Rajiv Gandhi University of Health Sciences, KarnatakaCurriculum Development Cell

CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Registration No. : 05_N199_13790Name of the Candidate : Seema.c

Address : #23, papaiah Garden, Diagonal Road, Near Chanammanakere Achakattu Bus Stop, BSK 3 rd stage, Bangalore 560085

Name of the Institution : Shushrutha College of Nursing, BangaloreCourse of Study and Subject : MSc Nursing in OBGDate of Adimission to Course : 03/06/2009

Title of the Topic

: A study to assess the knowledge on "Risk Factors in Pregnancy" among primigravid antenatal mother in selected maternity hospital, at Bangalore with a view to develop an information pamphlet.

Brief resume of the intended work : Attached

Signature of the Student :

Guide Name : Mrs. Annie Annal

Remarks of the Guide : The topic is relevant & it will help to improve the knowledge of primigravid antenatal mother on Risk factors in pregnancy

Signature of the Guide :

Co-Guide Name : Signature of the Co-Guide :

HOD Name : Mrs. Annie AnnalSignature of the HOD :

Principal Name : Mr. NagarajPrincipal Mobile No. : Principal E-mail ID :

Remarks of the Principal

:

Principal Signature :

Ms. SEEMA. C

1ST YEAR M. Sc NURSING

SUSHRUTHA COLLEGE OF NURSING

BANGALORE- 560 085.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

Ms. SEEMA. C1ST YEAR M. SC NURSINGSUSHRUTHA COLLEGE OF NURSING# 23, PAPAIAH GARDEN, DIAGONAL ROAD, NEAR CHANAMMANAKERE ACHAKATTU BUS STOP, BSK 3RD

STAGE, BANGALORE- 560 085.

2 NAME OF THE INSTITUTION

SUSHRUTHA COLLEGE OF NURSING# 23, PAPAIAH GARDEN, DIAGONAL ROAD, NEAR CHANAMMANAKERE ACHAKATTU BUS STOP, BSK 3RD

STAGE, BANGALORE- 560 085.

3 COURSES OF STUDY AND SUBJECT

1st YEAR MASTER SCIENCE IN NURSING OBSTETRIC & GYNEACOLOGY OF NURSING.

4 DATE OF ADMISSION

03-06-2009

5 TITLE OF THE TOPIC

A STUDY TO ASSESS THE KNOWLEDGE ON “RISK FACTORS IN PREGNANCY” AMONG PRIMIGRAVID ANTENATAL MOTHER IN A SELECTED MATERNITY HOSPITAL, AT BANGALORE WITH A VIEW TO DEVELOP AN INFORMATION PAMPHLET.

SYNOPSIS OF THE PROEJECT

6.0 BRIFE RESUME OF THE INTENDED WORK

Pregnancy - “A Precious gift offered by the nature that gives meaning to “Womanhood”.

6.1 INTRODUCTION

Every family looks forward to a healthy pregnancy and to the birth of a healthy newborn. And, for the vast majority of women, pregnancy follows a fairly routine course. But, for some, there may be unexpected difficulties and challenges along the way with a high-risk pregnancy.1

Having a high-risk pregnancy means that a woman has a greater chance of complications because of conditions in her pregnancy, her own medical status or lifestyle, or due to external factors. Many times, complications are unexpected and may occur without warning. Other times, there are certain risk factors that make problems more likely.2

National Institute of Child Health and Human development defines high risk pregnancy as mother or women increased changes for having a high risk pregnancy because of genetic background, existing medical condition their lifestyle, or factors that may develop with the pregnancy3

While many complications are unavoidable, with the help of your physician, you can minimize your risks and work toward the healthiest pregnancy possible. Fortunately, advances in technology have helped improve the care of both mothers and unborn babies. Being as healthy as possible before becoming pregnant, and getting early and regular prenatal care during pregnancy, are important ways to take the best care of you and your developing baby.4

Every pregnancy has some risks, but there are more dangers to your health and the health of your fetus with a high risk pregnancy. The causes can be conditions you already have or conditions you develop. They also include being pregnant with more than one baby, previous problem pregnancies, or being over age 35.5

If you have a chronic condition, you should talk to your health care provider about how to minimize your risk before you get pregnant. Once you are pregnant, you may need a health care team to monitor your pregnancy. Examples of common conditions that can complicate a pregnancy include:6

e.g., Heart disease, High blood pressure, Diabetes.

