RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
PROFORMA SYNOPSIS REGISTRATION OF SUBJECT
FOR DISSERTATION TITLE
TOPIC: A STUDY TO ASSESS THE KNOWLEDGE OF ANTENATAL MOTHERS REGARDING ILL EFFECTS OF TRAVELING DURING PREGNANCY IN A SELECTED HOSPITAL IN BANGALORE WITH A VIEW TO PROVIDE AN INFORMATIONAL BOOKLET.
SUBMITTED BY:
MISS P.SWAPNA
M.Sc(N) 1ST YEAR
GOLD FINCH COLLEGE
OF NURSING
BANGALORE-92.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.PROFORMA SYNOPSIS REGISTRATION OF SUBJECT FOR
DISSERTATION TITLE
1. / NAME OF THE CANDIDATE / MISS SWAPNA POGIRI
GOLD FINCH COLLEGE OF NURSING
NO. 150/24, KODIGEHALLI ROAD
MARUTHI NAGAR
BANGALORE-92
KARNATAKA.
2. / NAME OF THE INSTITUTION / GOLD FINCH COLLEGE OF NURSING
BANGALORE.
3. / COURSE OF STUDY AND SUBJECT / 1ST YEAR M.Sc NURSING
OBSTETRIC & GYNECOLOGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 15TH JUNE 2009.
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE KNOWLEDGE OF ANTENATAL MOTHERS REGARDING ILL EFFECTS OF TRAVELING DURING PREGNANCY IN A SELECTED HOSPITAL IN BANGALORE WITH A VIEW TO PROVIDE AN INFORMATIONAL BOOKLET.
6. BRIEF INTRODUCTION OF THE INTENDED WORK:
INTRODUCTION
“ Motherhood is neither a duty nor a privilege, but simply the way that humanity can satisfy the desire for physical immortality & triumph over the fear of death”.
The reproductive period of a woman begins at menarche and ends in menopause. It usually extends from 13-45 years. While biological variations may occur in different geographical areas, pregnancy is rare below 12 years and beyond 50 years. The duration of pregnancy is calculated as ten lunar months or nine calender months and seven days or 280 days or 40 weeks (1).
Most women can travel safely until close to their due date. For most women, the most comfortable time to travel is in the middle of pregnancy. Problems are least likely to happen during this time. During pregnancy, many women have concerns about seat belts. There is no question that you are much better off wearing your seat belt during pregnancy. The baby is very well protected in the uterus from trauma, but car accidents are the most common source of trauma during pregnancy. The most common reason for fetal death is maternal death, and maternal death is much less likely in mothers who wear seat belts. Both lap and shoulder belts should be worn at all times. The lap belt should be worn low on the hips, not over the uterus. Also remember that after delivery, an approved car seat must be in you car in order to take your baby home from the hospital. Antenatal mother should not sit with her legs crossed and that she should get out to walk every two hours (3).
People also have concerns about flying during pregnancy. In general, there does not seem to be an increased risk for women who fly during pregnancy. Any woman who sits for long periods of time without getting up for a walk is at risk for developing a blood clot in her legs. For this reason, on flights over two hours, you should get up, stretch your legs, and take a walk up and down the aisle. Because of this, an aisle seat is usually advisable (7).
Travel during pregnancy can be a safe, comfortable and enjoyable experience. Although traveling is not recommended if you have problems with the pregnancy or serious medical problems, almost every woman can travel safely until the last four weeks of the pregnancy. After that, the antenatal mother should travel only when it is absolutely necessary and only after clearance by doctor because there are many problems and complications that can develop in late pregnancy. The second trimester (13-28weeks), the time of fewest complications, is probably the best time to travel. During this time, she may also likely to be over morning sickness, she may feel more comfortable (8).
More individuals are traveling internationally now than ever before. International travel can lead to wonderful new experiences and lasting memories. Unfortunately travel can also lead to health problems when a preexisting medical condition is present it will be worsened during travel. Air travel can be associated with several problems like lower- oxygen environment, ear and sinus symptoms and blood clots.
