RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS
(IN BLOCK LETTERS) / Ms. BIDYA RANI YUMNAM
RAJEEV COLLEGE OF NURSING,
K.R. PURAM, HASSAN- 573201
2 / NAME OF THE INSTITUTION / RAJEEV COLLEGE OF NURSING,
K.R. PURAM
HASSAN.
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
OBSTETRIC AND GYNAECOLOGICAL
NURSING
4 / DATE OF ADMISSION TO COURSE / 3rd JUNE 2008
5 /

TITLE OF THE TOPIC

/ “A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME REGARDING FACTORS AFFECTING NORMAL FETAL GROWTH AND DEVELOPMENT ON KNOWLEDGE AMONG ANTENATAL MOTHERS IN S.C HOSPITAL, HASSAN.”

6. BRIEF RESUME OF THE INTENDED STUDY

6.1 INTRODUCTION

“Human being is unbelievably a hands-, time-, care-, attentiveness-taking specie, and as a result we pursue love”1

- Rika Ikuno

“Good nutrition and lifestyle matter from Womb to Tomb.”2

-Barker.

Most human embryos have the potential for a long and healthy life. From the moment of conception, however, adverse environmental limit this potential. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and babies. Fetal growth and birth weight are increasingly being considered crucial markers of future health status during infancy, childhood and adult life.3

Approximately, 10% of all human malformations are caused by environmental factors, 10% are caused by genetic facts and the remaining 80% are presumably the result of a complex interplay of several environmental and genetic factors.4

The major risk factors with respect to infant mortality are smoking, occupational hazards, injuries, viruses, nutritional disorders, stress and maternal workload. These risk factors may also referred to as teratogens, agents that cause congenital anomalies in fetus and also may cause adverse effect on fetal growth and development.4

Studies on women who conceived their offspring or were in early pregnancy at the time of the Dutch famine in the winter of 1944-1945 indicated that severe maternal under nutrition increases the risk of schizophrenia in the offspring. Similar results were reported in a study examining the effects of the Chinese famine in 1959-1961. Hence severe psychological stress during pregnancy is a recognized risk factor.5

According to ancient Finnish folklore, ifpregnant women arestressed, she will give birth to a shy and frightened child. The offspring of stressed mothers are compared to the shy and sensitiverabbit. Based on research findings and general medical opinion, the March of Dimes recommends that stress during pregnancy should be reduced.

The health of the fetus and mother are inextricably linked .Generally, a woman who eats well and takes care of her own health will provide a healthy environment for the fetus to develop and grow. She may need instructions, however, on what exactly constitutes a healthy lifestyle for herself and her baby. As a result, a major role in promoting maternal and fetal health is education.

Anticipatory guidance should be provided to women of child bearing age at their regular checkups, in school health classes, in the community groups through educational materials that are readily available to women of all economic and social groups. This should include planning for pregnancy, genetic counseling, nutritional counseling, general health counseling and teaching and counseling regarding embryonic and fetal development.4

The Barkers group findings have mentioned that preventive measures should begin with improving the nutrition and health of women to prevent damage to their fetuses. This will require attention to the risk factors for low birth weight before pregnancy since nutritional supplements during pregnancy are inadequate. Moreover, for a long and healthy life good nutrition and life style are necessary throughout the entire life span. Chances of avoiding premature degeneration disease can be dramatically improved by good nutrition and healthy practices from womb to tomb.2

6.2 NEED FOR THE STUDY

In Act IV of King Henry VI a pregnant Queen Elizabeth on learning of the imprisonment of her husband says that she must stop her tears so that she does not damage the heir to the English crown(Shakespeare , King Henry VI Part 3, Act IV, scene IV)6

By virtue of nature, life begins from a fusion of two tiny cells. It gets implanted and sheltered in a very protective and secured chamber-“the womb of a mother”. Further it gets its nourishment and begins to grow and develops, turning itself into a full fledged being ready to be survived in the world of human society. But as it grows and progress with different phases of development, certain factor hinders or deviates the normal process. These factors could be mothers own ignorance or other environmental factors.

Epidemiological evidences suggest that an adverse prenatal environment can have profound long term health consequences through out postnatal life.8

Attempts to manage the outcome of pregnancy are ubiquitous among human societies. Those practices are becoming standardized as prenatal care under a biomedically trained practitioner has come to characterize the formal management of pregnancy. However, many women don’t seek biomedical surveillance of their pregnancies, and in many contents particularly in modernizing or rural communities, prenatal care facilities are often poorly coordinated and under utilized for a variety of reasons.9

The social, family and community content and beliefs affect health during pregnancy either positively or negatively. Some cultures promote special foods and rest for pregnant women, but in other pregnancy is not being acknowledged. In these cases women continue to work hard and nutritional taboos may deprive them of essential nutrients, adding nutritional deficiencies, particularly iron, protein, and certain vitamins.3