Other conditions that can make pregnancy risky can happen while you are pregnant – for example, gestational diabetes. Good prenatal care can help detect and treat them.7

Identifying potential risks of a pregnancy is an important part of preconception care. Some women have increased chances for having a high-risk pregnancy because, of genetic background, existing medical conditions, their lifestyle, or factors that may develop with the pregnancy. e.g., anemia, substance use (cigarettes).8

6.2 NEED FOR STUDY

Risk factors in pregnancy playing a major role in public health problem and contributing significantly to prenatal and maternal morbidity and mortality in developing countries. This problem mainly occurs due to inadequate knowledge and antenatal care, low level of communication, poor socio-economic status.9

If these problem not identified with antenatal mother when she is carrying it will be leading to cause the complications of mother and fetus. So through the study we can came to know the risk factors of antenatal mother and how its causing complication to her pregnant in international, national, state, and district level by educating the antenatal mother, providing treatment, promotion of health care, the mother could have knowledge on high risk in pregnancy.

A study was conducted a study in west Bengal on maternal death were collected in the year of 1986-2008 over a 20-year period. The purpose of the study is to reduce the maternal mortality. An overall mortality rate of mortality ration (MMR) was 599.3 per 1, 00,000 live births. Deaths due to direct causes are still the leading cause. After ongoing efforts to improve the maternal morbidity, and have been fall in the maternal mortality was very low.10

A retrospective study was conducted in 2000 august to July 2001; the study took place in the government general hospital. The purpose of study is to compare obstetric outcomes of pregnancy in teenagers and old women. The study incidence was an annual delivery rate over 3,500, the older women is 3,326 it was compared with teenage pregnancies. They have concluded the study can prevent the incidence and complications in this risk group.11

A face-to-face survey study was conducted in 2004-2005 9 nation in Latin America. The study examined pregnant women’s for use of cigarettes and other tobacco products and the exposure of pregnant women. It was found that pregnant women commonly reported that cigarette smoking 78.3%. They have concluded study with pregnant women’s tobacco use and second hand smoking exposure are current or emerging problems in several low-and middle income nations. After ongoing efforts to improve maternal and child health.12

All the above studies were conducted in international, national, state, and district level to identify the risk factors during pregnancy. For reducing the risk during

primigravid antenatal period mother has to get provision of adequate health care, adequate health education. This all are necessary for the quality of pregnancy care. Earlier detection and prompt referral for appropriate treatments are vital to minimized the complication in pregnancy and ensure the safe delivery. This need particular attention in midwifery education during pregnancy.

6.3 REVIEW OF LITERATURE

Definition

Review of literature provides valuable to help in the development of knowledge of research project. A review of literature is an essential aspect of scientific research. One of the major review of literature is to ascerting what is already know relation to the problem of the interest and this help in developing a broad conceptual framework in to which a research will fit.13

Review of literature for this study has been organized under each following headings.

Studies Related to maternal Age. A study was conducted for a period of 6years to analyze knowledge, age

factors causing some of the complication during pregnancy and it was found that proportion of teenage mother (12-17years) progressively decreased by 91,699.14

Studies Related to maternal height.

Retrospective cohort study was conducted on women carrying singleton pregnancies in a Chinese south Asian population at queen Mary hospital, they assessed the knowledge about maternal height, found that 16,384 women who delivered with this period 25th , 50th, 75th percentile values of maternal height were 150cm. 156cm, 160cm. There was significantly increased incidence of preterm birth between 32 and 37weeks gestation in women with shorter stature.15

Studies Related to maternal Weight.

