REGISTRATION OF SUBJECTS
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE REGARDING HYPEREMESIS
GRAVIDARUM AMONG ANTENATAL MOTHERS IN SELECTED
Submitted By :
Ms. ABI T. AYROOR
I Year M.Sc Nursing
Shridevi College of Nursing,
Tumkur 572 106
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
SYNOPSIS Proforma for Registration of
Subject for Dissertation
1. NAME OF THE CANDIDATE MS. ABI T. AYROOR
AND ADDRESS 1ST YEAR M.SC. NURSING,
SHRIDEVI COLLEGE OF NURSING,
LINGAPURA, SIRA ROAD,
NAME OF THE SHRIDEVI COLLEGE OF NURSING,
1ST YEAR M.Sc. NURSING,
COURSE STUDY AND
3. OBSTETRICS AND GYNECOLOGICAL
DATE OF ADMISSION TO
5. TITLE OF STUDY “A STUDY TO ASSESS THE
EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON
HYPEREMESIS GRAVIDARUM AMONG
ANTENATAL MOTHERS IN SELECTED
6. BRIEF RESUME OF THE INTENDED WORK:
The reproductive period of a women begins at menarche and ends in menopause it
usually extends from 13-45 years. Fertilization is the process of fussion of spermatozoon with the
matured ovum. Pregnancy is the period which starts from the conception of ovum and sperm
and end by the delivery of foetus. This duration is around 280 days or 40 weeks, calculated from
the fist day of last menstrual period.
Pregnancy is an essential physiological process. The main signs and symptoms of
pregnancy are amenorrhoea, frequency of micturation, Morning sickness, breast discomfort,
fatigue etc. In the early weeks, nausea and vomiting are common. It generally starts about 4-8
weeks and may continue till about sixteenth week . Usually it is present in the early hours of
The vomiting in early weeks of pregnancy is very common. But it as mild, its frequency
being just once or twice in the morning, the quantity is small and seldom does it tell on the
patients’ health. She is able to retain enough food and does not lose weight appreciably.
Sometimes, however, the vomiting persists, increases in frequency, very little nourishment is
retained and the patient loses weight. To this excessive vomiting in pregnancy, the term
hyperemesis gravidarum applied.
In the severe cases, inspite of energetic treatment , the patient shows deterioration in her
condition, pregnancy will be terminated. It is safer to induce abortion a little earlier rather than
later when even termination of pregnancy may not help1 .
6.1.NEED FOR THE STUDY:
Nausea and vomiting are common in early pregnancy affecting 70% of pregnancy
mothers. In a majority of women, vomiting begins between 4-7 weeks of pregnancy . Nausea and
vomiting are usually mild and self limitng, however, some of the mothers have a more profound
course which lead to hyperemeris gravidarum, careful clinical evaluation is necessary to exclude
underlying medical illness or non pregnancy related cause of severe vomiting. Hyperemesis
gravid arum posess health risk to both mother and baby, therefore, prompt treatment should be
initiated without delay. Non pharmacotherapy such as dietary modification and emotional
support are useful . Pharmacotherapy with antiemetics ,pyridoxine methyl prednisolone are
effective and relatively safe. Severe hyperemesis with dehydration and electrolyte imbalance may
need hospitalization for electrolyte and fluid replacement2.
Chiossi.G. et al, conducted a study on hyperemesis gravidarum complicated by wernicke
encephalopathy in the year 2006 in Italy. They stated that wernicke encephalopathy is a rare but
known complication of severe hyperemesis gravidarum caused by thiamine deficiency . This
article present an unsual case that occurred at their institution and reviews the 48 previously
published cases of wernicke encephalopathy in pregnancy, considering all 49 cases, the mean
patients age was 26.7 +/-4.9 years, the mean gestational age when wernicke encephalopathy
manifested was 14.3 +/-3.4 weeks, and the mean duration vomiting and feeding difficulties was
7.7 +/- 2.8 weeks. Wernicke’s classic triad[Confussion (63.3%), ocular abnormalities(95.9%) and
ataxia(81.6%)] manifested. The diagnosis of wernicke encephalopathy is clinical and can be
rapidly confirmed by magnetic resonance imaging. They emphasize the importance of thiamine
supplementation to women with prolonged vomiting is pregnancy, especially before intravenous
or parenteral nutrition3.
