3.

SUBJECT AND AIMS OF THE RESEARCH

3.1. Subject of the research

To study the influence of the increased body mass index (BMI) before pregnancy and
the increased body mass index (BMI) during pregnancy, on the way and the result of the
delivery.

3.2. Aims of the research

The aims of the research are the following:

1. To study the association between the increased value of the body mass index during
pregnancy and the values of the Apgar score;
2. To study the influence of the increased body mass index on the way and the result of
the delivery;
3. To study the influence of the socio-demographic characteristics of the pregnant
women, the number of childbirths, the number of abortions, previous operations, the
gestation week of the delivery on the way and the result of the delivery in relation to
the body mass index.

4. METHODOLOGY OF RESEARCH (MATERIAL AND METHODS)

4.1. Research design

A cross-sectional study will be performed with a perspective approach to the research.

4.2. Sample

All of the women, who will give birth during the period from 01.10.2016 to
31.12.2016 at the maternity ward at the hospital in Kavadarci, will be included in this
research.

The women included in this research will be divided into groups according to Abrams
and Parker: women with normal weight with body mass index of 20 – 25; moderately
overweight women with body mass index of 25 – 30, and very obese women with body mass
index above 30.

According to the previously registered childbirths at the hospital in Kavadarci, during

the next period of three months, I expect that there will be approximately 150 deliveries.

4.2.1. Selection criteria (for admission and selection of patients)

The selection of the respondents will be performed according to predetermined

inclusive and exclusive criteria.
- Inclusive criteria:

 All the pregnant women with term delivery more than 37 gestation weeks at the
hospital in Kavadarci during the period of 3 months;
 All the pregnant women with identical foetus;
 All the pregnant women who gave birth with cephalic presentation (head-first
presentation)

- Exclusive criteria:

 All the pregnant women who had childbirth before their expected terms;
 All the pregnant women with multiple gestation;
 All the pregnant women who gave birth with breech presentation

The amount of kilograms that should be gained during the pregnancy depends on the
individual body mass index (BMI). By dividing someone’s weight with the multiplied height,
we get the result i.e. the value of the body mass index (BMI).
The weight of the pregnant woman before pregnancy ________________ kg
The height of the pregnant woman _____________ m
Body mass index (BMI)/ (height x height) = ________________ kg/m2

4.3. Instrument of research

A special questionnaire for this kind of research will be prepared with all the
necessary parameters which will note the demographic characteristics and the obstetrical
history of the patients. The completion of the questionnaire will be conducted with the
assistance of the researcher. The questioning of the patients will be anonymous and with the
concurrence of the respondent and a guaranteed privacy of the results and the comments.

The questionnaire consists of 26 questions which are grouped into several parts:

Demographic characteristics, containing 4 questions (age, place of birth, the degree of

education, work status)
Social characteristics, containing 2 questions (marital status, number of children)
Life habits, containing 3 questions (smoking, drinking alcohol, addiction diseases)
Obstetrical history, containing 17 questions (the number of births, the number of
abortions, the weight of the pregnant woman before pregnancy, the weight of the pregnant
woman before the delivery, the height of the pregnant woman, the increase of the weight
during pregnancy, the body mass index before pregnancy, the body mass index before the
delivery, single or multiple gestation, the outcome of the delivery – live or stillborn child, the
way of giving birth, cephalic (head-first) or breech presentation; gestation week of the
delivery, the weight of the newborn child, the height of the newborn child, gender (sex), and
the Apgar result of the of the newborn child in the first and the fifth minute – with the pulse
of the five parameters, the breathing, the reflex, tone and colour. The value of each parameter
is 0,1 and 2.
4.4. Approval

In order to conduct this research, the director of the hospital in Kavadarci was asked
for an approval. This approval was gained after the given explanation for the purposes of the
research and the inspection of the questionnaire.
Furthermore, all the patients included in this research were asked for giving an
approval. It was established that all of the patients were willing to do this research, without
any compulsion. The aims of this research will be thoroughly presented to all the participants,
and they will be given a guarantee of confidentiality and anonymity for the given
information.

