dissertation proposal - rajiv gandhi university of health...
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DISSERTATION PROPOSAL
“A STUDY TO EVALUATE THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF
ANTENATAL MOTHERS DIAGNOSED WITH MILD PREGNANCY
INDUCED HYPERTENSION IN A SELECTED HOSPITALS IN
BANGALORE AT KARNATAKA”.
SUBMITTED BY
MS. VIJAYALEKSHMI.H
I YEAR M.Sc. NURSING
OBSTETRICS AND GYNAECOLOGY
SMT.LAKSHMI DEVI COLLEGE OF NURSING
BANGALORE (RURAL)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATIONANNEXURE-II
6.0 BRIEF RESUME OF THE INTENDED WORK:
1. NAME OF CANDIDATE AND ADDRESS
MS. VIJAYALEKSHMI.H1ST YEAR M.Sc NURSINGOBSTETRICS AND GYNAECOLOGYSMT.LAKSHMI DEVI COLLEGE OF NURSING
2. NAME OF THE INSTITUTE SMT.LAKSHMI DEVI COLLEGE OF NURSING.
3. COURSE OF STUDY AND SUBJECT
M.SC. NURSING IN OBSTETRICS AND GYNAECOLOGICAL NURSING
4. DATE OF ADMISSION TO THE COURSE
5.TITLE OF THE TOPIC
‘’A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME OF ANTENATAL MOTHERS DIAGNOSED WITH MILD PREGNANCY INDUCED HYPERTENSION IN A SELECTED HOSPITAL IN BANGALORE AT KARNATAKA’’.
INTRODUCTION
“The key to growth is the introduction of higher dimensions of consciousness of into
our awearness”
Chinese philosopher
Pregnancy is a one of the wonderful and noble service imposed by nature, no
women can shrink. Pregnancy is a special event. Pregnancy is the period of happiness
expectancy, excitement, anxiety and fear. Pregnancy is natural physiological event.
Pregnancy is a process which places the health of the mother at risk.
In the life cycle, a female has to undergo various stages like daughter, wife,
mother, mother in law and grandmother. Among these one of the most beautiful and
memorable event is becoming a mother. Safe mother hood is an essential factor for all
women. Maternal mortality is an important index for monitoring the progress of safe
motherhood programmes. But unfortunately maternal mortality rate of India is one of the
highest in the world, 308/100000. Pregnancy and child birth related complication is the
major cause of death among women in their reproductive age group. Around 5,
29,000 women die each year from maternal causes, and for every women who dies, 20 or
more suffer from injuries, infection and disabilities during pregnancy or child birth.1
Most of the women may not have many problems during pregnancy, but some
are not lucky, they face various problems related to pregnancy and child birth. The
success of child birth depends on the cooperative effort from mother, family and health
care professional.
Hypertensive pregnancy has been documented as acomplication of pregnancy
for centuries but its aetiology remains absure to date.The occurance of fits in pregnant
women has been documented as early as 4th century B.C.by Hippocrates(O’Dowd
&Philipp,1994),hence the condition terms ECLAMPSIA, a greek word which literelly
means “ Shine Forth”, depictiang an abrupt development.It was also recognised that
hypertension and albuminuria a herald the onset of fits in these pregnant women as such
the term PRE-ECLAMPSIA was devised.2
Blood pressure is the force of blood pushing against blood vessel walls. The
heart pumps blood into the arteries (blood vessels) that carry the blood throughout the
body. High blood pressure, also called hypertension, means that the pressure in the
arteries is above the normal range Pregnancy Induced Hypertension which may also be
called pre-eclampsia, toxemia, or toxemia of pregnancy is a pregnancy complication
characterized by high blood pressure, swelling due to fluid retention, and protein in the
urine
Hypertensive disorders of pregnancy are the prime causes for early
hospitalization, labour induction, maternal and foetal morbidity and mortality. Though
perfect remedy is not available it is possible to minimize the hazards through early
detection and prompt action. Effective health education about hypertensive disorder helps
the pregnant women to take care of herself and to have a better child birth. So that it can
reduce the further complication which may ultimately effect on the foetus and mother.
