RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE, BANGALORE,KARNATAKA.

PROFORMA FOR REGISITRATION OF SUBJECTSFOR DISSERTATION.

1. / Name of the candidate & Address / MISS.C. RAJESWARI,
I Year M.Sc (N) Student,
FlorenceCollege of Nursing,
Bangalore- 560 043.
2. / Name of the Institution / FlorenceCollegeofNursing
3. / Course of Study and Subject / M.Sc Nursing Obstetrical andGynecological NursingGYNECOLOGICAL NURSING
4. / Date of Admission to Course / 21-05- 2007
5. / Title of the Topic / “A study to evaluate the effectiveness of a Self Instructional Module on prevention of abortion among young couples at selected rural communities,Bangalore”.

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION

Pregnancy is an exhilarating experience. It is the period of time when a fetus develops inside a woman’s uterus and ends with the birth of the infant. The onsetand degree of pregnancy symptoms will vary within women. Manywomen experience them within days of conception the early pregnancy symptoms generally can be felt once implantation occurs (4- 10 days from ovulation) and will lessen after the first trimester. Care during pregnancy includes proper nutrition, vaccination, avoidance of drug abuse avoidance of work place hazards and toxic substances1.

Pregnancy could however turn into a night mare or tragedy. The pregnant women should avoid all drugs and medicines as much as possible. Some drugs can be harmful when used at any time during pregnancy; however, are particularly damaging at a specific stage of pregnancy. Continuing drug use increases the risk of miscarriage and premature delivery.2

According to English law, abortion denotes the termination of a pregnancy before the twenty eight weeks, that is before the fetus is viable However, some authorities now, for scientific purpose,apply the term abortion when the fetus is expelled before the twentieth week of pregnancy or weighs less than 500gms.The term ‘miscarriage’ is commonly used in preference to the term abortion.3

Abortionis considered as a crime, for which the mother as well as the practitionerwere liable to be punished, except when abortions were induced to save the life of the mother. It is probably10 to 20%of allpregnancies end in miscarriageand another optimistic figure of 10% are induced illegally. About 75% of abortions occur before the 16th week of pregnancy4.

Abortion might have social, emotional and medical problems. Illegal abortion means miscarriage doing after sex determination of fetus due to social misconception about female feticide. But when terminated illegally such abortion develop complications and result in maternal mortality, induced by indirect or direct causes like trauma, hemorrhage etc.5

6.1NEED FOR THE STUDY:

Spontaneous abortion means termination of pregnancy before the fetus is viable, that is before 24 weeks of gestation. According to statisticsreleased in 2006 by the centerfor diseasecontrol and prevention, there were approximately 8,48 163 legal abortions performed in the united states. In India provisional estimate, from the 2001 census 10,000 sex – selective abortion of female fetuses were being performed. In Karnataka from the 2006 census 17,000 legal abortions were reported6.

Globally, 430 maternal deaths occur for every one lakh live births. In developing countries the rate is 480 maternal deaths and in developed countries, there are 27 maternal deaths for every one lakh live births. In India maternal mortality rate is highest in orissa ( 738 per 1 lakh population ) and lowest in kerala (87 per 1 lakh population). The main reason for abortion, includes lack of knowledge regarding prevention of abortion and unequal distribution of Health care delivery system in rural areas7.

In India medical termination of pregnancy is primarily a health care measure to reduce maternal deaths and sickness. At the same time there are three main chances for abortion including bleeding, infection and perforation of the uterus. The pregnant women should check with her doctor or midwife to see if she has a risk for abortion, she has to follow all the advise of her doctor for avoidance of abortion. Health education is necessary in rural areas to avoid the complications of abortion8.

Christiansen OB, Nielsen HS, Kolte AM (2006) Conducted a study an excessive uterine inflammation. When the level of inflammation is excessive at the feto- maternal interface miscarriage occurs. They have evaluated that if physicians would carryout appropriate therapy for women with uterine infection and inflammation abortion can be prevented 9.

Nardo LG, Sallam HN (2006) reported that women who had miscarriages , progestogen treatment showed a statistically significant decrease in miscarriage rate compared to no treatment and a recent meta- analysis has shown trends for improved live birth rates in those women. More randomized controlled trials are needed to evaluate progestogen supplementation in conditions10

Agnesi R, valentine F, Meneghetti M, Fedeli U, Fadda E, Tartari M, Mastrangelo G(2003) conducted a case- control study on risk factors for spontaneous abortion. They investigated the risk factors and found that risk is higher in the pattern of lifestyle and in occupational factors. They evaluated that increased risk in the first not in the second calendar period. Health education and counseling as an intervention resulted in decreased the rate of spontaneous abortion 11.

