RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING RISK FACTORS AND MANAGEMENT OF PRE-ECLAMPSIA AMONG PREGNANT MOTHERS IN BOWRING AND LADY CURZON HOSPITAL AT BANGLORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Miss. KONANKI SRAVANTHI BANGALORE CITY OF COLLEGE OF NURSING BANGALORE-560043

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MRS. KONANKI SRAVANTHI, 1ST YEAR M.SC NURSING, BANGALORE CITY COLLEGE OF NURSING, BANGALORE. BANGALORE CITY COLLEGE OF NURSING, BANGALORE M.SC NURSING, OBSTETRIC AND GYNECOLOGICAL NURSING 12-07-2010 A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING RISK FACTORS AND MANAGEMENT OF PREECLAMPSIA AMONG PREGNANT MOTHERS IN BOWRING AND CURZON HOSPITAL AT BANGLORE.

NAME OF THE CANDIDATE AND ADDRESS NAME OF THE INSTITUTION COURSE OF THE STUDY AND SUBJECT DATE OF ADMISSION

2.

3. 4.

5.

TITLE OF THE TOPIC

6. BREAF RESUME OF THE INTENDED WORK.

INTRODUCTION:The protection of the health of the expectant mother and her children is of prime importance for building of a sound and healthy nation Hypertension is one of the common complications met with in pregnancy and contributes significantly to maternal and prenatal morbidity and mortality. Hypertension is assigning of an underlying pathology which may be pre existing or appears for the first time during pregnancy. The identification of this clinical existing and effective management play a significant role in the out come of pregnancy both for the mother and the baby. In the developing countries with uncared pregnancy this entity on many occasions remains un detected till major complications supreme.(1)

Preeclampsia is a multisystem disorder of unknown etiology characterized by development of hypertension to extent of 140/90 mm of Hg or more with protenuria after the 20th week in a previously normotensive and non protenuric patient.(2)

The incidence of preeclampsia in hospital practice varies widely from 515%. The incidence in primigranda is about 10% and in multi gravida 5%. The

incidence varies from 8-10%.

Classification A. Primary 70% it includes preeclampsia, eclampsia (with convulsion).B. secondary 30% preeclampsia, eclampsia. Super imposed on chronic hypertension (25%). Preeclampsia, elampsia super imposed on chronic renal disease 5%.(3)

Urine for protenuria is one of the investigations for preeclampsia it may be trace or more. On boiling urine it becomes as solid. When 10-15 grams of protein excreted its severe & ophthalmic examination, blood values and serum uric acid level in blood >4.5 mg and serum createnine level is > 1 mg/dl and fetal monitoring.(4)

Some of the risk factors of preeclampsia are primigravida, family history of Hypertension, preeclampsia and placental abnormalities, like poor placenta (placenta not formed properly). Hyperplacentosis, placental ischemia, molar pregnancies, any immunological factors like thrombophelia.(5)

Clinical types of preeclampsia or mainly two types. 1. Mild and severe, mild preeclampsia in this sustained raise of blood pressure more than 140/90 mm of HG but <160 systolic or 110 diastolic without significant protenuria. Sever

preeclampsia in this a persistent systolic blood pressure less or equal 160 mm HG or diastolic pressure of <110 mm of HG, persistent sever epigastric pain, cerebral or visual disturbance, oliguria (<400 mm/20 HRS), protein excretion, Hemolysis, Elevated Liver Enzyme, Low platelets Syndrome, Intra uterine growth Retardation, Pulmonary edema.(6)

Path physiology of preeclampsia is reduced utero placental circulation will lead to hyperplacentosis and it will lead to increased placental pathology and it will lead to escape to trophoblast to lungs and then DIC & it will causes profibrin infiltration and they glamerulo endothelial lesions and it will lead to reduced Glomerular Filtration rate & causes sodium retention it will shift into intracellular & stimulates vasopressure substances and at last it will causes vasoconstriction.(7)

Clinical features of preeclampsia symptoms are slight swelling ankles which persist raising from bed & tightness of ring, gradually swelling extends to face abdominal wall.vulva and hole body, described sled dismissed urine output, epigastricpain , sign are abnormal weight gain with in short spasm of time before visible edema , edema, pulmonary edema, scanty, liquor.

