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Ultrasonography. Procedure Descriptions

Use of Ultrasonography for Predicting Fetal Outcome in Pregnant Women

Who Perceived Decreased Fetal Movement

Ultrasonography is a clinical procedure that incorporates the use of reflections and high sound waves to construct an organ or an image of an unborn child; usually called a sonogram (Froen, 2004). It is normally used to monitor fetal growth in pregnant women. This study will seek to evaluate the efficiency, applicability among other aspects of this clinical procedure in predicting the fetal outcome of pregnant women who are perceived to have a decreased fetal movement.

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Background Statement

Cessations in expectant women are not a rare occurrence. It is usually observed to be a cause of concern to most pregnant women and sometimes a cause of anxiety. The history of this condition is not well established in clinical circles and the treatment is not streamlined either. Clinical practitioners have therefore disagreed on the form of treatment to be administered to such women. The assessment of this condition is also unclear as most practitioners don’t use a standard method of diagnosing the condition (Froen, 2004).

Direct counting of the fetus’s movements by the mother is a traditional approach used by women to determine fetal movement. However, this action has not been established to be quite beneficial. Other clinical procedures have therefore been used to treat decreased fetal movements. The most common methods are: Cardiotocography (CTG) and Doppler velocimetry. Cardiotocography majorly incorporates questioning a number of variables in pregnancy such as a reduction in fetal movements or pregnancy bleeding. This method synchronizes fetal movements and FHR accelerations (Froen, 2004). It therefore combines the two to create a combined function. It is also affirms that decreased accelerations of fetal movements among pregnant mothers may lead to fetal hypoxia (Froen et al, 2005). It is also perceived that contractions may decrease the rate at which oxygen flows to the fetus, thereby decreasing the rate of fetal movements and a subsequent decrease in FHR deceleration. However, it is established that a decrease in FHR doesn’t necessarily amount to a decrease in fetal movement (Froen, 2004).

In a study undertaken on 1,914 expectant women, all the participants were expected to physically count the number of fetal movements. Two participants who had never experienced complications in pregnancy were observed to experience fetal movements that were attributed to abnormal traces of CTG. However, about 56% of high degrees of CTG anomalies were noted to result in decreased fetal movements (Froen, 2004).

Medical research studies have shown that sleeping positions of the fetus could sometimes result in inaccurate diagnosis of fetal movement rates. This is likely to warrant unnecessary obstetric procedures to rectify a situation that isn’t yet a problem. A vibroacoustic stimulus in the prediction of fetal movements is likely to lead to FHR increase which may seem to be the correct diagnosis in determining the wellbeing of the fetus.

Research studies have shown that vibroacoustic stimulus might reduce the occurrence on non reactive tests involving CTG. Vibroacoustic stimulus is also attributed to decreasing the time for the CTG test. This is achieved through a reduction in the number of traces associated with CTG, caused by the sleeping fetus (Heazell et al, 2005).

A research study cited Froen (2004) analyzed whether a vibroacoustic stimulus affected the ability of the fetal movements to be palpable or whether these movements resulted in an accompaniment of a resultant NST. Results concluded that about 89% of the fetus moved due to stimulation brought about by a highly reactive CTG. This observation was made in an overwhelming 99% of the cases. It can therefore be concluded that vibroacoustic stimulation is quite useful in cases involving low FHR activity. Further studies also affirmed that there was an increase in basic FHR a few minutes after the vibroaoustic stimulation. The act of manually stimulating the fetus is also a close resemblance to this procedure. Nevertheless, the effects of different types of physical stimulation of the fetus on the outcome of the pregnancy are yet to be determined (Heazell et al, 2008).

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Doppler Velocimetry was introduced in 1977 as a way of measuring fetal activity using wavelengths. No other physical fetal growth test has been more evaluated than this technique. However, Doppler velocimetry has not been proved to be of much use during screening of the fetus. The use of Doppler technique in high risk pregnancies is however likely to influence the outcome of such pregnancies. Highly complicated pregnancies here should be understood as an emphasis on pregnancies that are complicated by high blood pressure or previous still births. The rate of perinatal deaths through the use of the Doppler Velocimetry method is noted to be low. The rate of labor induction among pregnant women is also decreased using this method. However, no significant increase or decrease is noted in caesarian deliveries or labor distress (Heazell et al, 2008).

Research studies have however shown that CTG is more effective in determining fetal movements in low risk pregnancies than Doppler velocemetric method. Mortality and infant handicap can therefore be better established through CTG than Doppler velocemetric method. Decreased fetal movements is the only indicator for Doppler velocemetry when it comes to low risk pregnancies. Placenta vascular resistance is however the most eminent risk in this type of screening, posing a danger to either the fetus or the mother. It can therefore be concluded that adding CTG to Doppler velocemetric method would greatly increase efficiency when dealing with cases of low fetal movements.