Dodds L et al conducted a study in Canada to evaluate maternal and neonatal out
comes among women with hyperemesis during pregnancy. Of the 156091 singletone
pregnancies, 1270 had an admission for hyperemesis. Compared with infants born to women
without hyperemesis,rates of low birth weight and preterm delivery were substantially higher
among infants born to women with hyperemesis and low pregnancy weight gain(4.2% versus
12.5% and 4.9% versus 13.9%) respectively. The study suggest that adverse infant outcomes
associated with hyperemesis are a consequence of , and mostly limited to , women with poor
maternal weight gain4.
Nausea and vomiting commonly occur in pregnant women. Hyperemeris gravidarum is a
severe form of nausea and vomiting rarely occurring in pregnancy. Between 0.3% and 2% of all
pregnant women suffer from hyperemesis gravidarum . Recent studies supports that
hyperemesis gravidarum is a multifactorial disease and the incidence is more.5
Hyperemesis gravidarum is the excessive nausea and vomiting that persist beyond the
first triminister and causes disturbance in nutrition , electrolyte and fluid balance. Investigator,
during her clinical experience has found that the antenatal mothers believe this condition to be a
part of pregnancy and use house hold management. Thus, these antenatal mothers hesitate to go
to hospitals which could be lead to life threatening situation, both to the mothers and the fetus.
6.2. REVIEW OF LITERATURE :
The purpose of this study is to obtain knowledge and in depth information about the
1) Vikanes A et al, (2008), conducted a study to estimate the prevalence of hyperemesis
gravidarum in women living in Norway in 1967-2005. This was a cross sectional study . 900
primiparous women comprised as sample. The overall prevalence of hyperemesis
gravidarum in primiparous women in Norway during the study period was 0.89%. Women
born in western Europe had the lowest prevalence of hyperemesis gravidarum(0.8%),where
as those born in India and Sri Lanka had the highest(3.2%). Women born in Africa and India
or SriLanka were 3.4% and 3.3% times more likely to develop hyperemesis gravidarum
than women born in Norway , after adjustment for potential confounders . The study
concluded as substantial variations in the prevalence of hyperemesis gravidarum in
Norway by country of birth cannot be explained by the difference in maternal socio
2) Holmgren C. et al, (2008) conducted a study as hyperemesis in pregnancy; an evaluation of
treatment strategies with maternal and neonatal outcomes in Salt Lake city , USA , Subjects
were identified with confirm intrauterine pregnancy admitted with hyperemesis
gravidarum between 1998 and 2004. Subjects were assigned on the basis of management
plan, medication alone, PICC(Peripherally Inserted Central Catheter ) line nasogastric or
nasoduodenal tube . Out come were compared between groups. This study concluded as
maternal complications associated with PICC line placement are substantial despite no
difference is neonatal outcomes, suggesting that the use of PICC lines for treatment of
hyperemeris gravidarum patients should not be routinely used.7
3) Sheehan.P (2007) conducted a study on hyperemesis gravidarum-assessment and
management in Australia. This article outlines the aetiology, outcomes, history and
examination of women with hyperemesis gravidarum. Treatment modalities are discused
together with evidence regarding use. Assessment of severity by checking for ketones is
important as severity determines management . Management will include rehydration
(intravenous or oral). Evidence is lacking regarding dietary and life style recommendations
but, some women find them useful. Pyridoxine and metoclopramide are first line in
treatment of hyperemesis gravidarum followed by prochlorperazine, predinisolone,
promethazine and ondansetron.8
4) Fell D.B. et al (2006) conducted a study on the risk factors for hyperemesis gravidarum
requiring hospital admission during pregnancy. Data from a population based-Cohort of all
deliveries in Nova Scotia, Canada between 1988-2002. Hyperemesis were compared with
women with no admissions for hyperemesis. Conclusion of the study is although
hospitalization for hyperemesis occurs less than 1% of pregnant women, this translates to a
large number of hospital admissions. The factors associated with hyperemesis are primarily
medical and fetal factors that are not easily modifiable, but identification of there factors
may be useful in determining those women at high risk for developing hyperemesis. 9
5) Meighan M et al,(2005), Conducted a study on the impact of hyperemeris gravidarum on
maternal role assumption is USA during 2005 . Research design was qualitative descriptive
design. Eight women were interviewed about their experiences with hyperemesis
gravidarum in their homes or other suitable sites selected by them. Hyperemesis
gravidarum is a disorder that alters the usual response to pregnancy and birth . Participants
in this study described it as so debilitating that they had little concern for any thing else,