Pregnancy Induced Hypertension (PIH) affects approximately one out of every 14
pregnant women. Although PIH more commonly occurs during first pregnancies, it can
also occur in subsequent pregnancies. PIH is also more common in pregnant teens and in
women over age 40. Many times, PIH develops during the second half of pregnancy,
usually after the 20th week, but it can also develop at the time of delivery or right after
delivery.
PIH can prevent the placenta (which gives oxygen and food to your baby) from
getting enough blood. If the placenta doesn't get enough blood, baby gets less oxygen and
food. This can cause low birth weight and other problems for the baby. Most women who
have PIH still deliver healthy babies. A few develop a condition called eclampsia (PIH
with seizures), which is very serious for the mother and baby, or other serious problems.
Fortunately, PIH is usually detected early in women who get regular prenatal care, and
most problems can be prevented.
The primary aim is to monitor the mother and the fetus closely. This may require
hospital admission. Pre-eclampsia can, in severe cases, influence the placental function
and diminish the flow of nourishment and oxygen to the fetus, which will slow its
growth. Antihypertensive medicines of different groups are often used to reduce blood
pressure. If the woman's condition deteriorates and the fetus is at risk, the only solution is
to deliver the baby either by induction of labour or by performing a Caesarean section.3
6.1 NEED FOR THE STUDY
A study conducted in Calcutta identified the fact that 53.02% of maternal
mortality associated with pregnancy is due to Pregnancy Induced Hypertension effecting
both mother and foetus.
Hypertension is a complication of pregnancy and is a leading cause of maternal and infant morbidity and mortality. Pre-eclampsia or eclampsia may predispose the antenatal mothers towards lethal complication such as cerebrovascular accident, hepatitis, acute renal failure, abruption placenta, disseminated intravascular coagulation, cerebral haemorrhage.4
It also contributes to intrauterine foetal death and perinatal morbidity, placental
insufficiency, abruptio placenta and intrauterine growth restriction. Providing safe and
effective care for high risk client require a joint effort from all members of health care
team, with each member contributes unique skills and talents to provide optimal
outcomes for mother and infant.
In USA pre-eclampsia maternal morbidity is 12-15%,maternal mortality rate 9-
11%.In UK pre-eclampsia maternal morbidity is 15-18%,maternal mortality rate 10-12%.
In India pre-eclampsia maternal morbidity is 15-23%,maternal mortality rate 15-17%.In
this it shows that India has the highest incidence in pre-eclampsia maternal morbidity &
mortality rate.
In USA eclampsia maternal morbidity is 15-21%,maternal mortality rate12-
15%.In UK eclampsia maternal morbidity is 11-13%,maternal mortality rate 10-12%. In
India eclampsia maternal morbidity is 16-21%,maternal mortality rate 12-15%.5
A study was undertaken to assess the knowledge of primigravida women and
found that they had knowledge deficit in all the learning need areas under warning signs
and symptoms and prevention of Pregnancy Induced Hypertension. The study highlights
that need for structured teaching on self care for women with pregnancy induced
hypertension in a clinic to enable early identification and prevention of complication
contributing to safe motherhood. The Finding showed that the post test score of
experimental group was significant and (P<0.05). The findings showed that women in the
experimental group gained better knowledge on prevention of Pregnancy Induced
Hypertension than the control group. 6
A study was conducted to determine the effect of health education in enhancing
the self-care agency of pregnant women and to define the role of their background
characteristics in the success of this education.The success of given education was
measured by pre and post-test that were applied before and after health education using
“self care agency scale”. After the health education the self-care agency scores of
pregnant women increased significantly P<0.05. It was defined that pregnant women with
the least self-care agency score before health education, displayed the best progress after
the education. 7
A familial factor has been documented in the pathogenesis of Pregnancy Induced
Hypertension for several years.A familial gene factor predisposition for Pregnancy
Induced Hypertension has documented that genetic factors contribute to its
development.Studies have also established a 3 to 4 fold increase in the incidence of
Pregnancy Induced Hypertension in 1st degree relative of affected women.8
The investigator during her first year clinical placement in selected Hospital
observed that many antenatal mothers were admitted to the hospitals due to Pregnancy
Induced Hypertension. Statistics obtained from the health record of Hospital point out
that 50% of antenatal mothers are admitted in their first trimester of pregnancy and
among them 25% it suffering from pregnancy induced hypertension related
complications. This percentage is quite alarming and high in fast growing city of
Bangalore. Professional experience of the investigator also showed that majority of
pregnancy induced hypertension related high risk pregnancies are preventable if they are
receiving adequate information regarding it. Hence the investigator felt the need for
developing an effective structured teaching programme on Pregnancy Induced
Hypertension among antenatal mothers.9
6.2 REVIEW OF LITERATURES
A review of literature on the research topic makes the researcher familiar with the
existing studies and provides information , which helps focus on a particular problem lay
a foundation upon which to base new knowledge . it creates accurate picture of the
information found on the subject.