Complications during pregnancy are Hemolysis, Elevated Liver Enzyme, Low platelets syndrome, Oliguria, Anuria, dimness of vision, eclampsia, preterm labor during labor elampsia, PPM during puperium, shock sepsis, eclampsia, fetal Intra Uterine Growth Retardation, Intra Uterine death, Asphyxia, prematurity. (8)

Medical treatment include Rest, Diet, Sodium restricted diet, Protein rich diet, adequate fluid intake. Drugs are phenobarbitione 60 mg, diazepam 5mg, Antihypertensive- methyldopa, progress chart. Duration of treatment showed is based on severity of preeclampsia, duration of pregnancy, response to treatment.(9)

Prognosis of preeclampsia is detected easy, with prompt and effective treatment the preeclamptic feature subscribe competency, if cases are left serious complications one likely to occur.(10)

Management pd preeclampsia according to group A, Group B& Group C categories for Group A regular checkup Y fro Group B careful monitoring and for Group C termination of pregnancy. Careful management during labor, giving antihypertensive drugs, I/V ergometrin, etc. and pauperism. Patient should watched carefully for attend 48 hours, hypertensive drugs.(11)

6.1 NEED FOR STUDY:

Preeclampsia or pregnancy induced hypertension is a common problem during pregnancy. Affecting up to one in seven pregnant women around the world. This condition is defined as high blood pressure and excess protein into urine after 20 weeks of pregnancy. It may also be caused toxemia. Globally preeclampsia during pregnancy is a leading cause of maternal and infant illness and death.(12)

A study was conducted in department of gynecology and Obstetrics in 2006 October in University hospital Aachaen Pawelsstr . The aim of objective of study was to investigate the role of smoking in the development of Hemolysis, Elevated Liver Enzyme, Low platelets syndrome.

Preeclampsia and gestational hypertension methods of study is questioners method and statistically analysis. The sample selected are about 2600 women results obtained are after matching age parity, nationality and education a total of 905 women are identified with hypertensive disease in pregnancy that is preeclampsia, conclusion is smoking is associated with an 80% reduction of the risk developing Hemolysis, Elevated Liver Enzyme, Low Platelets syndrome, however pregnant women acquired to quit smoking.(13)

A study was conducted in department of gynecology and Obstetrics in 2006 October in University hospital Neumaier WagnerP. The main objective or aim of study is to know the significant women or overweight during childhood as a risk factor for hypertensive disease in pregnancy. (14)

The method of study is cross sectional case control study. A self administered questionnaire study, the sample collected is about 2600 women. The result obtained was based on medical records, 766 women with hypersensitive diseases during their pregnancy. Conclusion is that history of overweight during childhood is associated with our increased risk for hypersensitive disease in pregnancy.

Based on the studies and by the personal experience of the investigator found that many women are suffering with preeclampsia during pregnancy. So the investigator would like to conduct a study regarding knowledge on perversion and risk factors of preeclampsia. (15)

Women at high risk of pre-eclampsia or pregnancy induced high blood pressure can cut the potential threat of the disorder by taking dietary supplements, claims a novel study. (16)

According to researchers, women can downsize the dangerous complications linked with hypertension during pregnancy by taking a supplement containing Larginine, an amino acid and antioxidant vitamins. Preeclampsia, a medical condition characterized by high blood pressure during pregnancy can jeopardize the lives of both mother and baby.(17)

Lead author of the study, Dr Felipe Vadillo-Ortego at National University in Mexico City stated, "We saw a very strong protective benefit for supplementation with L-arginine and antioxidant vitamins. "Of course our findings need to be confirmed. But preeclampsia is a very dangerous condition, and this appears to be a very inexpensive approach for lowering risk in high-risk women." (18)

6.2 REVIEW OF LITERATURE: Review of literature is an important source for the development of research project it helps to gain knowledge about the research problem and providing the information of what has been done previously and it helps the researcher to be familiar with the existing study and helps to develop methodology, tool for data collection and research design.