. In today’s population children are the future of our Nation. Healthy women can give birth to a healthy child. In India 1,25,000 (460/1 lakh live births) women die due to pregnancy and causes of abortion. The pregnant women has to follow all the advise of her doctor to avoid abortion. Keeping in view above mentioned reasons, the researcher found it relevant to evaluate the effectiveness of a Self Instructional Module on prevention of abortion among young couples at selected rural communities12.

6.2 REVIEW OF LITERATURE :

Agarwal A , Gupta S , Banerjee J, Alvarez JG(2007),conducted a study on oxidative stress in spontaneous abortion. The objective of this study was to examine the relationship of stress in spontaneous abortion. They conducted an extensive literature and electronic search, as well as manual search of cross-references with 100 samples. At the time of implantation due to stress 30% to 50% of conceptions end and 15%-20% clinical pregnancies end in spontaneous abortion. However some of the causes are preventable and treatment of stress during or before pregnancy remains speculative13.

Omland A, Schinssen V, Viskum S, Bonde JP (2007), conducted a study on shift work as cause for spontaneous abortion.The objective of the study was to asses the effect of fixed night work on pregnant women. Result of the study showed that shift work or night work can cause abortion. If fixed night work for all pregnant women avoided, spontaneous abortion and still birth can be prevented. There is evidence to support avoid fixed night shift work can prevent the miscarriage.14

Simoni Z, Caetano MR, Couto E, Passini R Jr, Barini R(2006), conducted a study on Gestational prognostic factors in women with Recurrent Spontaneous Abortion. The objective of the study was to identify the causes of spontaneous abortion. They evaluated 246 medical records of women with Recurrent Spontaneous Abortion.The most frequently found etiological factors were immunological, all immune factors accounted to about (93.9%). Auto immune factors (93.9%) had higher rate of abortion (4:30). The highest rate of abortion age over 40 was in the years. The study concluded that age over 40, immunological factors and two or more concomitant factors were associated with highest rate of abortion.15

Zabits’Ka La (2006), conducted a study on Treatment of urogenital infections in pregnant womenwith the objective of investigating the efficacy of local antimicrobial medication. They have collected the samples from the diagnostics center and evaluated that Fluomisin was effective,safe and convenient. According to this study during pregnancy period urogenital infections commonly occur in pregnant women. Pregnant women can take anti microbial medications like Fluomisin. It has no side effects during pregnancy and also it reduces the infections and miscarriages16.

Kurbanova FA, (2006) conducted a study on prophylactics and treatment of pregnant women with anemia in risk of miscarriage. The aim of the study was to carryout complex measures of treatment and to define their efficacy in pregnant women suffering from anemia and facing threat of miscarriage. The study findings revealed that, vitamins and dietary supplements such as vitamin E, beta carotene and acetylsalicylic acid along with treatment measures resulted in improving suffering from anemia in risk of pregnancy interruption at 8-9 weeks term17.

Dr.Shamanthakamani Narendran (2005) conducted a study on Pregnancy and Yoga with the objective of yoga improves pregnancy outcomes. The samples were 169 yoga trained pregnant women. Yoga methods such as asanas and pranayamas, was practiced 1 hour daily. 14% of deliveries were premature in the yoga group compared with 29% in the controls. Results of this study suggest that, yoga improves pregnancy outcomes such as increased blood flow to the placenta and decreased premature release of hormones that trigger the onset of labor. It shows ,the practice of yoga during pregnancy seems to improve birth weight and reduce prematurity and overall complications18.

Rumbold, Middleton P, Crowther CA, (2005) conducted a study to determine the effectiveness and safety of vitamin supplementation on the risk of spontaneous miscarriage, maternal adverse outcomes and fetal and infant outcomes. The randomized trial comparing vitamins either with placebo or no vitamins prior to conception was done in women who is less than 20 weeks of gestation. The result suggested that, vitamin supplementation has significantly reduced the risk of still birth, miscarriages and preeclampsia.19.