A study was conducted on obesity which represents a rapidly increasing epidemic amongst pregnancy patient in Mc Ewin hospital Australia in 2009. They aimed to prepare a comprehensive overview of maternal and prenatal outcome in overweight, obese pregnancy patient. They result was with normal BMI-100, there were overweight-100, obese-110 1st 6 month of 2006. They included measures for were at increased risk for preexisting morbidity and requiring medication.16

Studies Related to Socio-economic relationship between antibiotic

A case control study was conducted on socio-economic status relationship between antibiotic, done and found the incidence of 868 control women. They conclude that socio-economic status during pregnancy result in low birth weight babies & findings suggested antibiotics use for better birth outcome.17

Studies Related to Maternal anemia

A study was conducted on anemia among primigravid antenatal mother in national and district level. Where they found the incidence of 6,923 anemic mother and the prevalence of anemia range from 33% to 89% among pregnant women. The purpose of the study was to assess the status of mother’s knowledge on anemia. The result of the study showed that 84.9% of pregnant women were anemic. They conclude that any intervention strategy for this population must address not only the problem of iron deficiency but also deficiencies of micronutrients.18

Studies Related to maternal diabetes or GDM

This study was conducted on gestation diabetes mellitus at siriraj hospital Thailand. They found the incidence of 162 mothers, who were diagnosed with GDM and who received treatment over a period of 2 years at hospital. They have concluded that GDM risk condition can cause increased maternal and fetal risk.19

Studies Related hypertension in pregnancy.

A study was conducted in 2007 on hypertension in pregnancy at Chandigarh, India, among 25 identified women over a period of 10 years. The objective of the study was to assess the knowledge about pregnancy outcome in mother with chronic hypertension in pregnancy. They conclude that hypertension I pregnancy is associated with small number of cases reflects the lack of antenatal supervision in developing countries.20

Studies Related to Maternal Heart Diseases and Pregnancy

This study was conducted on heart disease in pregnancy for a period of 10 years in a maternity hospital at Australia. The incidence of the study was 93 women with cardiac disease in 1996-2006. They concluded that heart disease risk conditions can effectively characterize women in which pregnancy is associated with appreciably increased maternal & fetal risk 21

Studies Related to Previous Pre-term Birth and Abortion

A study was conducted on previous preterm birth & abortion. The incidence of the study included 42,269 1st singleton births in 1998-2003. They concluded that previous preterm and abortion during pregnancy are preventable risk factor for preterm baby.22

Studies Related to Next Birth After a First Cesarean Delivery.

A retrospective cohort study was conducted in all singleton, second birth in the south Australian hospital, data collection was done by comparing the outcome of 8,725 women who underwent a cesarean delivery for their 1st birth, with 27,313 who underwent a vaginal delivery 1st birth. Finally the study has concluded that, cesarean delivery is associated with increased risks for adverse obstetric and prenatal outcome in the subsequent birth. 23

Studies Related to Substance use (Cigarettes and Tobacco)

Cigarettes

A prospective birth cohort study was conducted at mother’s hospital among children at the age of 21 years. The study involved 7,223 singleton children whose mother were enrolled 1st antenatal visit to the mother hospital. They concluded that smoking during pregnancy resulted in offspring being more likely to have dependence or withdrawal at 21 years that offspring of mothers who never smoked. 24

6.4 PROBLEM OF STATEMENT

A study to assess the knowledge on “Risk Factors in Pregnancy” among primigravid antenatal mother in a selected maternity hospital, at Bangalore with a view to develop on information pamphlet.

7.4 OBJECTIVES OF THE STUDY

The main objectives of the study are to identify the assess knowledge of nursing students in Nursing college at Bangalore.

Identify:

To assess the knowledge of primigravid antenatal mother regarding risk factors in pregnancy.

To develop an information pamphlet an selected group on risk factors in pregnancy.

To find out the association between the knowledge and selected demographic variables.