An extensive search of literature was done by the investigator to elicit factual information about risk factor and management of pre eclampsia. The related literature has been organized and presented under the following section.

1.

Review of Literature related to risk factors and prevalence of preeclampsia

2. Review of Literature related to management of preeclampsia.

REVIEW OF LITERATURE RELATED TO RISK FACTORS AND PREVALENCE OF PREECLAMPSIA: A study was conducted in department of gynecology and Obstetrics in 2006 October in University hospital Aachaen Pawelsstr. The aim of objective of study was to investigate the role of smoking in the development of Hemolysis, Elevated Liver Enzyme, Low Platelets syndrome. Preeclampsia and gestational hypertension methods of study is questioners method and statistically analysis. The sample selected are about 2600 women results

obtained are after matching age parity, nationality and education a total of 905

women are identified with hypertensive disease in pregnancy that is preeclampsia, conclusion is smoking is associated with an 80% reduction of the risk developing Hemolysis, Elevated Liver Enzyme, Low Platelets syndrome, however pregnant women acquired to quit smoking.

A study was conducted in department of gynecology and Obstetrics in 2006 October in University hospital Aachaen Pawelsstr. The main objective or aim of study is to know the significant women or overweight during childhood as a risk factor for hypertensive disease in pregnancy.

The method of study is cross sectional case control study. A self administered questionnaire study, the sample collected is about 2600 women. The result obtained was based on medical records, 766 women with hypersensitive diseases during their pregnancy. Conclusion is that history of overweight during childhood is associated with our increased risk for hypersensitive disease in pregnancy.

A study was conducted in Deportment of OBG in 2006 university of Transkei, Umtata, South Africa by Stephan H, Nordmeyer AK, Faber R. the main objective of study to determine the incidence, clinical features, complications and perinatal outcomes in patient with preeclampsia. The design is cross sectional analytical study setting in Umtata general Hospital. Results of the 16,376 deliveries were in that 760 complicated by hypertension. Conclusions of hypertensive disorders of pregnancy are a major cause of meternal and perinatal morbidity and

mortality.

Thousands of women and babies die or get very sick each year from a dangerous condition called preeclampsia, a life-threatening disorder that occurs only during pregnancy and the postpartum period. Preeclampsia and related disorders such as Hemolysis, Elevated Liver Enzyme, Low Platelets syndrome and eclampsia are most often characterized by a rapid rise in blood pressure that can lead to seizure, stroke, multiple organ failure and death of the mother and/or baby.

Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA. To review the rate, risk factors, and potential prevention of preeclampsia in women with pregravid diabetes mellitus.Detailed review of recent English literature describing pregnancy outcome in women with pregravid insulindependent diabetes mellitus (Type 1 diabetes). The primary focus of the review is risk factors for preeclampsia and potential methods suggested for prevention of preeclampsia.

In addition, pitfalls in diagnosis of preeclampsia will be emphasized.The reported rate of preeclampsia ranged from 9% to 66%. This rate increased with increased severity of diabetes by White's classification, with the highest rate reported in women with pregravid diabetic nephropathy. Risk factors identified for preeclampsia were nulliparity, chronic hypertension, microalbuminuria prior to pregnancy, nephropathy, and poor glycemic control early in pregnancy.

There is lack of agreement among reports in the literature concerning criteria used to diagnose preeclampsia. There are two randomized trials that included women with Type 1 diabetes who were randomized to receive either low-dose aspirin or placebo. There was no reduction in the rate of preeclampsia with lowdose aspirin in either trial.In women with pregravid Type 1 diabetes, the rates of preeclampsia and adverse neonatal outcome increase with increased severity of diabetes. Low-dose aspirin does not reduce rate of preeclampsia in such women. Further studies should address the role of good glycemic control prior to 20 weeks gestation and prevention of microalbuminuria.