A study was conducted on women attending antenatal care in Saudi Arabia on
Maternal risk factors and perinatal outcome in Pre -eclampsia. Data was collected from
27,787 pregnant women. The findings of the study showed that 685 women that is 2.47%
were diagnosed as having Pre-eclampsia among whom a high proportion (42%) were
nulliparous women. Similarly, Pre-eclampsia was encountered at a high percentage
(40%) in women at the extreme of their reproductive age (< 20 and >40 years), and more
women with pre-eclampsia delivered prematurely (30.2%) as compared to healthy
records (13.5%). It was concluded more maternal and neonatal complications were
encountered in antenatal mothers with Pre-eclampsia. 10
A study was conducted in Tianjin Medical University to determine the risk factors
of Pregnancy Induced Hypertension in 3205 women and 219 cases were found to have
Pregnancy Induced Hypertension. Data was collected by using a questionnaire. An
increased incidence was seen in parity. Family history of hypertension 8.955(95%),
weight gain during pregnancy 3.062 (95%), number of natural abortions 8.955 (95%),
were related to risks of Pregnancy Induced Hypertension. Study shows that antenatal
mothers with advanced age, family history of hypertension, number of natural abortions
weight of pregnancy is necessary to strengthen the screening programme in the
prevention strategy. 11
An evaluative study was conducted to find out the effectiveness of self-
instructional module on pre-eclampsia and its self-care management among Pregnancy
Induced Hypertension mothers. An interview schedule was used to collect data from 30
pre-eclamptic mothers. The findings showed a difference between Pre-test and Post-Test,
Knowledge score (‘t’ = 43.43) of Pre-eclamptic patients. This showed that self teaching
was very effective in patients about Pregnancy Induced Hypertension. 12
A study conducted in medical college in Kozhikode showed that 95% of
antenatal mothers were unaware of Pregnancy Induced Hypertension. The findings of the
study showed that a significant difference between pre-test and post-test knowledge
scores of experimental group (t=19.18, P≤ 0.0001).
The experience of pregnancy for women with Pregnancy Induced Hypertension
(PIH) is compared to the experience of women with a normal pregnancy course in order
to gain insights into the development of PIH and possible strategies for prevention and
care. This study was performed as a retrospective investigation of 21 women - 10 with
PIH and as control group 11 with uncomplicated pregnancies between 5 and 13 months
after delivery by means of an interview relating to their experience of pregnancy. The
interviews with women with PIH revealed a significantly more conflict-shaken
pregnancy, often unplanned and undesired. 13
A retrospective observational study was conducted to determine risk factors
for eclampsia among Japanese women with singleton pregnancies among patients with
and those without eclampsias who were registered and who gave birth to singleton infants
at 22 weeks or more between 2005 and 2009. In this One-third (75/225) of eclampsia
patients developed the condition in the absence of hypertension. Maternal age,
nulliparity, and Pregnancy Induced Hypertension (PIH) were all independent risk factors
for eclampsia. The risk of eclampsia decreased by 3.0% per 1-year increase in maternal
age, and increased 2.6-fold and 35.4-fold in nulliparous women and women with PIH,
respectively.14
A prospective study was conducted to investigate whether pharmacological
treatment of mild to moderate PIH is effective in improving maternal and fetal
outcomes.A total of 150 consecutive pregnant women without proteinuria and with
physician-recorded systolic BP of 140-160 mmHg and/or diastolic BP of 90-105 mmHg