including the fetus. After symptoms subsided, the participants reported that they were able
to regain control over their lives and made an effort to makeup for lost time in becoming
attached to their baby. The study concluded as women suffering from hyperemesis
gravidarum may not benefit from the usual prenatal education efforts. Additional supports
following delivery may be needed as the women attaches to her infant and learns to
6) Arsenault M.Y et al (2003), conducted a study on the management of nausea and vomiting
of pregnancy in France. The quality of evidence reported in the guidelines has been
districted using the evaluation of evidence criteria outlined on the report of the Canadian
Task Force on the periodic health exam. Nausea and vomiting of pregnancy has a profound
effect on women’s health and quality of life during pregnancy, as well as financial impact
on the health care system, and early recognitions and management are recommended.11
7) C,J, Blogger(2008) reported an article in citizen journalism about Indian, Sri Lankan women
prone to morning sickness. According to the report published by medindia based on the
results of a study, women born in India and Sri Lanka are three times more likely to suffer
from extreme nausea and vomiting, called hyperemesis gravidarum, and various among
pregnant women from different countries. 9,00,000 first time pregnancies registered in the
medical birth registry of Norway over a 40 year period. 300 cases of hyperemesis
gravidarum were recorded out of 9,00,000 pregnancies , giving an overall prevalence of
0.89%. Extreme nausea and vomiting results in dehydration, loss of important electrolytes ,
malnutrition and weightloss and it could be life threatening for mother and baby if lift
STATEMENT OF THE PROBLEM
‚ A Study to assess the effectiveness of structured teaching programme on knowledge
regarding hyperemesis gravidarum among antenatal mothers in selected hospitals,
6.3. OBJECTIVES OF THE STUDY :
1) To assess the knowledge of antenatal mother regarding hypermesis gravidarum before
structured teaching programme.
2) To assess the knowledge of antenatal mothers regarding hyperemesis gravidarum after
structured teaching programme.
3) To evaluate the effectiveness of structured teaching programme by comparing the pre and
post test knowledge score.
4) To find out the association between demographic variables and the antenatal mother’s
knowledge regarding hyperemesis gravidarum.
6.4. OPERATIONAL DEFINITIONS :
In this study assessment refers to an organized, systematic and continous collection of data
from antenatal mothers regarding hyperemesis gravidarum.
In this study effectiveness means the outcome of structured teaching programme on
hyperemesis gravidarum, which is measurable in terms of improvement in antenatal
mother’s knowledge score based on given questionnaire.
Structured Teaching Programme:
In this study it refers to a well prepared teaching programme for 45 minutes with
systematically developed instruction for a group of antenatal mothers regarding various
aspects of hyperemesis gravidarum.
In this study it refers to the responses of antenatal mothers to the questionnaire regarding
In this study antenatal mothers refers to pregnant women during the time of maternity cycle
that begins with conception and ends with the onset of labour.
It refers to a severe type of vomiting of pregnancy which has got deleterious effect on the
health of mothers.
6.5. RESEARCH HYPOTHESES:
The study is based on following hypotheses:-
H1 -The mean post test knowledge score will be significantly higher than the mean
pre test knowledge score.
H2 –There will be a significant association between knowledge score and selected
Structured teaching programme may facilitate better learning and it will be useful in
improving the knowledge regarding management of hyperemesis gravidarum.
The study may reduce the complication and length of hospitalization of patients and there
will reduce the expenditure of treatment
The study may limited to :-
1. The antenatal mothers who are available during the period of data collections.
2. The antenatal mothers who are willing to participate in the study.
6.8. Pilot Study :
Pilot study will be conducted with 6 samples. The purpose of pilot study is to find out the
feasibility of conducting study and design on plan of statistical analysis.
6.9. Variables :
Variables are an a attribute of person or objects that varies , that takes on different values.
Dependent Variables: knowledge Level of antenatal mothers regarding hyperemesis
Independent Variable: Structured teaching programme .
Extraneous Variables: age, gravidity, education qualification, occupation.
7. MATERIAL & METHODS:
7.1. SOURCE OF DATA :
Data will be collected from the antenatal mothers in selected hospitals, Tumkur.
7.1.1. RESEARCH DESIGN:
The research design in this study will be one group.
7.1.2. RESEARCH APPROACH:
The pre experimental research method will be chosen for the study to assess the
effectiveness of structured teaching programme on knowledge regarding hyperemesis
7.13 RESEARCH SETTING:
The study will be conducted in selected hospitals, Tumkur, Karnataka.
7.1.4. POPULATION :
The study population comprises of all the qualified antenatal mothers in selected
hospitals, , Tumkur.
7.2. METHODS OF DATA COLLECTION :
A structured questionnaire will be used for data collection
The study will be conducted after obtaining permission from the concerned
7.2.1. Sampling Procedure :
Non probability purposive sampling method will be used for selection of samples.
7.2.2. Sampling Size :
The total study sample consist of 60 antenatal mothers in selected hospitals, Tumkur.
CRITERIA FOR SAMPLE SELECTION:
7.2.3. Inclusion Criteria :
Mothers who are in antenatal period.
Mothers can speaks and understand kannada.
Present during the period of data collection.
7.2.4. Exclusion Criteria :
Antenatal mothers who are not willing to participate.
Mothers who are not able to speak kannada.
7.2.5. TOOLS FOR DATA COLLECTION:
A structured questionnaire regarding hyperemesis gravidarum.
7.2.6. DATA ANALYSIS METHOD:
Descriptive Statistics :
Mean, standard deviations range and mean score of subjects will be used to quantify the level
of knowledge before and after structured teaching programme.
Paired ‘t’ test will be used to examining the effectiveness of structured teaching programme
by comparing the pre and post test score. Chi-square test will be worked out to determine
the association of socio-demographic focuses of antenatal mother with pre test knowledge.
7.2.7. Time and Duration of Study :
Time and duration of study will be as per research committee.
7.3. Does the study require any investigation or interventions to be conducted on patients or
other human or animals ? If so please describe briefly.
Structured teaching programme will be administered to antenatal mothers.
7.4. Ethical clearance.
The pilot study and main study will be conducted after the approval of research
committee of the college. Permission will be obtained from the head of the institutions.
The purpose and the details of the study will be explained to the study subjects and
assurance will be given regarding confidentiality of the data collected..
8. LIST OF REFERENCE:-
1. A.L. Mudaliar, M.K. Krishna Menon, Mudaliar and Menon’s clinical obstetrics, 9th edition,
Chennai, orient Longman Pvt.Ltd, 2001 , P-48,127,454.
2. Loh KY, Sivalingam N, Understanding hyperemesis gravidarum; Medical journals,
Malaysia; 2005; V01 60(3); 394-399.
3. Chiossi.G, Neri I, Cavazzuti M, Basso.G Facehinetti .F Hyperemesis gravidarum
complicated by wernicke encephalopathy ; obstetrical and gynecologic survey 2006;
4. Dodds.L Fell DB, joseph K.S, Allen V M Butler.B; out of pregnancies complicated by
hypeeremesis gravidarum; journal obstetrics Gynecology 2006; 107(2 pt 1); 285-292.
5. Philip.B, Hyperemesis gravidarum literature review WHJ; 2003 ;102(3) 46-51.
6. Vikanes.A.Grjibovski A M, Vangen.S, Magnus.P, Variations in prevalence of hyperemesis
gravidarum by country of birth: a study of 900 pregnancies in Norway , 1967-2005, public
health journal; 2008,36(2);135-142.
7. Holmgren .C. Aagaard-Tillery K M , Silver R.M, Porter T F, Varner M, Hyperemesis in
pregnancy: an evaluation of treatment strategies with maternal and neonatal outcomes;
journal of obstetrics at gynecology 2008 ; 198(1);56.
8. Sheehan P, Hyperemesis gravidarum:- assessment and management: Australian Fam
physician journal ; 2007 36(9); 698-701.
9. Fell D B, Dodds L, Joseph K.S, Allen V M, Butler B; risk factors for hyperemesis
gravidarum requiring hospital admission during pregnancy; journal for obstetrics and
Gynecology. 2006; 107(2); 277-284.
10. Meighan M, Wood A F, The impact of hyperemesis gravid arum on maternal role
assumption; The journal for obstetrics gynecology and neonatal nurses; 2005; 34(2);
11. Arsenault .M.Y., Lane.C.A., Mackinnon. C.J., Bartellas.E., et al, the management of nausea
and vomiting of pregnancy, The journal for obstetrics and gynecology; 2003 ;25(1);13.
12. C.J. Blogger, Indian, Lunkan women prone to morning sickness, citizen journalism, 2008
9. Signature of the Candidate
10. Remarks of the Guide
11. Name and Designation of (in block letters)
11.3. Co-guide (if any)
11.5. Head of the Department
12. 12.1. Remarks of the Chairman and Principal