Travel for pregnant women is balancing of risks; both the possible risk of the travel itself and also the availability of good medical care in other countries. Pregnant women should avoid travel to malaria risk areas. Malaria is particularly dangerous in pregnancy, associated with miscarriage, small for date babies, premature labour, anemia and more severe illness in the mother. The risk for malaria is especially high in the second and third trimester of pregnancy and for 60 days after giving birth. Drugs used for malaria may also have adverse effects on the fetus and may cause diarrhea and vomiting in mother. Pregnant women should observe strict precautions and seek treatment if they become ill.
Travels by vehicles having jerks are better to be avoided specially in first trimester and the last six weeks. The long journey is preferably being limited to the second trimester. Rail route is preferable to bus route. Travel in pressurized aircraft offers less risk. Air travel is contraindicated in cases with placenta previa, pre-eclampsia, severe anemia and sickle cell disease. Travel by motorcycle is not recommended. It is best to notify the doctor of her travel plans and ask for any recommendations specific to her pregnancy (3).
Traveling to high altitudes may cause problems during pregnancy, as her body and fetus adjust to the lower air pressure and lower levels of oxygen. It’s generally best to let her body adjust to moderate altitudes 6000-8000 feet for a few days before going above 8,000 feet. Women with complicated pregnancies may want to avoid mountain- top excursions altogether.
Land travel should not more be than 5-6 hours a day. Always she should wear her seatbelt. Place the lap belt under her abdomen and across her hips so that it fits snugly and comfortably. Put the shoulder strap between her breasts and across her shoulder. She should always wear the lap strap when traveling while pregnant. The fluid filled sac inside the uterus, which is further, protected by muscles, organs and bones cushions the baby. However, if she is in an accident she should always check with her doctor to make sure that she and her baby are fine.
If she has never been on a cruise it may not be the best time to take one. Travels by sea may upset her stomach even if she is not pregnant, and may be more uncomfortable if she is pregnant. If she decides to go on a cruise, she should check what medical care will be available to her and what emergency measures her cruise is prepared to employ. Ensure that ships meet strict sanitation guidelines.
Flying during pregnancy is generally safe. She should consider getting an aisle seat for more room and to make it easier to walk around and get to the bathroom. She should wear layered clothing so that she can have some control when there are temperature changes. She should get up and walk at least once an hour, and drink plenty of fluids, to reduce the risk of blood clots forming in her legs. Women with complicated pregnancies are those with high risk of preterm delivery, pre-eclampsia, or signs of poor fetal growth and may need supplemental oxygen when flying. She should talk to the health care provider before she travels to see if she needs additional oxygen. Air travel also exposes passengers to small amounts of cosmic radiation (5).
Dehydration may lead to decreased placental blood flow and hem concentration and increasing risk of. thrombosis, and the low humidity in aircraft is said to aggravate dehydration. Avoid fluids not containing alcohol (or caffeine). Taking half an aspirin daily does not reduce the risk of thrombosis (blood clot) occurring in the legs. Those who have a past history of deep vein thrombosis should consider the use inject able low molecular heparin. (Safe in pregnancy).
HIV infection can pose several problems during travel. People with HIV may not be allowed to enter some countries. People with HIV will not be able to receive certain travel immunizations. HIV infected travelers should carry all necessary medications with them. It is preferable to avoid vaccinations, in the first three months of pregnancy and to avoid live viral vaccines, particularly (MMR) throughout pregnancy. Avoid vaccines which may be associated with a febrile reaction in the first three months of pregnancy, e.g. old typhoid injection.Hepatitis E, formerly called nonA non-B hepatitis is particularly serious in the 2nd & 3rd trimesters of pregnancy.