5. STATISTICAL PROCESSING

The data obtained during the research will be analyzed with statistical programs
Statistica 7.1 for Windows and SPSS Statistics 21.0.
The following methods will be used:
1. Percents of structure (%) will be determined for the series with attributive
characteristics (place of residence, degree of education, work status, social characteristics,
number of abortions, previous operations, the outcome of the delivery, the way of giving
childbirth);
1.1. Pearson Chi-square test, Exact Fisher test / Monte Carlo Sig (2-sided), Exact Fisher
test (2x2) will be used in order to test the associations/differences at the series with attributive
characteristics;
2. Descriptive Statistics (Mean; Std.Deviation;±95,00%CI; Minimum; Maximum)
will be prepared for the series with numeric characteristics (age of the pregnant women,
weight of the pregnant women before pregnancy, weight of the pregnant women before the
delivery, height of the pregnant women, weight gaining during pregnancy, BMI, gestation
week of the delivery, weight and height of the newborn child, Apgar score);
2.1. The distribution of the data will be tested with: Kolmogorov-Smirnov test;
Lilliefors test; Shapiro-Wilks test (p);

2.2. The differences at the series with numeric characteristics in relation to BMI &
Apgar score, BMI & weight and height of the newborn child, will be tested with Analysis of
Variance (F), Post-hoc / Turkey HSD test (p);

2.3. The impact of the socio-demographic characteristics of the pregnant women, the
number of childbirths, the number of abortions, previous operations, gestation week of the
delivery on the outcome will be analyzed by using the Logistic regression analysis (Wald /
Exp(B) / 95,0% CI for Exp(B).
The significance will be determined by p<0,05.
The data will be shown in tabular and graphic display.
 6. EXPECTED RESULTS

After the statistic processing of the data, it is expected to obtain the prevalence of
the newborn children who suffered from the syndrome of low apgar result, as well as to
determine the influence of the weight gaining during pregnancy on the Apgar result of the
newborn child in the first and the fifth minute. I expect to receive results about the relation
between the increased body mass index at pregnant women on the way (vaginal: spontaneous,
stimulated, and induced, or operative: forceps, vacuum or caesarean section) and the outcome
of the childbirth (live or stillborn child). I also expect that the results of this research will help
in the suppletion of the scientific perceptions for the weight gaining at pregnant women and
its influence on the way and the outcome of the delivery in the Republic of Macedonia. I
hope that health authorities will gain benefits from this results for the initiatives of the further
creations of the health policy. I also expect that this research will be a spur for further similar
researches about this topic.
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 ANNEX 1

QUESTIONNAIRE

Demographic characteristics:

1. Date / Year of birth: ________________

2. Place of residence: Town / City Village

3. Degree of education:
No education Primary Secondary post secondary High

4. Work status:
Student Employed Unemployed

Social characteristics:

1. Marital status:

Married Single Extra-marital affair Divorced

2. Number of children:

No children 1 2 3 4 5 more than 5

Life habits:

1. Do you smoke cigarettes? yes no

2. Do you drink alcohol? yes no

3. Addiction diseases: yes no

Obstetrical anamnesis (medical history):

1. Number of deliveries: 1 2 3 4 5 or more than 5

2. Number of abortions: AA ______ CA _______

3. Weight of the pregnant woman before pregnancy: ___________ kg

4. Weight of the pregnant woman before the delivery: ____________ kg

 5. Height of the pregnant woman: ____________ m

6. Weight gaining during pregnancy: ______________ kg

7. Body mass index (BMI) before pregnancy: ________________ kg/m2

8. Body mass index (BMI) before the delivery: ______________ kg/m2

9. Gestation: Single Multiple

10. Outcome of the delivery: Live Stillborn

11. Way of delivery:

Vaginal: spontaneous stimulated induced

Operative: instrumental vacuum forceps Caesarean section

12. Presentation: cephalic (head-first) breech

13. Gestation week of the delivery: _____________

14. Weight of the newborn child: ________________ gr

15. Height of the newborn child: _________________ cm

16. Gender / Sex: Male Female

17. APGAR: 1-st minute 5-th minute

Pulse: 012 012

Breathing: 012 012

Reflex: 012 012

Tone: 012 012

Colour: 012 012

Total: _______ _______

The approval was given by: Made by:

_______________________ Dr. Borche Sivakov

(signature)