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A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATION, EDUCATION AND COMMUNICATION REGARDING POST PARTUM HEMORRHAGE AMONG POST NATAL MOTHERS IN SELECTED HOSPITAL AT BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
SUBMITTED BY
CHANDRAWATI CHAUHAN
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 Name of the candidate and address CHANDRAWATI CHAUHAN
Harsha Collage of Nursing,
Nelamangala,
Bangalore
2 Name of the institution Harsha Collage of Narsing,
Nelamangala, Bangalore
3 Course of the study and subject 1st YEAR M.Sc NURSING
OBSTETRICAL AND
GYNECOLOGICAL NURSING
4 Date of Admission 06/07/2009
5 Title of the topic A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATION, EDUCATION AND COMMUNICATION REGARDING POST PARTUM HEMORRHAGE AMONG POST NATAL MOTHERS IN SELECTED HOSPITAL AT BANGALORE.
.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
All women lose some blood as the placenta separates from the uterus and immediately
afterward. And women who have c-sections generally lose more than those who give birth
vaginally. But because the amount of blood in your body increases by almost 50 percent during
your pregnancy, your body is well prepared to deal with this expected blood loss.
Normal bleeding just after childbirth is primarily from open blood vessels in the uterus, where
the placenta was attached. (If you had an episiotomy or tear during birth, you may also bleed
from that site until it's stitched up.)
As the placenta begins to separate, these vessels bleed into the uterus. After the placenta
is delivered, the uterus usually continues to contract, closing off these blood vessels.
Unfortunately, some women bleed too much after birth and require special treatment. This
excessive blood loss is called a postpartum hemorrhage (PPH) and it happens in up to 6 percent
of births. Occasionally, cervical lacerations, deep tears in your vagina or perineum, or even a
large episiotomy may be the source of a postpartum hemorrhage. A ruptured or inverted uterus
may cause profuse bleeding, but these are relatively rare occurrences.
Finally, a systemic blood clotting disorder may cause a hemorrhage. (A clotting disorder
may be an inherited condition or it may develop during pregnancy as a result of certain
complications, such as severe preeclampsia or HELLP syndrome or a placental abruption.) And a
hemorrhage itself can cause clotting problems, leading to even heavier bleeding1.
Postpartum hemorrhage is defined as a loss of blood in the postpartum period of more
than 500 mL. The average, spontaneous vaginal birth will typically have a 500 mL blood loss. In
cesarean births the average blood loss rises to 800-1000 mL. There is a greater risk of
hemorrhage in the first 24 hours after the birth, called primary postpartum hemorrhage. A
secondary hemorrhage occurs after the first 24 hours of birth2.
Hemorrhage is not something that we want to think about when it comes to giving birth.
In fact, 95% of births will not have a problem with hemorrhage. However it is important to know
the risk factors for hemorrhage and discuss your personal risk factors with your doctor or
midwife
Global health experts know what it takes to address the world’s leading cause of maternal
mortality: prevent postpartum hemorrhage. Postpartum hemorrhage, or excessive bleeding after
childbirth, kills an estimated 150,000 women each year. In developing countries, where most
births occur in homes or local clinics, the interventions needed to treat postpartum hemorrhage—
emergency referrals, obstetric care, blood transfusion, and surgery—are often out of reach.
Treatment simply is not available for the majority of women3.
Defining postpartum hemorrhage (PPH) refers to amount of blood loss in execass of
500ml following birth of baby is problematic and has been historically difficult. Waiting for a
patient to meet the postpartum hemorrhage criteria, particularly in resource-poor settings or with
sudden hemorrhage, may delay appropriate intervention. Postpartum hemorrhage is traditionally
defined as blood loss greater than 500 mL during a vaginal delivery or greater than 1,000 mL
with a cesarean delivery. However, significant blood loss can be well tolerated by most young
healthy females, and an uncomplicated delivery often results in blood loss of more than 500 mL
without any compromise of the mother's condition. The addition of "a 10% drop in hemoglobin"
to the definition provides an objective laboratory measure. Signs and symptoms of hypovolemia
(lightheadedness, tachycardia, syncope, fatigue and oliguria) are also of limited utility as they
can be late findings in a young and otherwise healthy female. As a result, any bleeding that has
the potential to result in hemodynamic instability, if left untreated, should be considered
postpartum hemorrhage and managed accordingly.