REVIEW OF LITERATURE PREECLAMPSIA

RELATED

TO

MANAGEMENT

OF

A Department of Obstetrics and Gynecology, College of Medicine, University of Malawi. A review of literature on pre-eclampsia/eclampsia indicates that this is one of the commonest causes of high maternal and infant mortality and morbidity rates. Current information on the condition indicates that use of aspirin, phenytoin and magnesium sulphate are on the increase.

However, in Malawi lytic cocktail and use of antihypertensive such

as Hydralazine and, anticonvulsants such as Valium are currently in use. Even with this type of management, Malawi experiences high morbidity and mortality rates. This literature review was done to identify baseline data for a study to be carried out in some of the hospitals in Malawi to establish a protocol for effective management of pre-eclampsia and eclampsia in Malawi. It is hoped that after using low dose aspirin and magnesium sulphate, the morbidity and mortality caused by the disease will be reversed with time

Eclampsia is the third commonest cause of maternal mortality after haemorrhage and infection. The morbidity and mortality in eclampsia is related to the number of convulsions. The control of convulsions is, therefore, important in reducing maternal morbidity and mortality. Teaching hospitals in Southern Africa contributed to the multicentre Collaborative Eclampsia Trial, which provided the overwhelming evidence for the superiority of magnesium sulphate as the drug of choice for eclampsia. While other parts of the world have put this evidence into practice, this trend has not yet become uniform in Africa. This paper seeks to encourage African governments, teaching hospitals, the pharmaceutical industry and the regional Cochrane Collaboration Centre in South Africa to co-operate in order to facilitate the practice of evidence-based medicine in this aspect of maternal health in the region. Chatterjee A, Mukheree J.Department of Obstetrics and Gynaecology, Nil Ratan Sarkar Medical College, Calcutta, India. One hundred eclampsia patients were

admitted in this hospital from January 1993 to November 1993 and they were subjected to different anticonvulsant regimes. There were 28 patients in lytic cocktail group, 16 in diazepam group, 16 in magnesium sulphate group and 40 patients in phenytoin sodium group. The results are compared in every aspect.

Feto maternal outcome is best with magnesium sulphate regime followed by phenytoin sodium regime. They produce significantly better results than lytic cocktail and diazepam.

Repke JT, Friedman SA, Kaplan PW.Johns Hopkins Hospital, Baltimore, Maryland.Treatment of this pathophysiologically poorly understood disease is controversial. Despite this uncertainty, the goals of management of the patient with preeclampsia and eclampsia are diagnosis, stabilization, and delivery of the baby. Stabilization refers to both mother and fetus and should include the prevention of eclampsia or the recurrence of eclamptic seizures. There are empiric data supporting the use of magnesium sulfate for the management of preeclampsia and eclampsia in North America, but there are few data to support its efficacy as a classic anticonvulsant. Until controlled trials are completed, we suggest that magnesium sulfate continue to be used in preeclampsia, with the addition of established anticonvulsant medications when eclampsia occurs.

Data on established antiepileptic drugs such as diazepam and phenytoin support their use in treating patients with eclamptic seizures. As stated in an earlier review, "in treating preeclampsia, magnesium sulfate therapy may have a role and may moderate factors leading to eclampsia. Whether magnesium sulfate therapy may have some as yet unproved effect on epileptogenic foci or seizure propagation is not the important issue for the physician caring for the eclamptic patient. Until adequately designed therapeutic trials are available, it is our opinion that treatment should be based on the use of anticonvulsant drugs of established efficacy in seizure control and prophylaxis (p. 1363)."

University of California, San Diego, USA, Preeclampsia has been called a disease of theories. One theory proposes a complex relationship between nutritional imbalance and the pathophysiology of this disease. The theoretical importance of selected nutrients is considered through reference to several recent basic research studies and clinical trials. With the clinical prevention of preeclampsia as a focus, suggestions for outpatient nutritional counseling, dietary alteration, and nutrient supplementation will be offered.

As with any pregnancy, a good prenatal diet full of vitamins, antioxidants, minerals, and the basic food groups is important. Cutting back on processed foods, refined sugars, and cutting out caffeine, alcohol, and any medication not

prescribed by a doctor is essential. Talk to your health care provider before taking any supplements, including herbal preparations.