Apart from these obstetrical emergencies may arise. Trauma during pregnancy may occur including motor vehicle accidents, falls, abruptio placenta etc which may endanger the life of both the mother and the foetus if immediate medical attention is not there. Other potential issues with pregnant passengers are spontaneous abortion, motion sickness, immobility and circulatory problems, hypoxia, barotraumas, cosmic radiation, noise, emergency egress, preterm labour, food and water born illness, malaria during pregnancy, isolation from proper obstetric care, motor vehicle accidents, hepatitis E.
Fortunately, most travel- related health problems can be prevented with a combination of pre-travel planning, immunizations, and safety precautions during travel. If you are planning travel outside of your home country, consult your healthcare provider at least one month prior to traveling. The provider can give immunizations, travel medications and tips for staying healthy during the trip, or may recommend a specialized travel medicine provider for some or all of these immunizations, medications and advice.
6.1 NEED FOR THE STUDY:
In the days of old, travel by horse and buggy was not recommended for pregnant women, but that method has given way to trains, automobiles, buses and airplanes. Sea cruises are becoming a major part of vacation packages. A 21st-century pregnant woman tends to travel commonly for business and recreation. Travel during pregnancy has long been a concern to the obstetrician. We are frequently asked to give recommendations to minimize the risk of travel-related illnesses. As women enter full-time careers that require business and professional travel, travel becomes imperative during the trimesters of pregnancy.
The number of people traveling by commercial aircraft in recent years is unprecedented. Over the last 30 years, the number of air passengers worldwide has nearly quadrupled, from 383 million in 1970 to 1.462 million in 1998. The aviation environment is complex and potentially dangerous. There have been doubts about the safety to flying in pregnant mothers. To complicated matters, the advent of ultra- long range aircraft such as the Airbus 34; has made non—stop air travel up to a grueling 18-19 hours a reality. Air travel is generally safe and most major airlines in the world would allow unrestricted travel for pregnant travelers up to 35th-36th week of singleton pregnancy and 32nd week for multiple (twin) pregnancy. Air travel is not recommended for women who have medical or obstetrical complications, such as pregnancy induced hypertension, poorly controlled diabetes or sickle cell disease, that would result in an emergency, who are at significant risk for premature labour or who have placental abnormalities. Unless absolutely necessary, it is also recommended that traveling during the first trimester be deferred as there is a small risk of cosmic radiation effect on the developing fetus.
Two hundred twenty-two women were studied. Out of these 53% traveled at least once during pregnancy. The results of traveled and non-traveled were compared and the results are: gestational age at delivery (38.4 wks vs 39.1); neonatal birth weight (3.27 kgs vs 3.379); rate of vaginal bleeding (5% vs 2%); preterm delivery (14% s 9%); pre-eclampsia (6% vs 5%); and neonatal intensive care unit admission (16% vs 13%).
Most of the pregnant women don’t know the risks of traveling during pregnancy. Some of them knew about the maternal risks but their knowledge is deficient about fetal risks and about the precautions to be taken while traveling. Reports of study reveals that in India majority of mothers (87.8%) don’t know that mediations during pregnancy should be taken on prescription of their obstetrician; and 26.48% believe that traveling is harmful for pregnant women.
Numbers of women is adversely affected by traveling during pregnancy; because of lack of knowledge regarding what precautions to take and are prone to many diseases affecting other and fetus. The incidence is more in women living in urban environment because of increase in modern lifestyle. Thus the investigator selected this problem for reducing the risks and ill effects of traveling during pregnancy.
6.2 REVIEW OF LITERATURE
This chapter deals with a review of literature relevant to the study. Review refers to an extensive, thorough and systematic examination of publications related to the research project. Critical review refers to the examination of the strength and weakness of appropriate publications. Review of literature gives an insight into various aspects of the problem under study. It helps the investigator in developing the methodology and tools for data collection and planning the analysis of data.
The review of literature is grouped under the following headings:
Section I: Reviews related to infectious diseases.