6.4.2 HYPOTHESIS

a) alternative hypothesis(H):-

There will be a significant association between the knowledge on high risk in pregnancy among primigravid antenatal mother and the selected demographic variables.

b) Null hypothesis (Ho):-

There will not be a significant association between the knowledge on the high risk in pregnancy among primigravid antenatal mother and the selected demographic variables.

6.4. 3 OPERATINAL DEFINITIONS

ASSESS

It refers to evaluation or judgment of primigravid antenatal mother knowledge on risk factors in pregnancy.

KNOWLEDGE

Refers to correct answer given by primigravid antenatal mother on risk factors in pregnancy.

RISK FACTORS IN PREGNANCY

A risk pregnancy means that a woman has a greater chance of complications because of conditions in her pregnancy, her own medical status or lifestyle, or due to external factors. Many times, complications are unexpected and may occur without warning. Other times, there are certain risk factors that make problems more likely

PRIMIGRAVID ANTENATAL MOTHER

Refers to the primigravid antenatal mothers who are conceived 1st time and going to deliver the primi baby in admitting as patient at selected maternity hospital.

INFORMATION PAMPHLET

A concised form of information related to knowledge on risk factors in pregnancy

6.4.4 RESEARCH VARIABLE

6.4.4.1 INDEPENDENT VARIABLE

Demographic variables such as age, gender, religion, previous health information regarding high risk factors in pregnancy.

6.4.2.2 DEPENDENT VARIABLE

Knowledge on risk factors in pregnancy.

6.4.5 ASSUMPTION

Primigravid antenatal mother who are admitting may have moderate knowledge.

6.4.6. DELIMITATIONS

The study is limited to the primigravid antenatal mother admitting in selected maternity hospital.

7.0 MATERIAL AND MTHODS

7.1 SOURCES OF DATA

Primigravid antenatal mother those who are admitting in the selected maternity hospital will be sources of the data.

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7.2 METHOD OF COLLECTION OF DATA

The data will be collected by using structured interview technique (schedule).

7.2.1 RESEARCH DESIGN

Descriptive method.

7.2.2 RESEARCH APPROACH

Quantitative approach.

7.2.3 RESEARCH SETTING

Study will be conducted in selected maternity hospital at Bangalore.

DURATION OF STUDY

Study will be conducted for a period of 6 weeks.

7.2.4 POPULATION

The populations of the present study consist of primigravid antenatal mother in selected maternity hospital.

7.2.5 SAMPLE SIZE

The sample of the study consists of 80 numbers of antenatal mothers who are primigravid women in selected maternity hospital.

7.2.6 SAMPLE TECHNIQUE

Convenient sampling technique.

7.2.7 SAMPLING CRITERIA

Inclusion criteria

Primigravid antenatal mother who are willing to participate in the study.

Primigravid antenatal mother who are admitting in that selected maternity hospital.

Primigravid antenatal mother who are available during the period of data collection.

Exclusive criteria

Primigravid antenatal mother who are not participate in the study.

Primigravid antenatal mother who are not available during the study.

7.2.8 TOOL FOR DATA COLLECTION

The data collection toll consists of two parts, part I and part II

PART I

Items on demographic variables like age, previous health information regarding risk factors in pregnancy, religion.

Part II

Question to assess the knowledge on risk factors in pregnancy.

7.2.9 DATA ANALYSIS METHOD

Data analysis will be through descriptive statistics and inferential statistics.

DESCRIPTIVE STATISTICS

Frequency, percentage, mean, median, mode, standard deviation will be used.

INFERENTIAL STATISTICS

Chisquare (X2) test will be used to find out the association between the test knowledge scores will selected demographic variables.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON NURSING STUDENTS OR OTHERS?

Yes: a questionnaire will be used to assess the knowledge on risk factors in pregnancy.

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

Permission will be obtained from research committee of Sushrutha College of nursing, Bangalore-85.

Permission will be obtained from the authorities of selected maternity hospital, Bangalore.