STATEMENT OF THE PROBLEM: A study to assess the effectiveness of structured teaching programme regarding risk factors and management of pre-eclampsia among pregnant mothers in Bowring and Lady Curzon Hospital at Bangalore.

6.3 OBGECTIVE OF THE STUDY:

1.

To assess the existing knowledge regarding risk factors and management of preeclampsia among pregnant mothers.

2.

To determine effectiveness of structured teaching programme regarding knowledge of risk factors and management of preeclampsia among pregnant mothers. To find association between pre & post test knowledge scores regarding knowledge on risk factors and management of preeclampsia among pregnant mothers. To associate the level of knowledge and practice with selected demographic variables.

3.

4.

1. 5.

OPERATIONAL DEFFINITIONS: EVALUATE: It refers to the evaluation of the level of knowledge regarding risk factors and management of pre eclampsia.

1.

EFFECTIVENESS: it refers to the outcomes of structured teaching programme assessed by differencing pre& Post test scores.

STRUCTURED TEACHING PROGRAMME: It refers to the system of planed instruction design to impart information in order to bring a change in knowledge regarding risk factors and management of pre eclampsia.

2.

RISK FACTORS: eclampsia.

it refers to the pre disposing factors leading to pre

3.

MANAGEMENT: It refers to measures adopted by the pregnant mothers s to manage pre eclampsia in homes. PRE ECLAMPSIA: It refers to Blood pressure more than 140/90 mm HG in pregnant women.

4.

2. 1.

ASSUMPTIONS:The pregnant mothers may have some knowledge on risk factors and management of pre eclampsia.
2.

Structured teaching programme may improve the knowledge of pregnant mothers on risk factors and management of pre eclampsia.

3.

Systematically planed health teaching programme bring about changes in the health practices of pregnant mothers.

3. 4.

HYPOTHESIS: There will be a significant relation between pre& Post test Knowledge scores of pregnant mothers. After structured teaching programme regarding knowledge on risk factors and management of pre eclampsia

6. VARIABLES UNDER STUDY: 6.6.1. DEPENDENT VARIABLE:

Knowledge of pregnant mothers regarding risk factors and management of pre

eclampsia.

6.6.2. INDEPENDENT VARIABLE:

Structured teaching programme regarding knowledge on risk factors and management of pre eclampsia

7.1 MATERIAL AND METHODS:7.2. SOURCE OF DATA:

Pregnant mothers coming to the Bowring and Lady Hospital in Bangalore.

7.3 METHOD OF DATA COLLECTION: Prepared questionnaire.

1.

RESEARCH DESIGN:-

Pre Experimental design (one group pre test-post test)

2.

SETTING OF THE STUDY:-

The study will be conducted among pregnant mothers in Bowring and Curzon Hospital in Bangalore.

3.

POPULATION:-

The study included pregnant mothers coming to Bowring Hospital for antenatal check ups.

4.

SAMPLE SIZE:- 50 SAMPLING TECHINIQUE: Convenient sampling technique.

5. 6.

SAMPLING CRITETIA: INCLUSTION CRITERIA: The pregnant mothers coming to antenatal check up in Bowring and Curzon Hospital. The pregnant mothers who are willing to participate in this study. The pregnant mothers who know English and Kannada. EXCLUSION CRITERIA:The mothers who are not willing to participating in the study. The mothers who do not know English and Kannada.

7.

TOOLS OF DATA COLLECTION:-

PREPARED QUESTIONNAIRES THIS CONSISTS OF THREE PARTS. Part one consists of objective questions to demographic data. Part two consists of questions regarding risk factors. Part three consists of Management of pregnant mothers regarding Preeclampsia.

7.3.7. METHODS OF DATA COLLECTION:-

The prepared questioner will be distributed to the subjects or interview by the investigator to the study. The data was collected through prepared questionnaire after assessment lecture to the nurses with help of flash cards and pamphlets. Doubts were clarified at the end of the teaching. Reassessment was done after 10 days by using the same questionnaire.

