Effectiveness of Ultrasound inDiagnosis of Placental Abruption
Savitri S. Mills
Nova Southeastern University
Effectiveness of Ultrasoundin Diagnosis of Placental Abruptions
Placental abruption is thecomplete or partial separation of the placenta prior to delivery. Ithas known as one of the major reasons of vaginal bleeding during thelast half of pregnancy. The main symptoms of the condition arebleeding and pain but clinical diagnosis may show varying symptoms.It is estimated that between 0.5% and 1% of all pregnancies aroundthe globe are made complex by placental abruption (Oyelese andAnanth, 2006). The condition has been identified as one of theleading causes of perinatal mortality and maternal mortality, withabout a third of perinatal deaths and 10% of preterm births comingabout as a result of placental abruption. There are several riskfactors for placental abruption, but the main causes of the conditionremains unknown (Ananth et al, 2006). To minimize cases of maternalmortality and perinatal mortality, early analysis and detection ofthe placental abruption is important. The current study seeks toanalyze the effectiveness of ultrasound in the diagnosis of placentalabruption. The overall research question that the study seeks to findanswers to is how effective is ultrasound in the diagnosis ofplacental abrasion?
Importanceand Significance of the Problem
Cases of placental abruptionare steadily rising in both the developed and the developing world.Being one of the major reasons for the occurrence of maternalmortality and perinatal mortality, the detection of the condition andearly management are important. There are several methods and waysthrough which placental abruption can be diagnosed. The current studyseeks to identify whether utilization of ultrasound alone iseffective compared to combining other approaches including evaluationof the patients history, sign and symptoms and speculum examination.
Elsasser etal. (2010)investigate the relationship between clinical findings andhispathological findings in the diagnosis of placental abruption.They point out that placental abruption is an important obstetricalcondition and that despite this it has no joint method of analyzingand treating it clinically. Elsasser etal. (2010) reportthat the relationship between clinical and pathologic criteria fordiagnosis of the abruption is poor and that sonographicvisualization of abruption, evidence of retroplacental clots, orbleeding in the vagina which often is followed by less assuring fetalstatus or uterine hypertonicity should be utilized in diagnosis formore accurate results. Glantz and Purnell (2002) investigate thesensitivity and specificity of sonography in the discovery ofplacental abruption. They point out that sonography is not effectivein the diagnosis of placental abruption and that a positiverelationship exists between more aggressive management and worseneonatal outcome.
Placentalabruption was more common in older women of lower socio-economicstatus in the past, but lifestyle changes have led to the occurrenceof the condition across different ages of women irregardless of theirsocial classes. Continuous abuse of substances such as cocaine,benzoylmethylecgonine and some alkaloids has been reported as beingthe main contributors to placental abruption. Additionally, patientswho have a history of placental abruption are at a greater risk ofhaving the condition recur in subsequent pregnancies (Yeo et al,2008). Oyelese and Ananth (2006) are of the view that it is importantfor the management of placental abruption to be individualized on acase by case basis.
The main hypothesis:ultrasounds are more likely to identify placental abruption than Partial thromboplastin time. The dependent variable in the hypothesisis number of placental abruption cases identified while theindependent variable is the type of diagnostic tool used. Theeffectiveness of ultrasound relies on the additional approaches usedsuch as blood count and fibrinogen level. The control variable isthe quality of images produced, user experience, stage of abruptionand/or patient condition/body habitus.
The target population for thestudy is all women who are at 24 weeks of gestational age or later inSt Petersburg Florida, US? The condition being analyzed specificallyaffects pregnant women meaning that the target population is limitedto this group.
Purposeful sampling would beutilized in this study. This technique is utilized when researchersare of the view that by observing or interviewing a certain group,most information would be obtained. Prior to carrying out of thepurposeful sampling, the researcher will create a list of theattributes that the participants need to have in relation to thestudy objectives. Typical sampling, which involves the selection ofa sample that reflects the average individuals, would be utilized inthe study. The critical goal of purposeful sampling is to aim on thespecific characteristics of the population which the researcherharbors interests. One of the advantages of purposeful sampling isthat it eliminates those participants who do not meet the inclusioncriteria from the sample size. Additionally, it is relatively cheapand not time-consuming compared to other sampling methods. However,the approach is prone to biasness on the part of the researcher andmakes it difficult for the representativeness of the sample to bedefended. Participants will be sourced from a high risk OB center inSt Petersburg.