Postpartum hemorrhage can be divided into 2 types: early postpartum hemorrhage,
which occurs within 24 hours of delivery, and late postpartum hemorrhage, which occurs 24
hours to 6 weeks after delivery. Most cases of postpartum hemorrhage, greater than 99%, are
early postpartum hemorrhage. With many women delivering outside of hospitals and early
postpartum hospital discharge being a growing trend, postpartum hemorrhage that presents to the
emergency department may be either early or late4.
The POPPHI team works closely with a range of partners to share information and,
ultimately, increase use of the prevention measures. For example, the project is working with the
International Federation of Gynecology and Obstetrics and the International Confederation of
Midwives to promote AMTSL among their member associations, which include both physicians
and midwives. Working with other partners—particularly Rational Pharmaceutical Management
Plus (RPM Plus) and Access to Clinical and Community Maternal, Neonatal, and Women’s
Health Services—the project is also identifying opportunities to create synergies and maximize
impact5.
High-quality evidence suggests that active management of the third stage of labor reduces
the incidence and severity of PPH. Active management is the combination of (1) uterotonic
administration (preferably oxytocin) immediately upon delivery of the baby, (2) early cord
clamping and cutting, and (3) gentle cord traction with uterine countertraction when the uterus is
well contracted (ie, Brandt-Andrews maneuver).
6.2 NEED FOR THE STUDY
“Every minute around the world 380 women become pregnant, 190 women face
unplanned or unwanted pregnancies, 110 women experience pregnancy related complications, 40
women have unsafe abortions, 1 woman dies.”
The World Health Organization states that every minute, at least one woman dies from
complications related to pregnancy or childbirth – that means 529 000 women a year.
Unavailable, inaccessible, unaffordable, or poor quality care is fundamentally responsible.
Postpartum hemorrhage accounts for of 34% and 31% of women dying from
complications related to pregnancy or childbirth in Africa and Asia, respectively. The primary
intervention shown to reduce the incidence of postpartum hemorrhage is active management of
the third stage of labor (AMTSL).[iv] A safe, cost-effective, and sustainable intervention and a
practice that can save facilities money, according to studies conducted in Guatemala, Vietnam,
and Zambia[v],[vi].The International Confederation of Midwives (ICM) and the International
Federation of Gynecology and Obstetrics (FIGO) issued two joint statements in 2003 and 2006
stating that every woman should be offered active management of the third stage of labor as a
means of reducing the incidence of postpartum hemorrhage6.
Although accountable for only 8% of maternal deaths in developed countries, postpartum
hemorrhage is the second leading single cause of maternal mortality, ranking behind
preeclampsia/eclampsia. Globally, postpartum hemorrhage is the leading cause of maternal
mortality. The condition is responsible for 25% of delivery-associated deaths, and this figure is as
high as 60% in some countries. International initiatives to improve outcomes have invested in
training birth attendants (traditional or otherwise) and nurse midwives on the active management
of the third stage of labor (the period immediately after delivering of the infant). Most efforts
focus on uterine atony, which is the primary cause of postpartum hemorrhage. This has included
education on manual techniques to increase uterine contraction-retraction and making
pharmacologic uterotonic agents (oxytocin and misoprostol) more available.
world health organization estimate that, of the 529000 maternal death occurring every
year, 136000 or 25.7 % take place in India where two third of maternal death occur after
delivery, post partum hemorrhage being the most commonly reported complication and leading
cause of death ie 30%7.
In the first study by Sadeghi and colleagues, among 18 134 women undergoing delivery,
141 patients with postpartum hemorrhage were identified in Tehran’s Akbarabadi and Firoozgar
hospitals. This represents a frequency of 1%. Of these occurrences, 90% occurred in patients
undergoing normal spontaneous vaginal delivery and 10% in patients undergoing Cesarean
section. About two-thirds of cases of postpartum hemorrhage occurred in the first and second
pregnancies. While 91% of cases were early cases of postpartum hemorrhage, 9% were late.