8.

DATA ANALAYSIS AND INTERPRETATIONS:The frequency tables were formulated for all baseline information, the

statistical test and Karl Pearsonss co-efficient of co relation was adapted to verify the specific authencity of result.

9.

DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED WITH FROM OTHER CLIENT OR ANIMAL IS TO DESCRIBE BRIFLY.

The study will be conducted in pregnant mothers in Bowring And Curzon Hospital in Bangalore.

7.3.9 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM INSTITUTES: Prior permission will be obtained from the concerned authorities of Bowring and Curzon hospital and also from the Bangalore city college of

nursing committee in Bangalore. The purpose of study will be explained to the subject related in college; scientific objectivity of the study will be maintained with honesty and impartiality.

2.

LIST OF REFFERENCE BOOKS:1. Daine M.Fraser & Margrate A.Coper, Myles text Book for Midwives ,14th Edition, 2003, Churchi living stone,Page NO.357 368
1.

David K. James, Phillip Steer, Cael. P. Weiner & Bernard Gonik, High risk pregnancy, 2nd Edition, W.B.Saunders,Page No.639 653 D.C.Dutta, Test Book of obstetrics, 6th Edition 2004, New Central Book agency (p) Ltd. Page No.221- 239.

2.

3.

B.T. Basavanthappa, Nursing research , Tappea brothers Medical publishers 1998, page No. 93-94, 127-129,153-155. Brunner and Siddarth , Test book of medical surgical nursing 10th Edition page NO.569 ,589.

4.

5.

Kothari C. R Reasearch Methodology jaipur (India) 2nd Edition new age international publication 1990 page No.91-95.

6.

Piot F. Devis & Bernodatta P. Wrangler B.P Nursing research Principles and Methods., J.B Hppincot Compeny 1987, Page No.223 225. Websters New Wand, 4th edition 2004, Wiley dream tech india pvt. Ltd., page no. 85, 793. Bailliers nurses Dictionary 23rd Edition page No.201, 3220. Joy A. Ingallis et al. maternal and Child health nursing, United states of America. Mosby year book 1987.

7.

8. 9.

10.

Drife JO, Magowan (eds). Clinical Obstetrics and Gynaecology, chapter 39, pp 367-370. ISBN 0-7020-1775-2.

11. 12. 13.

"Hypertension - Validations - Pregnancy". microlife.com. "MATERNITY GUIDE - Labor & Delivery". Retrieved 2010-01-02. "Preeclampsia and High Blood Pressure During Pregnancy : University of Michigan Health System". Retrieved 2010-01-02.

14.

World Health Organization (WHO). World health report 2005: make every mother and child count. Geneva: WHO; 2005, page 63

15.

Robbins and Cotran, Pathological Basis of Disease, 7th ed.

JOURNALS:

1.

Lind, care during pregnancy health for the millions, May June 1998, pp 29 32.

2.

Archana sinba, Nutrition and womens health: health for the Millions, December 1999, pp, 42 -43.

3.

Gridhar, expected complications in expectant mothers, health action, April 1998, pp 42- 43.

4.

vimala thakare , Maternal and child health nursing 1982 pp 76- 78.

WEB SITES

http://www.google.com

http://www.nurses.info http://www.beterhealth.vic.gov.au. http://www.helathwebsite.com

UNPUBLISHED

1. 2. 3.

Alexander, daily activities of pregnant women, 1997 New Delhi. Hob craft,antenatal care , 1993 Bombay. Villar, statics in midwifery 1998 rajastan.

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SIGNATURE OF THE CANDIDATE REMARKS OF THE GUIDE NAME OF THE DISIGNATION 11.1 GUIDE

11.2. SIGNATURE 11.3 CO-GUIDE 11.4 SIGNATURE 11.5. HEAD OF THE DEPARTMENT 11.6. SIGNATURE

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.1. REMARKS OF THE CHAIRMAN & PRINCIPAL

12.2 SIGNATURE