The biophysical profile as a method of pregnancy outcome has been quite common in Canada and the US. This is because of an established link between biophysical profiles and the poor outcome in pregnancies. This has seen a subsequent surge in the use of biophysical profile technique. However, the five attributes related to biophysical analysis need to be used in synchrony to come up with the best results in an analysis of its applicability. These five attributes encompass a profile of the CTG and other (four) variables determined by an ultrasound scan.

Normally, these attributes are the breathing rate of the fetus, fetal movements, tone of the fetus and a determination of the volume of amniotic fluid in the pregnancy. The use of biophysical profile on high risk pregnancies does not have different outcomes from conventional methods of monitoring the fetus like CTG. Currently, more analysis needs to be made to determine the benefits associated with biophysical profile (Heazell and Froen, 2008).

Ultrasonography has been widely used in these types of screenings as an antepartum fetal assessment. However, its effectiveness and applicability is not well established. The derived benefits associated with this procedure is also still in wide contention. In comparison, vibroacoustic stimulation as a method of treatment has well established benefits and should therefore be further evaluated. The same goes for biophysical profile. Currently evaluations and management methods used in the treatment of decreased fetal movements are still unclear with undefined benefits. Scientific evidence has also not been well developed to support benefits traditionally assumed to be in association with some of these methods. There is therefore an urgent need to create a well defined framework and analogy of these forms of treatment for their applicability in future treatment.

Aims and Objectives

Aims

To evaluate ultrasonography treatment as a viable method of predicting fetal outcome among pregnant women with decreased fetal movement

Objectives

  • To compare Ultrasonography treatment with vibroacoustic stimulation
  • To compare Ultrasonography treatment with biophysical profile
  • To establish the reliability of Ultrasonography treatment in predicting fetal outcome
  • To evaluate the effectiveness of Ultrasonography in pregnant women with decreased fetal movements
  • To determine the applicability of Ultrasonography in pregnant women with decreased fetal movements
  • To establish how Ultrasonography can be used as a predictive analysis of fetal outcome
  • To establish why Ultrasonography has unclear benefits to its use

Hypotheses

  • Ultrasonography treatment is far less effective than vibroacoustic stimulation
  • Biophysical profile is widely used than Ultrasonography
  • Ultrasonography is an effective method of predicting fetal outcomes among pregnant women with decreased fetal movements
  • Ultrasonography is a reliable method of predicting fetal outcomes among pregnant women with decreased fetal movements
  • Ultrasonography is applicable as a method of predicting fetal outcomes among pregnant women with decreased fetal movements
  • Ultrasonography works by analyzing specific variables in the fetal movement to predict fetal outcome
  • Ultrasonography has varying results on fetal outcome

Research Method and Analysis

This study will be a qualitative study because it will be an in-depth analysis of Ultrasonography as a clinical tool for predicting fetal movements in pregnant women with decreased fetal movements. It will also establish the effectiveness, applicability, reliability and the reasons for its unclear benefits. The qualitative study will establish how and why this clinical method is used.

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Data Collection

The study will incorporate a field study of fourteen medical centers that specialize in antenatal care. The head medical practitioner in each medical centre will then be interviewed using a simple questionnaire. Previous records of fetal prediction movements will be evaluated and comparisons drawn. Established records of vibroacoustic stimulation and biophysical profile will be analyzed to draw a comparison with Ultrasonography.

The sample study of fourteen hospitals will be used to obtain clinical data because the same procedures are bound to have the same effect on any pregnant mother in any other location. The structure of the interview to the medical practitioners will be very simple and easy to understand. Interviews will be used because of their prompt response and their ability to be undertaken anywhere. Data will be recorded on the questionnaires but the analysis will be done using statistical techniques to compare the effectiveness, applicability and reliability against a graph. Graphs will also be used to compare ultrasonography with vibroacoustic stimulation and biophysical profile because they are more established clinical methods. The use and procedures of using ultrasonography will be analyzed against five common reasons and analyzed on a pie chart in form of percentages.

Ethical Consideration and Justification of Systematic Review

This research project will be undertaken with professionalism and the highest form of integrity. It will respect the confidentially principle within the medical field and also refrain from infringing on doctor-patient confidentiality. Information will be obtained with free consent from the participants and their response would be undiluted. The identity of the participants will also be concealed; no attribution will therefore be made to the specific source of information or the medical centre where the information was obtained. The participation of the medical practitioners will be done purely on voluntary basis and nobody will be coerced into taking part in the research. No harm will be done on the participants either. Every detail will be undertaken at their convenience. To ensure the integrity of the research is upheld, the study will be done with impartiality and a clear conscience. No conflict of interest will be noted because the research will majorly be for academic purposes.