on two occasions ≥6 h apart between 20 and 38 weeks of gestation were randomly
allocated to receive either labetalol or methyldopa (50 patients each) plus standard care
(treatment group) or only standard care (50 patients) (control group).As compared to the
control group, the treatment group had lower rates of severe PIH15
A study was conducted to know Pregnancy Induced Hypertension (PIH) is
associated with oxidative stress and low plasma proteins. This study explored the effect
of oxidative stress on plasma protein level in PIH. Serum total proteins (TP), albumin,
globulin, malondialdehyde, protein carbonyls (PC) and protein bound sialic acid (PBSA)
were measured in gestational hypertensive, pre-eclamptic, eclamptic and healthy
pregnant women (n=20/group). Serum proteins were separated by electrophoresis for
assessing protein damage. This resulted that Serum TP and albumin decreased and
malondialdehyde, PC & PBSA increased.16
A study was conducted to identify the serum protein markers for the
gestational diabetes mellitus(GDM) complicated by Pregnancy Induced Hypertensive
(PIH) syndrome to provide a molecular biological basis for the screening, prevention and
therapy of the related diseases. For this Serum samples were collected from the patients
with GDM, PIH syndrome, and GDM complicated by PIH syndrome. IgG and albumins
were removed from the samples. The protein bands showing significant differences
among the 3 samples were collected, digested and identified with mass spectrometry, and
the function of the identified proteins was analyzed. Mass spectrometry indicated that the
proteins showing obvious differences among the 3 samples were haptoglobin, protein
SMG8 and apoptosis-inducing factor-1.17
The study was conducted on Previous pregnancy history, parity, maternal age
and risk of Pregnancy Induced Hypertension. They examined 67 preeclamptic and 129
normotensive pregnancies. Average age is 25.73+/-5.77 years. After all, the largest
number of primipara with preeclampsia is in category from 20 years
(p<0.01).Considering the multipara we noticed that preeclampsia is most commonly
developed in age between 31-35 years (p<0.01).Biggest number of pregnancies in
normotensive group had previous normal pregnancies (59.15 %), while in hypertensive
group only 30.77% patients had normal pregnancies (p<0.05).PIH is most frequently
appearing in young primiparas and adult multiparas18
A study was conducted on Early onset of Pregnancy Induced Hypertension
disorders. In pregnancy with an incidence of 1:141 deliveries. Most cases presented at
between 28-32 weeks gestation (78.3%) The disease was severe at presentation or rapidly
progressive in 39 cases (84.8%) leading to delivery within 72 hours of presentation.
Caesarean section was the mode of delivery in 58.7% of cases. The perinatal survival rate
was 34.0%. Early onset pregnancy induced hypertension was associated with
significantly higher risk of presenting with eclampsia, having induction of labour and
worse perinatal outcome than late onset disease. It contributed 6.3% of all cases of
hypertensive disorders. Most cases of early onset pregnancy induced hypertension in the
study population presented with severe and rapidly progressive disease and were
associated with significantly higher risk of obstetric intervention and worse perinatal
outcome than late onset disease.20
A study was conducted on prospective of 140 pregnant women with
hypertension admitted to Kamla Nehru Hospital in Shimla to examine pregnancy
outcomes. These women represented 4.1% of all pregnant women admitted to this
hospital during the study period. 52.8% of the 140 women were primigravida. The mean
diastolic blood pressure was 99.9 mmHg. The mean arterial pressure was 113.7 mmHg.
9.5% for 140/90-149/94; 38% for 150/95-159/109; and 52.3% for 160/110 and above.
