SYNOPSIS



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

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|1. |Name of the candidate and address (in block letters) |APARNA J. VALLITHOTTATHIL |

| | |I YEAR M. Sc. NURSING |

| | |DR. M. V. SHETTY COLLEGE OF NURSING |

| | |VIDYANAGAR |

| | |MANGALORE – 575013. |

| | | |

|2. |Name of the Institution |DR. M. V. SHETTY COLLEGE OF NURSING |

| | |VIDYANAGAR |

| | |MANGALORE – 575013. |

| | | |

|3. |Course of Study and Subject |M. Sc. NURSING |

| | |OBSTETRICS AND GYNAECOLOGICAL NURSING |

| | | |

|4. |Date of Admission to the Course |20.10.2011 |

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|5. |Title of the study |

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| |A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE ON URINARY COMPLICATIONS AMONG POSTNATAL MOTHERS IN A SELECTED PRIMARY HEALTH CENTRE AT |

| |MANGALORE, DAKSHINA KANNADA, KARNATAKA WITH A VIEW TO DEVELOP A HEALTH EDUCATION PAMPHLET. |

| | |

|6. |Brief resume of the intended work |

| |Introduction |

| |The urinary system is chiefly thought of in connection with its elimination function and the production of urine. In the female it has |

| |an importance associated with its proximity to the reproductive organs. Women face many complications in the postnatal period. Most of |

| |the mothers get urinary complications after their delivery, because when the woman is pregnant the enlarging uterus affects all the |

| |parts of urinary tract at various times and during the labour some of the factors like caesarean section, catheterisation, instrumental |

| |delivery, episiotomy, etc. may affect the urinary system. These factors lead to urinary complications in the postpartum period.1 |

| |However, some mothers get urinary complications in the postpartum period. The postpartum period begins after the delivery of the baby |

| |and ends when the mother’s body has returned as closely as possible to its pre-pregnant state. This period usually lasts six weeks2. The|

| |postpartum bladder has a tendency to be under-active and is therefore, vulnerable to the retention of urine following trauma to the |

| |bladder, pelvic floor muscles and nerves during delivery. If postpartum voiding dysfunction is unrecognised, it can lead to bladder |

| |under-activity and prolonged voiding dysfunction, with sequelae such as recurrent urinary tract infection and incontinence3. |

| |According to International Continence Society, urinary incontinence is the involuntary loss of urine that represents a hygienic or |

| |social problem to the individual. Urinary retention or bladder retention is an obstruction of the normal flow of urine from the bladder |

| |in to the urethra and out of the body4. Urinary tract infection is an infection that can happen anywhere along the urinary tract5. |

| |Worldwide, every minute one woman dies of pregnancy-related complications. Nearly 6,00,000 women die each year; of these 99 percent die |

| |in the developing countries; 50-60 percent deaths occur during the postnatal period. According to the World Health Organisation about |

| |5,10,000 maternal deaths occurred globally during the year 2002. Globally the major causes of maternal death are severe bleeding (20%), |

| |infection (15%), |

| |eclampsia (12%), obstructed labour (53%), and other problems such as infection, urine retention, incontinence and breast problems such |

| |as mastitis and breast abscess6. |

| |According to statistics of International Continence Society, urinary incontinence in women during pregnancy with prevalence of urinary |

| |incontinence being reported before, during and after pregnancy is four percent, 43.7 percent, and 14.6 percent, respectively7. |

| |Postpartum urinary retention after vaginal delivery is a relatively common event, with the reported ranging from two percent to 17.9 |

| |percent. Similarly, the incidence of urinary tract infection is increased in the puerperium to approximately eight percent8. |

| |In the United States, an estimated eight million women suffer from urinary incontinence. In United Kingdom, postpartum urinary retention|

| |has a reported incidence of up to 14.5 percent after vaginal delivery and 24.5 percentage following caesarean section. Similarly, 12 |

| |percent mothers get urinary tract infection after delivery9. |

| |In India, 14.6 percent postpartum mothers have urinary complications. Among these six percent have urinary incontinence, six to eight |

| |percent had urinary retention, and two percent had urinary tract infection in Karnataka10. |