Approximately two-thirds of cases of postpartum hemorrhage were mild, and one-third was
either moderate or severe. The etiologies of postpartum hemorrhage in this study were uterine
atony (38%), retained products of conception (38%), lacerations (8%), prolonged stage 3 of labor
(4%), puerperal infection (1.4%), uterine rupture (1.4%), placenta accreta/increta (1.4%),
hematoma (1.4%), etc8.
Two cases of postpartum hemorrhage among 5601 patients undergoing delivery in
Tehran’s Arash hospital between 2001 and 2002. Here, a frequency of 1.3% postpartum
hemorrhage was observed over 3 years. The most common etiologies were uterine atony (60%),
lacerations (23%) and retained products of conception (16%). Of those patients with postpartum
hemorrhage, 77% and 70%, respectively were between 20 and 35 years of age and between 38
and 40 weeks of gestational age. Nulliparity and multiparity were almost evenly distributed, and
two-thirds of patients underwent normal spontaneous vaginal delivery, in contrast to 32% who
underwent Cesarean section. Four patients delivered macrosomic babies (5.4%). Multiple
gestation was present in two patients (2.7%) but polyhydramnios was present in only one of
them. One patient had a previous history of postpartum hemorrhage. The duration of labor was
normal in 88% of patients, prolonged in 11% and short in 1%. One-third of patients were
induced by oxytocin and no induction method was used in the remaining two-thirds9.
The United States Cesarean rate in 2004 was 29.1%. Look at the sharp comparison with
the farm according to farm midwifery centre the birth completed at home is emergency transport
of delivery is 1.3%, vaginal birth is 98., cesarean section is 2% , the cases with preeclamsia is
1%, the cases with post partum hemorrhage is 2%10.
The maternal mortality ratio (MMR) in Africa is at crisis level. African women of
reproductive age have the highest death risk from maternal causes in the world, with an average
of 830 deaths per 100,000 live births. As it currently stands, the United Nations Millennium
Development Goal to reduce maternal mortality in Africa by 75 percent by 2015 is a far-reaching
target11
Maternal mortality is high (281/100,000). Demographic Health Survey (2006), almost
half of which is a result of postpartum hemorrhage (PPH)12.
This study describes the results of Morbidity and Performance Assessment (MAP)
conducted to provide insight into the medical factors contributing to maternal and newborn
morbidity and mortality in a rural district of northern India, and to use these insights to develop a
locally appropriate, community-based safe motherhood program The MAP study was based on
verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a
family member) participated in the study. This article describes a subsample of women who
reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor
knowledge of danger signs; poor problem recognition during labor, birth, and the immediate
postpartum period; and a low level of health seeking that was consistent with poor recognition.
Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs
were generally not associated with problem recognition and health seeking. The case fatality rate
was 4%. These findings suggest an urgent need to understand the phenomenon of problem
recognition and to integrate this into the design of interventions to reduce delays in health
seeking13
A study conducted on trends in postpartum hemorrhage in high resource countries and a
review and recommendations from the International Postpartum Hemorrhage in collaborative
Group researchers reviewed available data sources on the incidence of PPH over time in
Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was
available, the incidence of PPH was stratified by cause.The results of the study was observed an
increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the
USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to
immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage
in Australia, Canada, the UK and the USA14
Most studies quote an incidence of around 5%,15 but a figure of 12% of vaginal deliveries
was recorded in one Australian tertiary referral hospital.16
The Active Management of the Third stage of Labour; prophylactic oxytocics should be
routinely used in the third stage of labour as they decrease the risk of PPH by 60%17 For most
women syntometrine ( ergometrine 0.5mg with 5mg.i.u oxytocin) is the drug of choice. Oxytocin
alone (10i.u) is preferred by some clinicians in women with hypertension.
