RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DESSERTATION.

1 / Name of the candidate and address / Ms. SITHARA GEORGE
I year M.Sc.(N)
Faran College of Nursing
Bangalore -49
2 / Name of the institution / Faran College of Nursing
3 / Course of the study and subject / M. Sc Nursing
Obstetrics and Gynaecological Nursing
4 / Date of admission to course / 15. July.2011
5 / Title of the topic / “A descriptive study to assess the knowledge of antenatal women regarding danger signs during pregnancy in selected maternity hospitals at Bangalore with a view to develop an information booklet.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

Pregnancy is the most beautiful phase in a women’s life. It brings about emotional and physiological changes as well as poses extra demands on the body. Having a baby is a wonderful thing; of course it is also an occasion of changing your life. When a woman becomes pregnant, she is very aware that a new life is growing within her for the next nine months. Millions of women give birth to still born children or children with birth defects. This act as a constant reminder of just how fragile and delicate the process from conception to child birth is. It is a long road with pitfalls at every burn. While most women negotiate the path to motherhood successfully, always at the back their minds runs the thought that things can go wrong if they are not careful.1

Pregnancy is a normal process that results in a series of both physiological and psychological changes in expectant mothers. It brings woman some discomforts. It is crucial to know how to differentiate normal discomforts and signs and symptoms of potentially dangerous conditions. Danger signs are the life threatening complications that are occurring in pregnancy, during or after labour and delivery. At least 40% of all pregnant women will experience some type of complications during their pregnancies. About 15% these complications will be potentially life threatening, and will require immediate obstetric care. Maternal death also compromises the health and survival of infants and children they have behind. The death of a woman during pregnancy and child birth is not only a health issue but also a matter of social injustice.2

Millions of births are not attended by doctors, nurses or trained midwives, despite India’s booming economy which grew at nearly 9 percent in each of the past three years. Literature shows that in India most of the mothers have poor knowledge regarding antenatal, intranatal and postnatal care. Illiteracy, poverty and lack of communication and transport facility make them vulnerable to serious consequences. Though they are the prominent care providers within the family and key to human development and wellbeing, the fundamental right to health is denied to them in most parts of the world. The death of mother increases the risk to the survival of her young children, as the family cannot substitute a maternal role.3

Today nurses and midwives have an important role in health care promotion and prevention. Dissemination of health related information to the clients, family and community is one of the important functions of midwives in caring pregnant women and attaining safe motherhood. Providing information to the pregnant women about prenatal care visits help to ensure a safe and healthy pregnancy. Pregnant women and their families need to be able to recognize the signs of labour and the danger signs of pregnancy. They need to have plans and resources for obtaining skilled care for the birth and immediate help if problems arise.4

6.1 NEED FOR THE STUDY:

Raising awareness of women on danger sign of pregnancy, child birth and the postpartum period is crucial for safe motherhood. Any women can develop life threatening complication at any stage of pregnancy, delivery and postpartum period as can the new born, especially in the first few days post delivery. A pregnancy can be a very exciting and wonderful in a woman’s life. Unfortunately, it can also be a very scary time when something does not go as planned.5

Most women will have normal pregnancies with no complications whatsoever. Normal pregnancy may be accompanied by some problems and complications which are potentially life threatening to the mother and or foetus. Danger signs during pregnancy include vaginal bleeding, convulsions, pelvic or abdominal pain, persistent back pain, gush of fluid from vagina, swelling of the hands or face, severe headaches, blurring of vision, regular contractions prior to 37 weeks and absence of foetal movement. The vast majority of maternal mortality and morbidity is avoidable through timely use of obstetric care.6

As literature indicates, in developing countries the figure is about 480 maternal deaths for every 100,000 live births. In developed countries, there are about 27 maternal deaths for every 100,000 live births. Globally every minute at least one woman dies from complications related to pregnancy or child birth that means about 529,000 women a year. According to the United Nations Children’s Fund (UNICEF) states that in India, every year about 78,000 mothers die in childbirth and from complications of pregnancy. It is mainly due to large number of deliveries conducted at home by untrained persons, lack of adequate referral facilities to provide emergency obstetric care for complicated cases and contribute to high maternal morbidity and mortality. Social stigma associated with seeking care and the lacks of awareness about illness that require care have been identified as major problems. India’s maternal mortality rate stands at 450 per 100,000 live births. The figures are way behind India’s Millennium Development Goals which call for a reduction to 109 by 2015, according to UNICEF.7

A community based cross-sectional study was conducted to assess the knowledge of pregnant women on obstetrical danger signs. The study sample consisted of 812 pregnant women selected from 8 rural and 2 urban areas. A structured pretested questionnaire was used to collect quantitative data on socio-demographic characteristics and knowledge about danger signs of pregnancy, child birth and postpartum period. Qualitative data was collected based on focus group discussions and indepth interview with traditional birth attendants. The result of the study showed that out of 743 pregnant women who responded 226 (30.4%), 305 (41.3%) and 279 (37.7%) knew at least two danger signs of pregnancy, child birth and postpartum period respectively. Urban residents were found to be strongly associated with mentioning at least two danger signs of pregnancy (OR=4.1; 95% CI: 2.4, 7.0), child birth (OR=3.3; 95% CI: 1.8, 6.1), and postpartum period (OR=8.4; 95% CI: 4.5, 15.4). So the study concluded that the knowledge level of pregnant women about obstetrical danger signs was low and affected by residential area. Therefore researcher recommends improving maternal and child health services by designing an appropriate knowledge and expectation of labour among primi gravid.8