Consent will be obtained from the primigravid antenatal mother

who are participating in the study.

8.0 REFERENCES:

BOOK REFERENCE

1. Helen Varney “Nurse Midwifery”, Jones and Bartlett Publishers, London. 1999

2. Dutta D.C. “Text book of obstetrics”, Calcutta, New central book agency, 2004.

3. Churchill living stone Myles “Text book for midwifery”, London.2007.

4. Tank D.K. Usha Krishna “pregnancy at risk current concepts”, New Delhi, jaypee brothers publications 1997

5. Thresyamma C.P “A Guide to midwifery students”, New Delhi Jaypee brothers publications, 2007

6. Annammajacob “A comprehensive Text Book of Midwifery” New Delhi, Jaypee Brothers Publication 2008.

7. Dr. B.T.Basavanthappa, “Text book of Midwifery & Reproductive Health Nursing, New Delhi, Jaypee brothers publication, 2008.

8. Mathai M.Clin obstetrical gynaecology, 2009.

9. Ebeigbe PN, Igberase GO. “Maternal mortality”. 2007, medline.

10. Sudip chakravarti, Shirish N Daftery “Mannual of obstetrics”. Jaypee brothers, New Delhi, 1997.

11. Society of Gynaecology and Obstetrics of Nigeria (SOGON) a needs assessment report June 2004

12. Denise F. Polit, “Nursing research” Library of Congress, New York, 2003

13. WHO Coverage of maternity care. AA Maternal mortality in a Nigerian teaching hospital:A continuing tragedy Trop J Obstetrics Gynecology 2004;21:S8

14. Myers Rp, Gregor PJ Yee the effectiveness of hepatitis a vaccination in patients with chronic helpatitis C 2000

15. Neilsen GA Bodsworth NJ, A vaccination of hepatitis in human immunodeficiency virus-infected 1997.

JOURNALS REFERENCE

1. Ms. K.K. Kulani, ‘The Nursing Journal Of India’, July 2004, volume 1

2. William osler ,‘ Nurse Of India’, August 2004. Volume 1 3. William osler ‘Indian Journal Of Nursing and Midwifery’, June 2002. Volume 2

16. William osler ,‘Nightingale Nursing Times’, 2005. Volume 2

17. Mrs. Reddemma ,‘Nursing Times’, 2006. Volume 1

18. Mrs. Reddemma, ‘Nightingale Nursing Times’2008. Volume 1

19. Hoofnagle JH. Hepatitis C: the clinical spectrum of disease. Hepatology 1997; 26:15S-20S. Volume 2

20. Huemer HP, Prodinger WM, Larcher C, Most L, Dierich MP. Correlation of hepatitis C virus antibodies with HIV-1 seropositivity in intravenous drug addicts. Infection 1990; 18:122-3. Volume 2

21. Eskild A, Magnus P, Petersen G, Sohlberg C, Jensen F, Kittelsen P, Skaug K. are associated with more rapid progression. Aids 1992; 6:571-4. Volume 2

Weblieography

14. www.pubmed.gov.in

15. www.britishnursingindex.com

22. www.maternitiy&Infant care

23. www.medline

24. www.book@ovid

9. Signature of the Student :

10. Remarks of the Guide : The topic is relevant and it helps to enhance the

knowledge of primigraviid antenatal mother

regarding risk factors in pregnancy

11. Name and Designation of Guide: Mrs. Annie Annal

Vice PrincipalSushrutha College of NursingB.S.K 3rd StageBangalore.

11.1 Guide Name & Address : Mrs. Annie Annal

Head of the DepartmentObstetric and Gynecological NursingSushrutha College of NursingB.S.K 3rd StageBangalore.

11.2 signature of Guide

11.3 Head of the Department: Mr. Annie AnnalHead of the DepartmentObstetric and Gynecological Nursing

11.4 Signature of HOD

12.1 Remarks of The Principal

12.2 Signature of The Principal