The sample under investigationwill include women who are at 24 weeks of gestational age or later. Atotal of 120 women will be included in the study. They will be placedinto 4 different groups of 30 members each with the main factorsconsidered in this grouping including normalpregnancy, high blood pressure (preeclapmsia), motor vehicle accident(trauma) as well as smokers and substance abusers.The sample would include women of varying ages and race to analyzewhether the effectiveness of the ultrasound varies with race and age.There are a number of problems that are anticipated in contacting andmeasuring the sample. Since it involves human participants, the needto ensure that all ethical issues are adequately addressed mightprove challenging. Additionally, it might be hard to get the requirednumber of participants to agree to participate in the study.
ExternalValidity and Considerations
The current study will beconducted in a developed country. This means that the findings canonly be applied to settings within developed countries. Thedifferences in the social, economic and environmental factors betweenthe developed and developing countries mean that the findings cannotbe generalized to the wider public. Ok good
Effectiveness would bemeasured based on the number of correct diagnosis that the differentcombinations of diagnosis approaches as well as ultrasound wouldachieve. Approaches that would attain many correct diagnoses wouldhave better outcomes compared to those that attain less correctdiagnosis. Therefore with our independent variable be it use ofultrasound one would measure its effectiveness in detectingabruption of >/= 24 week pregnant women who present to theemergency room with lower back pain, bleeding and tightening of theabdomen. Of these women would we say ultrasound was effective,some-what effective or ineffective in the detection of abruption.
The current study wouldutilize interviews and observation as the main qualitativetechniques. With observations, the participants subjected todifferent screening approaches would be closely observed. Observationof patients whereby abruption is not detected with ultrasound andfurther taken to the operating room and therefore abruption isdetected will be noted. Observations should be systematic, subjectto checks and balances and should address the specific researchquestions if time permits, in order for it to be considered as aneffective data collection tool. In the current study, the researcherwill make clear his intentions to observe the participants.Additionally, the researcher will participate in the activities ofthe research setting. This will make it possible for a goodrelationship to be established between the researchers and theparticipants. Descriptive field notes will be used as the mainmethods of recording the observations
In the semi-structuredinterviews, the participants and the researcher will take part informal interviews after such findings are achieved via clinically orsonographically. The researcher will develop a set of guidingtechniques and questions that would guide the whole interviewprocess. It is an effective method when the chances of meeting withthe participants for a second time is limited and when the populationunder study is scattered hence necessitating sending out more thanone interviewer. This data collection approach will precede theobservational method. This will allow the researcher to come up withthe appropriate set of questions to guide the interview. Open-endedquestions will also be included in the guide in order to facilitatethe gaining of further insight into the topic under discussion. Theinterviews will be tape-recorded after which the transcripts of thetapes would be obtained for analysis.
Designand Procedures Section
A cross sectional survey wasutilized with the participants being subjected to different screeningapproaches. Observation of patients whereby abruption is not detectedwith ultrasound and further taken to the operating room and thereforeabruption is detected was noted. The survey was distinct andsystematic in nature.
To ensure validity, theobservations made were systematic, subject to checks and balances andthe researcher ensured that the specific research questions wereaddressed in order for it to be considered as an effective datacollection tool. Theresearcher also develops a set of guiding techniques and questionsthat guides the whole interview process. The techniques developedwould adhere to SMART objective. This would address the issues suchas biases that might arise during the semi-structured interviews.
In carrying out the study, theresearcher will make known his objective. This would then be followedby studying of the individuals (respondents). First, the study willbegin by carrying out observations of the respondents. Throughobservations, the participants are subjected to different screeningapproaches would be closely observed. Observation of patients wherebyabruption is not detected with ultrasound and further taken to theoperating room and therefore abruption is detected will be noted. Observations are to be systematic, subject to checks and balances andshould address the specific research questions for it to beconsidered as an effective data collection tool. The observationswould then be followed by semi-structured interviews. Theparticipants and the researcher will take part in formal interviewsafter such findings are achieved via clinically or sonographically.In doing this, the researcher then develops a set of guidingtechniques and questions that would guide the whole interviewprocess. Results of the study would then be made via both methods andnoted down. Validity and reliability of the data would then betested. The study would then embark on the discussions of thefindings which are then followed by conclusion and recommendation.
Fundingand Data Sources
Some of the organizations thatwe have enlisted to fund our research includes Medical ResearchCouncil, European Research Council, The Leverhulme Trust,Biotechnology and Biological Sciences Research Company, and ThrasherResearch Fund.
Looking at the variousresearch funding organizations, the grants guidelines are rather thesame. First, the researcher must define their willingness to embarkon a research and be ready to be fully engaged in the researchproblem. The researcher should have a minimum of graduate degree withPhD being integral as well. If the individuals applying for thefunding are less experienced then they need to do it in collaborationwith a more senior colleague. Demonstration of full engagement withthe research is mandatory. The applications include MICA with a dulycompleted Project Partner section submitted as part of theapplication. The duration as well as the terms of the funding isdefined by the grantor.
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