Aleman A, Althube F, Beliz A, Bergel E ( 2005) conducted a study to evaluate the effect of prescription of bed rest during pregnancy to prevent miscarriage in women who are at high risk for miscarriage. A randomized clinical trial was conducted to compare clinical outcomes in pregnant women who are prescribed bed rest in hospital or at home for preventing miscarriage. Where compared with groups who received alternative care or no intervention. This study shows that, significant difference between bed rest in hospital and home. It concluded that bed rest in hospital set up helps to reduce miscarriage in women with confirmed fetal viability and vaginal bleeding 20

Dempsey JC, Sorensen TK, Qiu CF, Luthy DA, Williams MA. (2003) examined the effect of type of abortion, number and timing of abortion on risk of pre-eclampsia in subsequent pregnancies. A hospital based case control study was conducted on 199 subjects. The result reveal that multiparous women of abortions experienced a relatively high risk of pre-eclampsia when compared to nulli-paraous women with no history of abortions. Type of abortions such as spontaneous and induced and number and timing of abortion did not appear to influence the risk of pre-eclampsia21.

Carrier JA, Oates – whitehead RM, Haas DM (2003) conducted a study to determine efficacy and safety of progestogens as a preventive therapy against miscarriage. A randomized control trial was done to compare the effect of progestogen with placebo or no treatment given an effort to prevent miscarriage. The study findings revealed that progestogen treatment shows a statistically significance decrease in miscarriage rate compared to placebo or no treatment 22.

6.3STATEMENT OF THE PROBLEM :

A study to evaluate the effectiveness of a self instructional module on prevention of abortion among young couples at selected rural communities, Bangalore.

6.4OBJECTIVES OF THE STUDY:

1. To assess the knowledge of the young couples regarding prevention of abortion.

2.To evaluate the effectiveness of the self-instructional module regarding prevention of abortion at selected communities.

3.To find out the association between knowledge regarding prevention of abortion and selected demographic variables.

6.5HYPOTHESIS :

H1The mean pretest knowledge score of the young couples regarding prevention of abortion will be significantly lower than average.

H2The mean posttest knowledge scores of the young couples regarding prevention of abortion will be significantly higher than the mean pretest knowledge scores.

H3There will be a significant association between the mean pretest knowledge scores regarding prevention of abortion and the selected demographic variables.

6.6OPERATIONAL DEFINITIONS:

EFFECTIVENESS :-

It refers to the desired change brought about by the self instructional module and measured in terms of significant knowledge gain in the mean, post test score.

SELF INSTRUCTIONAL MODULE:

It is a booklet in Kannada , which deals with causes & prevention of abortion among young couples.

PREVENTION OF ABORTION :

It refers to measures taken to avoid the involuntary loss of the products of conception prior to 24 weeks of gestation.

YOUNG COUPLES :

In this study it refers to recently married men and women in the age group of 18-35 years.

6.7ASSUMPTIONS :

  1. Young couples will be aware about the concept of abortion
  2. The Self Instructional Module will enhance the knowledge about prevention of abortion among young couples
  3. Young couples will cooperate and participate in the study
  1. DELIMITATIONS :
  1. Young couples in the age group of 18 to 35 years.
  2. Knowledge will be assessed only by the verbal responses given by the young couples.

7.MATERIALS AND METHODS:

7.1Source of data:

This study will be carried out among young couples residing in selected rural community at Bangalore.

7.2METHODS OF DATA COLLECTION :

Research methods:Quasi Experimental Method

Research design:one group pre and post test design

Sampling technique:convenience sampling technique

Sample size:50 young couples

7.2.1CRITERIA FOR SELECTION OF SAMPLES :

INCLUSION CRITERIA:

Young couples:

  1. In the age group of 18 to 35 years
  2. Willing to participate in the study
  3. Available at the time of data collection.
  4. Know to read and write English or Kannada

EXCLUSION CRITERIA:

Young couples:

  1. Below 18 yrs and above 35 years.
  2. Not willing to participate in the study will be excluded.
  3. Those whodo not know English and Kannada.
  4. DATA COLLECTION TOOL :

A knowledge questionnaire will be prepared to assess the knowledge regarding prevention of abortion. A self instructional module will be prepared on prevention of abortion.

Content validity of the tool and Self Instructional Module will be ascertained in consultation with guide and experts from various fields like medicine and nursing. Reliability of the tool will be established by split-half method. Prior to the study, written permission will be obtained from the concerned authority from the community. Further consent will be taken from the young couples with their willingness to participate in the study.