Postpartum hemorrhage (PPH) is the main cause of maternal mortality. Yet, even though
solutions have been identified, governments and donor countries have been slow to implement
programs to contain the problem. While poverty and low educational level remain the underlying
cause of PPH, the current literature suggests that active management of the third stage of labor
can prevent it. The International Confederation of Midwives (ICM) and the International
Federation of Gynecology and Obstetrics (FIGO) are attempting to address the chronic PPH
crisis by educating their members on best practices and on troubleshooting where resources are
inadequate. Some studies found oxytocin to be preferable to misoprostol in settings where active
management is the norm. However, secondary clinical effects may prove more troublesome with
oxytocin than with misoprostol, and misoprostol may prove to be more practical and equally
effective in low-resource settings. Two new interventions are also proposed, the anti-shock
garment and the balloon tamponade18
Severe bleeding after childbirth is the largest cause of maternal mortality, accounting for
at least one-quarter of maternal deaths worldwide. An estimated 550,000 women die every year
of maternal causes. Among these, an estimated 125,000–150,000 deaths are from PPH. In Asia,
PPH contributes to an even higher proportion of maternal mortality, and some countries report
that as many as 45% of maternal deaths are linked to PPH19.
All the study shows that hemorrhage during the labour is more common. But blood lose more
than 400 ml, leads to more complication that should be prevented. So postnatal mothers have
knowledge, motive the researcher to do this study.
6.3 REVIEW OF LITERATURE
Review of related literature is an integral component of any study or research project. It
enhances the depth of the knowledge and inspires a clear insight into the crux of the problem.
Literature review throws light on the studies and their findings reported about the problem under
study
A study conducted on the impact of primary postpartum hemorrhage in "near-miss"
morbidity and mortality in a tertiary care hospital in North India. Aim was to assess risk factors,
mortality and "near-miss" morbidity in early PPH.: Retrospective analysis of 178 women with
early PPH (within 24 h of delivery) over 4 consecutive years in a tertiary care hospital in North
India. All case sheets of patients identified by labor record registers as having early PPH were
reviewed by the same person to identify the actual impact of condition. The data was analyzed
by chi-square analysis. Conclusion was both "near-miss" morbidity and mortality in early PPH
reflect the level of obstetric care in the developing world. These need to be reduced by
strengthening peripheral delivery facilities, active 3rd stage management and early referral20
A study conducted on Prevalence and risk factors for obstetric haemorrhage in 6730
singleton births after assisted reproductive technology in Victoria Australia. This retrospective
cohort study compared the prevalence of ante partum hemorrhage (APH), placenta praevia (PP),
placental abruption (PA) and primary. post-partum hemorrhage (PPH) in women with singleton
births between 1991 and 2004 in Victoria Australia: 6730 after IVF/ICSI, 24 619 from the
general population, 779 after gamete intrafallopian transfer (GIFT) and 2167 non-ART
conceptions in infertile patients. Risk factors for haemorrhages in the IVF/ICSI group were
examined by logistic regression. Conclusions of the study was obstetric hemorrhages are more
frequent with singleton births after IVF, ICSI and GIFT21.
A study explained trends in maternal mortality due to hemorrhage This study analysis of
records of over a period of 20 years from April 1982 to March 2002 reveals that it was a
contributory cause of maternal mortality in 19.9% of cases. The majority of deaths, (65%) had
occurred within 24 hours of admission and in 47.5% of cases there was severe anaemia on
admission; 17.5% had died due to an atonic PPH, which was the largest category, followed by
ruptured uterus (15%), abruptio placenta (15%) and retained placenta (12.5%). Deaths due to
obstetric haemorrhage because of a ruptured uterus, retained placenta and abortion have
decreased from 22.22% between 1982 and 1987 to zero in the last 5 years and an increase
was seen in deaths due to haemorrhage because of gestational trophoblastic neoplasia and
ectopic pregnancy, from 1.69% to 4.87%, unclassified haemorrhage 1.96% to 7.31% and
placenta praevia from zero between 1982 and 1987 to 4.87% between 1997 and 200222
This study was conducted in a sub divisional hospital of eastern Himalayan region among
5,273 pregnant women over a period of 8 years. There were 29 deaths, the maternal mortality
rate was 55 per 10,000. Septic abortion was encountered in 4 among them. Direct obstetric cause
was responsible in 72.41% of cases and indirect cause in 27.59% cases. Sepsis, both puerperal
and postabortal resulted in 24.14% followed by postpartum haemorrhage in 20.69%. Two of
these cases were associated with inversion of the uterus. Preeclampsia caused 10.34% and
eclampsia 6.9% of the deaths. Among the indirect causes severe anaemia and pulmonary
tuberculosis accounted for 10.34% and 6.9% respectively. Infective hepatitis was the cause in
6.9% cases. Only 17% of the cases were booked and the rest were unbooked. Majority of the
cases (62.07%) belonged to the age group of 20-30 years. Primigravida constituted 41.38% of
the cases23.