Timeline

The research project is expected to be undertaken within a timeframe of four months. Data collection will be undertaken within two time frames of a month each. The first seven medical centers will be analyzed within the first month and the last seven will be analyzed the following month. The data analysis will also be carried out within a month after which the final details will be undertaken during the fourth month. Synthesis of the data will also be undertaken during the fourth month.

Anticipated Results and Dissemination

The rate of ultrasonograph applicability in determination of fetus outcome is expected to be high because of its ability to visualize the fetus. This is probably one of the biggest advancement in the study of obstetrics. The ability of doctors to determine the baby’s age, gender or even detect an abnormality of the fetus is likely to increase the applicability of the method too. The fact that Ultrasonography services are widely available and probably comfortable for most pregnant women, could lead to its high applicability among patients because it doesn’t pose much discomfort.

Ultrasonography being an early form of pregnancy screening could have a therapeutic advantage over later forms of pregnancy screening which would probably treat conditions that have negatively progressed. When expectant mothers are able to see their unborn children (through screening) it is likely to be an emotional experience that would overwhelm them. This might increase the acceptance of ultrasonography among pregnant women as a method to predict the fetal outcome. The relatively lower cost of this type of treatment is also likely to influence its affordability among many patients thereby increasing its applicability within medical circles (Sergent et al, 2005).

The inferiority of ultrasonography to vibroacoustic stimulation and biophysical profile is likely to be attributed to non determined risks associated with the method. Increased use or high frequency of ultrasonography could pose some problems if used on one patient, severally. The use of ultrasonography is also used to predict fetal conditions which are normally suspected; thereby limiting its applicability to screening purposes only and not predicting the correct outcome.

Ultrasonography is expected to work through variables that might be exhibited during pregnancy to predict the fetal outcome. Some of the common variables among pregnant women with decreased fetal movements are an incorrect approximation of gestational age, probability of twins, and slow intrauterine development. These variables could directly affect the outcome of fetal movements and probably be used in ultrasonography. Other common clinical variables that could affect fetal outcome would entail: congenital anomalies (which is quite prevalent among women who have irregular antenatal checkups); macrosomia; placenta previa (which affects the supply of food and oxygen to the fetus) and fetal malpresentation (Yosida et al, 2000).

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The outcomes of ultrasonography are also likely to vary because of different diagnosis of the variable conditions of decreased fetal movement. The method is likely to be affected in terms of its sensitivity and its ability to predict fetal outcome. This would probably entail the use of sonography in determination of gestational age or congenital anomalies which would be important factors in predicting fetal outcomes.

Several mistakes are also bound to arise from projected assumptions on the effectiveness or variability of the results when the method is used universally. A variation is likely to occur from false positive diagnosis because of the screening of low prevalent patient groups. This might therefore mislead users of the research data because such groups are observed to have a low prevalence rate of fetal anomalies (Yogev et al, 2003).

The research might however experience some setbacks in the collection of information due to the unavailability of some of the medical personnel. Different patient diagnosis may also affect the end analysis of data collected because the results might be unique only to the condition of the patient. In addition, the conclusion would not show a distinction of the results between high and low risk pregnancies. Nevertheless, this paper will be a good exhibit on the study of obstetrics. It would be disseminated to a wide audience through its availability in many library shelves.

References

Froen, J. (2004) A Kick From Within – Fetal Movement Counting and the Cancelled Progress in Antenatal Care. Journal of Perinatal Medicine, 32, 13–24.

Froen, J et al. (2005) Clinical Practice Variation in Reduced Fetal Movements. Tidsskr Nor Laegeforen, 125, 2631–4.

Heazell, A et al. (2005) What Investigation is Appropriate Following Maternal Perception of Reduced Fetal Movements. Journal of Obstetrics & Gynecology, 25(7), 648-650.

Heazell, A et al. (2008) Midwives’ and Obstetricians’ Knowledge and Management of Women Presenting with Decreased Fetal Movements. Acta Obstetrics and Gynecology Scand, 87, 331-339.

Heazell, A and Froen, F. (2008) Methods of Fetal Movement Counting and the Detection of Fetal Compromise. Journal of Obstetrics and Gynecology, 28(2), 147–54.

Sergent, F et al. (2005) Decreased Fetal Movements in the Third Trimester: What to do? Gynecology and Obstetrics Fertility, 33, 861-869.

Yogev, Y et al. (2003) PGE2 Induction of Labor for Consistent Decreased Perception of Fetal Movements at Term. International Journal of Gynecology and Obstetrics, 82, 173-178.

Yosida, S et al. (2000) Prenatal Detection of High-Risk Group for Intrauterine Growth Restriction Based on Sonographic Fetal Biometry. International Journal of Obstetrics and Gynaecology, 68(3), 225-232.

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