7.2.3DATA ANALYSIS METHODS :

Data analysis will be done by descriptive and inferential statistics Mean, Median, standard deviation and percentage distribution will be done in descriptive analysis. A chi-square will be done to find out association between knowledge regarding prevention of abortion and selected demographic variables.

7.3DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

YES

Only a structured knowledge questionnaire regarding prevention of abortion will be assessed. No other invasive physical or laboratory procedures are done on the samples.

7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED ?

YES

a)Consent will be obtained from the community centre before conducting the study.

b)Confidentiality and anonymity of the subjects will be maintained.

c)Informed consent will be taken from the young couples who are all willing to participate in the study.

  1. LIST OF REFERENCES:
  1. Roo KA, population and development review, vol.28, No.4 Dec (2002).
  2. Myles, Text book for midwives, 14th edition, Elsevier publication, London.(2006) P.No. (279 – 284).
  3. Varney’s,Text book of midwifery, 4th edition, All India publisher, India P.No. (575-577).
  4. DuttaDC, Text Book of Obstetrics,5th edition, New central book agency publication, Calcutta(2001)P.No. (107- 189).
  5. Park K, Text Book of Preventive and Social Medicine, 4th edition, Banarsidas Bhanst publishers (649,738).
  6. Abouzahr C, The epidemiology of abortion, vol.14, No.8, (2005) Jul.
  7. Romero SQ , Magnitude, management and prevention of abortion, (2004) April.
  8. Greenslade FE, Mckay H, Wolf M, Mclaurin K, A Women’s health initiative to

combat unsafe abortions, (2002) Feb.

  1. Christiansen OB, Nielson HS, kalte AM, information and Miscarriage, semin fetal

neonatal med. 2006 oct:11 (5): 302-8.

  1. Nardo LG, Sallam HN. Prevention of abortion, Reprod Biomed online. (2006)

Jul;13(1):47-57.

  1. Agnesi R, Valentini F Menegetti M, Fedeli U, Risk factors for spontaneous

abortion, GItal Med Lav Ergon (2003) July-Sept; 25 suppl (3):79-80.

  1. Ray Sahelian, Pregancy information. Retrieved from www. Google .com.
  2. Agar wall A, Gupta S, Banerjee J, Alvarez JG (2007), The role of oxidative stress in spontaneousabortion, obstetrics and Gynecology(2007) May, 62(5), (335-47).
  1. Omland A, Schinssen V, Viskum S, Bonde JP (2007), Does shift work cause

spontaneous abortion, ugeskr Laeger (2007) Mar 5 ; 169(10) : (893-900)

  1. Simoni Z, Caeteno MR, Couto E, Passini R Jr, Barini R, Gestational prognosticfactorsinwomen with recurrent spontaneous abortion, Sao Paulo Med J (2006) July 6 ; 124 (4) : 181-5.
  2. Zhabits’ Ka La, Treatment of urogenital infections in lower part of the genital organs inpregnant women which are at risk of miscarriage, Lik sprava.(2006) Apr-May;(3):49-51.
  3. Kurbanova F.A , prophylactics and treatment of pregnancy women with anemia in

risk of miscarriage, Georgian Med News. (2006) Sept.(37-40)

18.Dr.Shamanthakamani Narendran, Yoga and pregnancy , Journal of Alternative

and complimentary Medicine , (2005 April).

  1. Rumbold A,Middletron P,CrowthaCA, vitamin supplementation for preventing

miscarriage, Coachrane Datebase Syst Rev.(2005)Apr8 (2).

  1. Aleman A, Althobe F, Beliz A, Bergel E. Bed rest during pregnancy for preventing miscarriage, Cochrane Database system Rev(2005) April 18;2.
  2. Dempsey JC, Sorensen TK, Qiu CF, Luthy 2A, william MA, History of abortion and subsequent risk of pre-eclampsia. J Reprod Med 2003 Jul ‘ 48(7) : 509-14.
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miscarriage, Cochrane Database syst Rev . (2003); (4).

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27. pregnancy.html

9. / SIGNATURE OF CANDIATE
10. / REMARKS OF THE GUIDE
11. / NAME AND DESIGN
11.1GUIDE
11.2SIGNATURE
11.3CO-GUIDE
11.4SIGNATURE
11.5HEAD OF THE DEPARTMENT
11.6SIGNATURE
12 / 12.1REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE