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. martina.rauchfuss@charite.de

16.Morikawa M, Cho K, Yamada T, Yamada T, Sato S, Minakami H Center for Perinatal Medicine, Hokkaido University Hospital, Sapporo, Japan. mmamoru@med.hokudai.ac.jp

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,drsaba2007@yahoo.com.

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. wangshuoshi1985@126.com

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. dehrenthal@christianacare.org

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