An article explained in a 10-year retrospective study of maternal deaths at RA Kar
Medical College, Calcutta there were 651 maternal deaths with 410 in first 5-year period and 241
in second 5-year period. The leading causes of deaths were due to abortion, toxaemia,
haemorrhage (antepartum and postpartum) and jaundice in pregnancy. Direct causes were
responsible for death in 77.6% cases, indirect causes in 17.5% cases and unrelated causes in
4.9% cases. Majority (557) were unbooked and mostly multigravida (434) cases. Most of them
(251) were in the age group of 20-25 years. Haemorrhage was the single most common cause to
claim 188 lives. It was also noted that 155 deaths occurred within 12 hours of hospital
admission24.
A study investigated the risk factors for postpartum hemorrhage among Saudi women.
Objective of the study was to identify health-related risk factors for the development of post
partum hemorrhage (PPH) in Saudi women and to estimate the incidence of primary
A case-control study was conducted between July 1, 2007 and June 30, 2008 at King Abdulaziz
Medical City, Riyadh, Saudi Arabia. One hundred and one patients with PPH and 209 control
patients were included. Bivariate associations between the different risk factors for the
development of PPH were studied. Multivariate logistic regression analysis to identify significant
risk factors for the occurrence of this obstetrics complication was carried out Conclusion of the
study was risk factors for developing PPH among Saudi women are comparable to other reported
studies with a greater influence of parity, presence of APH, multiple gestation, CTG
abnormalities and prolonged third stage of labor. There is a need for patient education on family
planning and antenatal care, physician education on active management of the third stage, and
correct estimation of blood loss25.
An article explained on B-Lynch Brace Suturing in primary post-partum hemorrhage
during cesarean section. Primary atonic post-partum hemorrhage during lower segment cesarean
section, which was not controlled by ecbolics--oxytocin, methylergometrine, 15-methyl-
prostaglandinF2alpha--was managed by applying a B-Lynch Brace Suture. The test of potential
efficacy was the control of hemorrhage by bimanual uterine compression. Six primigravida
patients at their term gestation, who underwent emergency cesarean section, all except one under
spinal anesthesia, received this type of suture. Interestingly, in every case hemorrhage was
controlled successfully with the compression suture. None of them received blood or blood
products transfusions or developed disseminated intravascular coagulopathy. Postoperative
recovery was good and all patients are in follow-up to assess their future reproductive activity.
B-Lynch Brace Suturing is an invaluable procedure for the control of atonic primary post-partum
hemorrhage following cesarean delivery26
A study explained the Hypo gastric artery ligation for post-partum hemorrhage Objective
of the study was bilateral ligation of hypo gastric arteries (BLHA) experience in the post-partum
hemorrhage management. Retrospective study conducted between January 2001 and December
2008. Researcher collected all the patients who had undergone a BLHA in case of post-partum
Hemorrhage Conclusion of the study was BLHA is an interesting and effective option in the
management of severe post-partum hemorrhage. Technique learning is recommended especially
in case of non availability of uterine artery embolization27.