The first trimester is a critical period in the development of fetus. Exposure to teratogens at this time may cause severe congenital malformations. Exposure to teratogens in the second and third trimester

can cause problems related to brain growth, intrauterine growth retardation and developmental delays in children.4

A study was conducted to assess maternal diet and nutritional adequacy prior to conception and during pregnancy. A cohort of pregnant women with collection of questionnaire data throughout pregnancy and after delivery was followed .the study was conducted at antenatal clinics at two public hospitals in Porto, Portugal. The study identified low dietary intakes of vitamin E, folate and magnesium both in the preconceptional period and during pregnancy, and low intake of folate during pregnancy only. The low dietary intake of folate and the late initiation of supplementation indicate that current national guidelines are unlikely to be effective in preventing neural tube defects. Hence the study emphasized increase intake of essential nutrients.10

A study was conducted to estimate the influence of living conditions, smoking, alcohol, and maternal stress on fetal growth indices in an urban Russian City. All pregnant registered at antenatal care centers in Severodvinsk and their infants comprised the study base .Multivariate linear regression analysis was applied. The study revealed that poor housing conditions, maternal stress, smoking and alcohol consumption are determinants of fetal growth.11

Providing health teaching to pregnant women about factors affecting fetal growth and development will help them to understand the importance of eating well and avoiding substances that may be dangerous to the fetus.

A number of National Health Goals have been devised specifically to increase the health of the fetuses during pregnancy. These goals include:

* Reduce the fetal death rate (death below 20 or more weeks of gestation) to no more than 5 per 1000 live births from a base line of 7.6/1000.

* Reduce low birth weight to an incidence of no more than 5% of live birth and very low birth weight to no more than 1 % of live birth from base lines of 6.9 and 1.2%.

Nurses can be instrumental in helping the nation achieve these goals by being an advocate, counselor and an educator. Informed decision making concerning avoidance of known or suspected teratogens is the responsibility of the client and her family.

The more women know about measures they should take during pregnancy to safeguard their health, the more likely they will avoid substances or activities harmful to fetal growth. This makes prenatal education an important part of prenatal care.7

In present trend, pregnant women attaining antenatal care in private clinics are more likely to receive health information regarding pregnancy and growth and development knowledge of their growing fetus. But this is usually contrast for women attaining public health clinic or government health set up.

The investigator during her clinicals, experienced that the pregnant mother attending the antenatal clinic were not having adequate knowledge regarding factors affecting normal fetal growth and development. The investigator felt the need of imparting knowledge to the mothers in a view to develop healthy fetus for a healthy infant.

6.3 STATEMENT OF THE PROBLEM

A study to assess the effectiveness of planned teaching programme regarding factors affecting normal fetal growth and development on knowledge among antenatal mothers in S C Hospital, Hassan.

6.4 OBJECTIVES

1. Assess the knowledge of antenatal mothers on factors affecting normal growth . . and development before and after PTP

2. Determine the effectiveness of planned teaching programme regarding factors

affecting normal fetal growth and development.

3.Assess the level of knowledge regarding factors affecting normal fetal growth and development among antenatal mothers with demographic variables.

6.5. HYPOTHESIS.

H1: There is significant increase level of knowledge during post test than pretest.

6.6. ASSUMPTIONS

1. Knowledge will influence the mother’s attitude in developing healthy fetus.

2. Knowledge will help the antenatal mothers in preventing teratogenic exposures

to the fetus.

3. Learning improves self confidence.

6.7. OPERATIONAL DEFINITION

Assess: - It refers to evaluation or estimation of knowledge..

Effectiveness: - The changes in the level of knowledge after the PTP on factors affecting normal fetal growth and development among antenatal mothers measured through questionnaire. The score will be interpreted as below average (<50%) average (51-75%) and excellent (>75%).

Knowledge: - Relevant information related to normal fetal growth and development

inutero before birth.

Planned teaching programme: -It is a planned instruction regarding factors affecting normal fetal growth and development inutero and responsibility of the mother in developing a healthy fetus. It is given to 5-10 antenatal mothers at a time in the antenatal OPD at S C Hospital, Hassan.

Growth and development: - Growth and development refers to physiological changes which takes place from the time of conception till delivery.

Antenatal mothers: -Mothers who are pregnant and attending antenatal OPD.

6.8. CRITERIA FOR SAMPLE SELECTION

Inclusion Criteria

  1. Antenatal mothers who are attending antenatal OPD at S C Hospital, Hassan.
  2. Both primi and multi gravid mothers.
  3. Antenatal mothers with gestational age between 10-16 weeks.

Exclusion Criteria

1. Antenatal mothers who are not willing to participate.

2. Antenatal mothers with complicated condition.

3. Mothers with twin pregnancy.

6.9 DELIMITATIONS OF THE STUDY

*Sample size is limited to 80 antenatal mothers.