Based on these findings, obstetricians are advised to regularly check the blood pressure of
pregnant women in order to reduce hypertension.21
A Pregnancy Induced Hypertension (PIH) plays a major role in the perinatal
outcome for mother and neonate. With the rising prevalence of obesity, the role of
prepregnancy Body Mass Index (BMI) as an independent risk factor for PIH and a target
for preconception care is important to explore. We completed a retrospective cohort study
of 16,582 women who received obstetrical care at a regional medical center and delivered
a singleton pregnancy between 2003 and 2006. Clinical data were derived from the
electronic medical record. Logistic regression was used to explore the association of
demographic characteristics and medical risk factors with the outcome of PIH.This
resulted in diagnoses of chronic hypertension, prepregnancy diabetes, and gestational
diabetes were more likely in women with increasing prepregnancy maternal BMI (p <
0.0001).22
The aim of the study was to estimate the usefulness of the biochemical
markers of fetal defects and uterine Doppler examination in predicting PIH and IUGR in
the third trimester of pregnancy. We examined 156 pregnant patients in The Department
of the Fetal Medicine and Gynecology Medical University of Lodz, between 2006-
2009.In case of each pregnant woman we estimated biochemical markers in the first
(PAPP-A +beta-hCG) and second trimester (AFP, beta-hCG, uE3 - triple test). Each
patient underwent three ultrasonographic examinations in the first, second and third
trimester (between 11-13, 15-20, and 22-27 weeks gestation, respectively) with uterine
artery Doppler examination. We monitored these pregnancies for PIH and IUGR and
divided them into three groups: 28 patients with PIH (study group 1), 14 patients with
IUGR (study group 2), and 114 patients with uncomplicated pregnancies (controls).In
both study groups we observed: higher concentration of beta-hCG, higher percentage of
the positive biochemical prenatal tests and abnormal uterine artery Doppler waveform.
Positive triple test was the strongest predictor of PIH and IUGR (PPV=60.87% for PIH
and PPV = 30.77% for IUGR)23.
A study was conducted to assess the prevaillences of Pregnancy Induced
Hypertension among the pregnant women hospitalized in the Leonor mendecls de barros
maternity hospital was13.9%.The data shows that 95.8% of women received pre-natal
care.64.5% were white,78.5% were had 2 or more pregnancies and 52.9% multiparous
during their hospitalization it was varrified that 49.6% the pregnant women were
presented a diastolic blood pressure 110mmofHg & 46.3% had edema of which 54.5%
were classified as degree124.
6.3 STATEMENT OF THE PROBLEM
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNOWLEDGE OF ANTENATAL MOTHERS
DIAGNOSED WITH MILD PREGNANCY INDUCED HYPERTENSION IN A
SELECTED HOSPITAL IN BANGALORE AT KARNATAKA”
6.4 OBJECTIVES
1. To determine the knowledge of antenatal mothers on Pregnancy Induced
Hypertension as measured by structured interview schedule.
2. To evaluate the effectiveness of Health Education on Pregnancy Induced
Hypertension in terms of gain in knowledge scores
3. To find the association between pre-test knowledge score of antenatal mothers with
selected demographic variables such as age, religion, educational status, socio-
economic status and parity.
6.5. OPERATIONAL DEFINITONS
1. Assess: It is to carefully consider a situation, person, or problem in order to make a
judgment.
2. Effectiveness: In this study it refers to the extent to which structured teaching
programme is effective in improving the knowledge scores of antenatal mothers as
measured by structured interview schedule.
3.Structured Teaching Programme:
is the process by which antenatal mother will learn about their health and more
specifically, how to improve their health and reduce the complication of Pregnancy
Induced Hypertension
4. knowledge: It is the correct response of the individual to questions regarding
knowledge of Pregnancy Induced Hypertension as measured by structured questionnaire.
5. Antenatal mothers: In this study it refers to selected antenatal mothers diagnosed
with mild Pregnancy Induced Hypertension (this includes cases of sustained rise of blood
pressure of more than 140/90 mm Hg but less than 160 systolic or 110 diastolic without
significant proteinuria) fulfilling the inclusion criteria in a selected hospital at Bangalore.
6. Mild Pregnancy Induced Hypertension: In this study it refers to cases of sustained
rise of blood pressure of 140/90 mm Hg and more but less 6 than 160 systolic or 110
diastolic without significant proteinuria.
6.6.ASSUMPTIONS
1. Antenatal mothers may not have any knowledge on Pregnancy Induced
Hypertension.
2. Teaching programme help to enhance the knowledge of antenatal mothers
6.7.HYPOTHESIS
Ho1: there will be no significant difference between the pre-test and post-test
knowledge score on pregnancy induced hypertension among antenatal mothers diagnosed
with mild Pregnancy Induced Hypertension.
Ho2: There will be no significant association between pre-test knowledge scores of
antenatal mothers with selected demographic variables.
6.8 DELIMITATION
The study is delimited to only those antenatal mothers fulfilling the inclusion criteria.