An exploratory descriptive study was conducted to assess women’s awareness of danger signs of obstetric complications. The study sample consisted of 200 pregnant women selected from 2 Maternal and Child Health Centres (100 from each). A structured interview schedule was developed by the researcher to collect the necessary data which comprised socio-demographic data, obstetric characteristics and danger signs and its management. The result of the study showed that slightly more than one quarter of the study subjects ( 26.5%) were unaware of obstetric danger signs compared to almost the same proportion ( 26.0% ) that had good awareness about such signs, while ( 47.5%) of the study subjects exhibited fair awareness. It also revealed that the lack of awareness about obstetric danger signs was related to younger age, low level of education, gravidity and parity, previous experiences with any obstetric complications and lack of antenatal care. The study concluded that there is a need for a strategic plan to increase the awareness to shape health seeking behaviour of the public related to signs of obstetric complications. 9

A community based study was conducted to assess the knowledge of women about obstetric complication and care. The study sample consisted of 329 married women of reproductive age selected systematically from the community. A structured questionnaire was used to collect the data. The study revealed that most of the women (75%) had poor knowledge of common and serious pregnancy related complications based on their perception related to danger signs. About 5% of the women perceived absent or decreased foetal movement as a danger sign of pregnancy. Other reported danger signs included premature uterine contraction by 3%, premature rupture of membranes by 3%, convulsions by 13%, obstructed labour by 23% and bleeding by 39%. About 86% of women had wrong perception regarding unsafe practices of obstetric care that a case of ante-partum haemorrhage should be examined internally and 50% thought that no precaution is required to sterilize the instrument for cutting the cord. So the researcher concluded that there is a clear need to create awareness regarding obstetric complication and to promote early recognition of the obstetric emergency.10

Based on the above facts the investigator felt that a large population of the antenatal mothers are in need of knowledge about danger signs of pregnancy. Complications can arise suddenly and cause immediate harm if there is no appropriate medical care and treatment. Therefore understanding early warning signs and actions to take when complications occur are crucial steps to reduce maternal and newborn morbidity and mortality. Knowledge of danger signs will improve people’s awareness when they need to seek health services. Knowledge and awareness of danger signs can increase women’s confidence and willingness to seek care. It can alert people to take immediate and appropriate actions for preventing and minimizing the development of complication.

6.2 REVEIW OF LITERATURE

A literature review refers to an extensive and systematic examination of books, publication and articles relevant to the research. A literature review involves the systematic identification, location, scrutiny and summary of written material that contains information on a research problem. The purpose is to determine the extent to which theory and research have been developed about the studied topic, identify the definition of concepts and variables already established, examine elements of research used by others such as designs, methods, instruments and techniques of data analysis that may prove useful in the proposed object.11

A descriptive cross sectional study was conducted to assess the knowledge of primigravid women on warning signs during pregnancy at Coimbatore. The sample of the study included 100 primigravid mothers. The data were collected by using structured interview schedule after testing the validity and reliability. Most of the mothers (66%) were in the age group of 21-25years. Among them about (74%) mothers were belongs to joint family. About 36% of mother had secondary education, where as 31% had graduates and illiterates were 2%. About 76% of the mothers were housewives. The result of the study showed that mean knowledge score was highest (3.94±1.46) on the area of definition, duration, signs and symptoms of pregnancy and definition of warning signs during pregnancy. More or less similar percentage was obtained in the area of maternal weight gain, foetal movement and signs and symptoms of PIH (3.7±1.31) and management of oedema, preterm labour and signs and symptoms of anaemia (3.5±1.53). Lowest mean score was obtained in the area of warning signs during pregnancy (2.78±2.0) and normal value of Hb, causes and effect of anaemia and effect of warning signs and its prevention ( 2.73±1.31). So the study revealed that the mothers had poor knowledge on warning signs during pregnancy.12

A study was conducted to assess women’s awareness of danger signs of obstetric complications and to identify associated factors. The study sample consisted of 1118 women who had been pregnant in the past two years and they were interviewed. The result of the study showed that more than 98% of the women attended antenatal care at least once. Half of women knew at least one obstetric danger sign. The percentage of women who knew at least one danger sign during pregnancy was 26%, during delivery 23% and after delivery 40%. Few women knew three or more danger signs. The likelihood of having more awareness was increased significantly by increasing age of the mother, increasing education, number of deliveries, number of antenatal visits, whether the delivery took place at a health institution and whether the mother was informed of having a risks or complications during antenatal care. So the study concluded that women had low awareness of danger signs of obstetric complications. The researcher recommended to increase awareness of obstetric danger signs by improving the quality of counselling and involving other family members in antenatal and postnatal care, to use radio messages and educational sessions targeting the whole community.13

A descriptive cross sectional study was conducted to evaluate birth preparedness and complication readiness among antenatal mothers. The study sample consisted of 394 women who attended antenatal clinic. A pre-tested questionnaire was used to collect the data from women who were above 32 weeks of gestation and had attended the clinic more than twice. The result of the study revealed that 60% of the respondents were counselled by health workers on various elements of birth preparedness. About 87.3% of the respondents were aware of their expected date of delivery, 84.3% had set aside funds for transport to hospital during labour while 62.9% had funds for emergencies. About 67% of the respondents knew at least one danger signs in pregnancy while only 6.9% knew of three or more danger signs. One hundred and nine percent of the respondents did not have a clear plan of what to do in case of an obstetric emergency. The researcher concluded that education and counselling on different aspects of birth preparedness was not provided to all clients and respondent’s knowledge of danger signs in pregnancy was low.14