* Prescribed data collection is 4-6 weeks.

6.10. SIGNIFICANCE OF THE STUDY

Increasing the antenatal mother’s knowledge regarding the factors affecting normal fetal growth and development may help in decreasing the fetal morbidity and mortality and giving birth to a healthy infant.

6.11 CONCEPTUAL FRAME WORK

This study is based on “Penders Health Promotion Model”

6.12 REVIEW OF LITERATURE

Survey of literature provides valuable help in the development of knowledge of research project. A review of literature is an essential aspect of scientific research. One of the major functions of review ofresearch literature is to ascertain what is already known in relation to the problem of interest and this will help in developing a board conceptual frame work into which a research problem will fit.12

An extensive review of literature was done by the investigator to gain insight into the selected problem and it is presented under the following headings:

1. Review of literature related to factors affecting fetal growth and development.

2. Review of literature related to influence of health education on fetal growth and development.

Review of literature related to factors affecting fetal growth and development

A study was conducted to determine the association between maternal smoking during pregnancy and low birth weight, small for gestational age birth weight and preterm birth, and to quantify the population- attributable fractions for these outcomes in Switzerland. Data were gathered for all births in the canton of vaud over a 12 month period in 1993-1994. The study revealed that maternal smoking during pregnancy was closely associated with low birth weight, small for gestational age and preterm birth. A large proportion of these perinatal outcomes could have been prevented in Switzerland if maternal smoking had been avoided.13

A hospital based case control study was conducted to identify and quantify the risk factors for preterm and low birth weight (LBW), linked with a population survey in Ahmedabad, India.The case control study of 673 term low birth weight, 644 preterm LBW cases and 1465 controls showed that low maternal weight, poor obstetrics history, lack of antenatal care, clinical anemia and hypertension were significant risk factors for both term and preterm LBW. Another risk factor with considerable attributable risk factor was no prenatal care. This result emphasized the need for maternal health and nutritional interventions to reduce the incidence of both preterm and term low birth weight infants in rural India.14

An explorative study was conducted to determine whether pregnant nonsmoker’s exposure to environmental tobacco smoke (ETS) affects the average birth weight at term. The population studied consists of pregnant non smokers participating in a study called Smoke- free Newborn Study. The study resulted that pregnant nonsmokers exposed to ETS both at home and outside the home gave birth to children with a birth weight of 78.9 gms lower than the weight of children born to unexposed women The study recommended that pregnant women should not be exposed to passive smoking and that it should be considered whether work place legislation should be instituted in order to protect women against the adverse effect of passive smoking.15

A study was conducted at Baltimore to determine whether fetus response to maternal stress. The study enrolled low risk pregnant women with normally developing fetus.Matenal stress were induced at 24 and 36 weeks gestational age using the Stroop Color – word task. The study concluded that fetuses responded to the manipulation with increased variability in heart rate and suppression of motor activity and suggested that fetal neuro behavioral regulation is routinely disrupted by maternal environmental intrusions.16

A prospective observational study was conducted to describe the relationship of the mother’s physical activity to the birth size of her baby of Maharashtra,India. A total o 797 pregnant women were studied using an activity questionnaire. Measures of outcome were on birth outcome, maternal weight gain and neonatal anthropometry. The finding suggested that excessive maternal activity during pregnancy is associated with smaller fetal size in rural India.17

A study was conducted to assess fetal response to maternally administered morphine. Study enrolled 10 study and 6 control singleton pregnancy patients. Only studied patients were administered morphine intramuscularly. A significantly lowered biophysical profile score was observed in study patients as a result of absent fetal breathing movements and nonreactive non stress test. The study concluded that morphine administered to the mother causes a significant decrease in a biophysical profile score and suggested that morphine act as vasoconstrictor to the placental vasculatures.18

A study was conducted to investigate the effect of alcohol consumption during pregnancy on the incidence of Atopic dermatitis in the offspring in Denmark. A total of 24341 mothers- child pairs enroll in the Danish National Birth Cohort were followed prospectively .Information about alcohol consumption was obtained by interview at 12 and 30 weeks. The study suggested that alcohol during pregnancy increases the risk of early-onset Atopic dermatitis in predisposed infants.19

Review of literature related to influence of health education on fetal growth and development.

A study was conducted to examine the impact of nutrition education on the pregnant women’s food and nutrient intake. Researcher compared data on 33 pregnant women attending nutrition, education class regularly with data on 33 other pregnant women who did not receive such education. The 66 pregnant women were selected from 2 hospitals and 2 urban family welfare centers in Ludhiana, India. Women in the nutrition education group were more likely than the control group to consume more protein, vitamin a, thiamine, folic acid and vitamin c. Nevertheless, intake was below RDIs for many nutrients. This finding suggest that nutrition education for pregnant women does improve nutrient intake but also than more needs to be done to bring intake levels up even higher.20