A study conducted on Arterial balloon occlusion of the internal iliac arteries for treatment
of life-threatening massive postpartum hemorrhage in a series of 15 consecutive cases. Objective
of the study was to evaluate arterial balloon occlusion of the internal iliac arteries for treatment
of life-threatening massive postpartum hemorrhage. Retrospective cohort study at a tertiary
referral perinatal centre in a teaching hospital in the Netherlands. All patients who delivered in
this hospital between January 1998 and January 2008 were included in the study. A retrospective
analysis of all cases of postpartum hemorrhage was performed. All 15 consecutive cases of
massive postpartum haemorrhage were selected from an electronic database. The patients with
massive postpartum haemorrhage (blood loss>5000ml) and the patients with postpartum
haemorrhage treated with arterial balloon occlusion of internal iliac arteries were analyzed.
Conclusion of the study was arterial balloon occlusion of the internal iliac arteries is a safe and in
most cases effective procedure for treatment of massive life-threatening postpartum
hemorrhage28.
A study investigated Benefit of misoprostol for prevention of postpartum hemorrhage in
cesarean section Objectives of the study was to assess the benefit of sublingual misoprostol in
addition to standard oxytocin in the prevention of post-partum hemorrhage at caesarean section.
This was a prospective randomized controlled clinical trial conducted from March to June 2007
at our department of obstetrics-Sousse-Tunisia, including 250 single low risk pregnant women
undergoing caesarean section at gestational age>32 weeks gestation. Patients were randomly
assigned to receive at cord clamping either sublingual 200microg misoprostol (Cytotec) with
20UI intravenous oxytocin (Oxytocin): bolus 10UI and infusion 10UI in 500ml Ringer Lactate):
Group I, or only oxytocin at the same dose: Group II. The main outcome was total blood loss
assessed by decrease in perioperative hematocrit. Secondary outcomes included measured
collected blood loss; drop in hemoglobin level, additional oxytocin, side-effects and
postoperative complications. Conclusions of the study was sublingual misoprostol (in addition to
oxytocin) is effective in prevention of post-partum hemorrhage at caesarean sections when
compared to oxytocin alone, without major side-effects.
Larger studies are needed to confirm our results29.
STATEMENT OF THE PROBLEM
“a study to evaluate the effectiveness of information, education and communication
regarding post partum hemorrhage among post natal mothers in selected Hospital at
Bangalore.”
6.4 OBJECTIVES OF THE STUDY
1. Assessing the knowledge regarding post partum hemorrhage among post natal mothers in
terms of pretest.
2. Evaluate the effectiveness of information, education and communication regarding post
partum hemorrhage by comparing pretest score on post test knowledge score
3. Find out the association between knowledge score on post test knowledge score and
selected demographic variables.
6.5 OPERATIONAL DEFINITIONS
1) Effectiveness: Refers to the extent to which the information, education and
communication on post partum hemorrhage has achieved the desired effect in improving the
knowledge of post natal mothers as assessed by structured questionnaire
2) Information, Education and Communication: Refers to systematically planned group
instructions by lecture cum discussion method designed to provide information regarding
post partum hemorrhage such as meaning, causes, diagnosis, clinical manifestation, treatment
and prevention
3) Post Partum Hemorrhage: refers to amound of blood lose in excess of 500 ml following
birth of baby.
4) Post Natal Mother: Refers the interval extending from the birth of the baby and till 6
weeks after.
5. Evaluation: Evaluation is the process of determining what extent the educational
objective are being realized.
6.6HYPOTHESIS
H1: There is a significant deference in the knowledge score on post partum hemorrhage in the
post test knowledge score than the pretest knowledge score among post natal mothers.
H2: There is a significant association between knowledge score and demographic variable
6.7 ASSUMPTION
The post natal mothers will have inadequate knowledge regarding post partum
haemorrhage
The planned teaching programme improves the knowledge of mothers regarding post
partum haemorrhage.
6.8 PROJECTED OUTCOME
The structured teaching programme will enhance post natal mother’s knowledge
regarding post partum haemorrhage
6.9 DELIMITATION
The data collection period is limited to 6 weeks
Assessment of knowledge is measured by one observation only
Teaching strategy is delimited to lecture method only
6.10 VARIABLE
Dependent variable of this study is the knowledge of post natal mothers regarding post
partum haemorrhage
Independent variable is information, education and communication on post partum
haemorrhage
Demographic variables in this study are Age, education, occupation, religion, and
family income, number of delivery, number of death, number of live children, type of
family and source of information.
7MATERIALS AND METHODS
The study is designed to determine the effectiveness of information, education and
communication on prevention of post partum haemorrhage among post natal mothers
in selected Hospital at Bangalore.
7.1METHOD OF COLLECTION OF DATA
SAMPLING TECHNIQUE
7.1SOURCE OF DATA
All mothers aged 20-35 in selected Hospital at Bangalore.
7.1.1RESEARCH APPROACH AND DESIGN
On experimental study of one group pre-test and post test design with evaluative approach.
7.1.2SETTING OF THE STUDY:
The study will be conducted the selected Hospital at Bangalore.
7.1.3POPULATION
The population of the study composed by all post natal mothers aged 20-35in selected
Hospital at Bangalore.
7.2METHODS OF DATA COLLECTION:
By self administered questionnaire.
7.2.1SAMPLING PROCEDURE.
These samples will be selected by simple Random sampling technique.
7.2.2SAMPLE SIZE
The proposed sample size of the study is 60 mothers.
SAMPLING CRITERIA
7.2.3INCLUSION CRITERIA
Post natal mothers who are willing to participate.
Post natal mothers who are present at the time of data collection.
7.2.4 EXCLUSION CRITERIA
Post natal mothers who are not understand Kannada or English
Post natal mothers who are not willing to participate
7.2.5 TOOL FOR DATA COLLECTION
Tool for data collection in the study is structured knowledge questionnaire. It consist two
part, part 1 and part 2.
Part 1 – items on demographic variable like Age, education, occupation, religion, and
family income, number of delivery, number of death, number of live children, type of
family and source of information.
Part 2 – structured knowledge questionnaire to elicit knowledge of post natal mothers
regarding post partum haemorrhage
7.2.6PROCEDURE FOR DATA COLLECTION
The data will be collected with the prescribed time period in selected hospitals.
Permission will be obtained from higher authorities
Purpose of the study will be explained to the respondents
Pre test will be conducted using structured knowledge questionnaire. Subsequently
information, education and communication will be given on the day.
On the seventh day post test will be conducted. Proposed data collection period will
be 30 days.
7.2.7METHOD OF DATA ANALYSIS AND INTERPRETATION
The researcher will use appropriate statistical technique for data analysis and present in
the form of tables and diagrams. Knowledge will be assessed by frequency and percentage
distribution. Level of knowledge will be assessed with mean and standard deviation.
Association between demographic variables and knowledge on postpartum hemorrhage will
be assessed with chi square test.
7.2.8DURATION OF STUDY
Duration of study of this study is 30 days.
7.2.9 PROJECTED OUTCOME
The information, education and communication will enhance post natal mothers
knowledge regarding post partum hemorrhage.
7.3 Does the study require any investigation to be conducted on the patient
or other human beings or animals?
NO.
7.4 ETHICAL CLEARANCE
The main study will be conducted after approval of the research committee.
Permission will be obtained from the concern head of the institution. The purpose and
after details of the study will be explained to the study subjects and as informed
concerned will be obtained from them. Assurance will be given to the study subject on
the confidentiality of the data selected from them.
Information consent will be taken from nurses who are willing to participate in the study
8. BIBLIOGRAPHY
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postpartum hemorrhage: frequency, etiologies and risk factors in Tehran’s Arash Hospital
between 2001 and 2003. Tehran University of Medical Sciences, 2005 450
10. http://www.naturalbirthandbabycare.com/farm-statistics.html
11. http://www.news-medical.net/news/2006/03/27/16912.aspx
12. http://www.jsi.com/NFHP/Docs/TechnicalBriefs/
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9 Signature of candidate
10 Remarks of the guide
11 Name and designation of (in block letters
11.1 Guide
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
12 12.1 Head of the Department
12.2 Signature
13 13.1 Remarks of the Chairman or
Principal
13.2 Signature
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