operating procedure for Cardiotocography (CTG) and Biophysical Profile (BPP)

    as tools for fetal surveillance.

    Setting: This study took place at Kenyatta National Hospital, the largest referral hospital

    in Kenya located in Nairobi.

    Duration of the study: The study took 4 months to complete. The study was conducted

    between June-September 2010.

    Data collection: Data was collected using a structured questionnaire. The questionnaire

    was administered by the principal researcher and three trained research assistants.

    Data analysis: Data analysis was performed using Statistical Package for Social

    Scientists (SPSS Version 17.0). Proportions were estimated using simple frequencies.

    Multivariate analysis was performed using logistic regression to determine independent

    factors associated with poor obstetric outcome.

  • xi

    Main outcome measures: Apgar score at 5 minutes, resuscitation of the new born,

    admission to Newborn Unit (NBU), low birth weight, congenital anomaly a

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