6.9. PILOT STUDY
A pilot study is trial run of the methodology planned for the main study. It will
be conducted 10% of sample with similar characteristics to that of main study to find
out the feasibility of the study and the tool. The pilot study will be with the individuals
who are suffering from hypertension
6.9. RESEARCH VARIABLES
Research variables are the concept at various levels of abstraction that are entered
manipulated and collected in the study.
Independent variable:- Structured teaching programme on knowledge of antenatal
mothers diagnosed with mild pregnancy induced hypertension.
Dependent variables:- Knowledge of antenatal mothers diagnosed with mild pregnancy
induced hypertension.
Demographic variables:- Age, Sex, Education, Occupation, Economic status, family
history, Diet.
7.0 MATERIALS AND METHODS
This chapter explains the methodology adopted by the researcher. It includes
research approach setting of the study, population, criteria for sample selection, sampling
technique, selection of sample, development and description of instrument, validity and
reliability of the tool, pilot study data collection and plan of data analysis.
7.1 SOURCE OF DATA
In this study, data will be collected from antenatal mothers diagnosed with mild
Pregnancy Induced Hypertension in a selected hospital at Bangalore.
7.1.1 RESEARCH APPROACH
Quasi Experimental research approach
7.1.2 RESEARCH DESIGN
One group pre-test post-test design.
Group Pre-test Structured
teaching
programme on
PIH
Post-test
Experimental
group
O1 X O2
O1 - pre-test assessment of knowledge on PIH among antenatal mothers diagnosed with
mild PIH.
X- administration of structured teaching programme on PIH
O2- post-test assessment of knowledge on PIH among antenatal mothers diagnosed with
mild PIH.
7.1.3 SETTING OF THE STUDY
Selected Hospital at Bangalore. This is a 260 bedded hospital. Here 50% of
antenatal mothers visiting the antenatal clinic are in first trimester. Of this 25% of
antenatal mothers are having Pregnancy Induced Hypertension.
7.1.4 SAMPLE SIZE
In this present study sample size is 60 antenatal mothers fulfilling the inclusion
criteria.
7.1.5 INCLUSION CRITERIA
1. Antenatal mothers in diagnosed with mild Pregnancy Induced Hypertension.
2. Antenatal mothers who are willing to participate in the study.
7.1.6 EXCLUSION CRITERIA
Antenatal mothers who have other super imposed complication like diabetes
mellitus, Reno vascular hypertension, essential hypertension, and thyrotoxicosis.
7.1.7 INSTRUMENTS INTENDED TO BE USED
Structured interview schedule prepared by the investigator.
7.1.8 DATA COLLECTION METHOD
- Permission will be obtained from the authority of the selected antenatal clinic.
- The investigator will select the samples by convenient sampling technique on the
daySS of data collection.
- Pre-test of the sample by the administration of structured interview schedule.
- Structured teaching programme is administered to the samples.
- Effectiveness of Structured teaching programme after fifteenth day by administration of
same tool.
7.1.9 DATA ANALYSIS METHOD
Descriptive and inferential statistics will be used to analyse the data. The data
will include descriptive mean, median, standard deviation, mean percentage and
inferential (paired‘t’ test and chi square test).
7.2 Does the study require any investigations or interventions to be conducted on
patients or other humans or animals?
Yes, the investigator conducts and interview followed by the Structured
teaching programme administration for the selected antenatal mothers.
7.3. HAS ETHICAL CLEARENCE BEEN OBTAINED?
Ethical clearance will be obtained from the ethical committee and permission will be
obtained from the concerned authority.
Written consent will be obtained from subjects.
Confidentiality and anonymity of subjects will be maintained.
8.LIST OF REFERENCES.
1. Shenoy K. Pregnancy in women. JAMA 2004 Feb 12;30(12):7-8.
2. Linda Ahenkoram (2009), Kwasme Nkrumah University of Science and Techonology.
3. Abouzahr C. Maternal mortality at the end of the decade. In: Wardlaw T,ed. Proceedings of the fourth Congress of World Health Organisation; 2001 Sept. 5-7; Brinola, Geneva: World Health Organization; 2004. 182-193.
Reingardiene D. Pregnancy induced hypertension related complication. Medicina
2003 Mar 14;39(12):1244-52.
4. Majhi AK, Mondal A, Mukherjee GG. Maternal mortality associated with pregnancy. Indian Journal of Medical Association 2001 Mar 4;99(3):132- 7.
5. Lowdermilk DL, Perry ES, Boback MI. Maternity and women’s health care. 6th ed. Edinburgh: Mosby; 2000.
6. Soya K, Kumari GVP, Mumthaz S. Self-care activities of pregnancy induced hypertension and maternal outcome. Nursing Journal of India 2003 Mar 12;98(2):17-8.
7. Clare J. A quasi-experimental comparative study on effectiveness of structured self teaching programme among primigravida antenatal women in selected hospital of MGR University. Master of Nursing dissertation submitted to MGR University, Chennai. 1997.
8. Cincotta(1998), “Pathogenesis of Pregency Induced Hypertension”.
9. Passnlio A. Education for pregnant women. Patient Educ Couns 2004 April 5;53(1):101-6.
10. Al Mulhim AA, Abu Heija A, Al Jamma F, Elttanthel HA. Pregnancy related complication. Obstet Gynecol 2006 Sep 12;108(3):565-71.
11. Znow S, Wang JH. Screening programme and prevention of pregnancy induced hypertension syndrome. JAMA 2004 Jun 6; 25(10):410-5.
12. Soya K, Kumari GVP, Mumthaz S. Self-care activities of pregnancy induced hypertension and maternal outcome. Nursing Journal of India 2003 Mar 12;98(2):17-18.
13. Kumari GVP. A study to evaluate the self-instructional modules on pre-eclampsia on the basis of identified learning needs of mothers in selected hospital Kerala.
14. Kumari GVP. A study to evaluate the self-instructional modules on pre-eclampsia on the basis of identified learning needs of mothers in selected hospital Kerala
15. Rauchfuss M, Enderwitz J, Maier B, Frommer J. Medizinische Klinik mit Schwerpunkt Psychosomatik and Psychotherapie, Charité-Universitätsmedizin Berlin, Germany. [email protected]
16.Morikawa M, Cho K, Yamada T, Yamada T, Sato S, Minakami H Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan. [email protected]
17. Molvi SN, Mir S, Rana VS, Jabeen F, Malik AR. The Department of Obstetrics and Gynecology, Government Lal Ded Hospital forWomen, Government Medical College, Srinagar, Jammu and Kashmir, India,[email protected].
18.Asmathulla S, Koner BC, Papa D.Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education & Research Institute, Puducherry, India.
19 Wang SS, Hu SW, Zhong M.Department of Obstetrics and Gynecology, Nanfang Hospital, Southern MedicalUniversity, Guangzhou 510515, China. [email protected]
20. Jasovic-Siveska E, Jasovic V, Stoilova S.School of Nursing, Dept. of Gynecology and Obstetrics, University St. Kliment Ohridski, Bitola, Macedonia. valentino.siveski@t-h ome.mk
21. Ebeigbe, (2010) “ Early Onset Of Pregency Induced Hypertension”, Vol 13:4 P.P.No. 388- 393.
22. Cruptaka, (1996) “Prospective of pregnant women with Hypertension”, Vol 94:1 P.P.No.6,16. 23. Ehrenthal DB, Jurkovitz C, Hoffman M, Jiang X, Weintraub WS.Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, DE 19718, USA. [email protected]
24. Słowakiewicz K, Perenc M, Sieroszewski P.Klinika Medycyny Płodu i Ginekologii, I Katedra Ginekologii i Połoznictwa w Łodzi.
25. Lutherlick (2002) “ Prevalances of pregnancy Induced Hypertension among the pregenent women hospitalized”.
SMT. LAKSHMI DEVI COLLEGE OF NURSING
BANGALORE-560014ETHICAL COMMITTEE
SL.NO.
TITLE NAME SIGNATURE
9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE
11.NAME AND DESIGNATION
11.1 GUIDE 11.2 SIGNATURE
11.3CO GUIDE
11.4 SIGNATURE
12. HEAD OF THE DEPARTMENT
13. REMARKS OF THE CHAIRMAN AND PRINCIPAL
13.1 SIGNATURE