| |From the previous facts, it is found that there is increased incidence of urinary complications after the delivery. So, the postnatal |

| |mothers should get the knowledge regarding the prevention and management of urinary complications during puerperium. The researcher |

| |found that there was a need to assess the knowledge of postnatal mothers on urinary complication. |

| |6.1 Need for the study |

| |“Hundreds of dewdrops to greet the dawn, hundreds of bees in the purple clover, hundreds of butterflies on the lawn, but only one mother|

| |the wide world over” |

| |George cooper |

| |Urinary incontinence is present in the postpartum period. It can take between three to six months, or even longer for some women to |

| |regain complete bladder control. Similarly, mothers get urinary retention as a result of decreased bladder tone and delayed emptying can|

| |lead to urinary tract infections after the delivery. So, there is a need to give importance to the prevention of urinary complication |

| |among postnatal mothers. |

| |A study was conducted to assess the risk factors for urinary tract infection in the postpartum period among postnatal mothers in |

| |Washington. The result revealed that 95 percent mothers got urinary tract infection after delivery. Hence the researcher further |

| |concluded that maternal medical conditions and procedures cause urinary tract infection which can be prevented by proper treatment and |

| |aseptic techniques. So, there is a need to educate the mothers about the risk factors of urinary tract infection in postnatal period11. |

| |A prospective study was conducted to assess postpartum urinary retention after caesarean delivery among 605 pregnant mothers in Taiwan. |

| |The result revealed that 24.1 percent of mothers got postpartum urinary retention after the caesarean delivery. The researcher concluded|

| |that the treatment begins with supportive measures to enhance the likelihood of micturation, privacy, and warm bath. Therefore, these |

| |measures help the mother to reduce the postpartum urinary retention. So, there is a need to educate the mothers about management of |

| |urinary retention12. |

| |A comparative study was conducted to assess urinary incontinence after vaginal delivery or caesarean section among 15,307 mothers in |

| |Norway. The result revealed that 16 percentage of mothers got urinary incontinence after caesarean delivery and 21 percent mothers got |

| |urinary incontinence after their vaginal delivery. The researcher concluded that the risk of urinary incontinence is higher in mothers |

| |who had vaginal delivery and educated mothers about the Kegel exercise that will reduce the urinary incontinence. Therefore, there is |

| |need to educate postnatal mothers about the causes and prevention of urinary incontinence13. |

| |A study was conducted to assess the urinary incontinence during postpartum period among 532 postnatal women in Pennsylvania. The result |

| |revealed that at six weeks postpartum eleven percent women reported urinary incontinence. The researcher further concluded that, the |

| |child preparation classes and pelvic floor muscle exercise were helpful to prevent incontinence. So that, it is important to give |

| |awareness about prevention of urinary incontinence in postnatal period among postnatal mothers14. |

| |A cross-sectional study was conducted to assess the postpartum urinary retention after the vaginal delivery among 771 mothers in |

| |Vellore, India. The result revealed that eleven percent mothers had urinary retention after the vaginal delivery. The researcher |

| |concluded that instrumental delivery and duration labour are the causative factor of urinary retention and encouraged the mothers to |

| |void at least once within six hours after the delivery. So, it is important to give emphasis on the risk factors and management of |

| |urinary retention among postnatal mothers15. |

| |It is clear that most of the mothers get urinary complications in their postpartum period. By creating awareness in postnatal mothers |

| |regarding the importance of preventing urinary complications, it can reduce the maternal, mortality and morbidity and there by achieving|

| |the millennium development goal. Hence the researcher felt the need to assess the knowledge of postnatal mothers regarding urinary |

| |complications. |

| |6.2 Review of literature |

| |A retrospective case controlled study was conducted to assess the factors that are associated with clinically overt postpartum urinary |

| |retention after vaginal delivery among 11,332 postnatal mothers in Minnesota. The result revealed that, 80 percentage of women get |

| |urinary retention after the delivery. The researcher further concluded that the instrument assisted delivery and regional analgesia were|

| |significant risk factors for the urinary retention after the delivery16. |

| |A comparative study was conducted to assess urinary tract infection due to intermittent and indwelling catheterisation after the |

| |caesarean section among postnatal mothers in Thailand. The result revealed that 31.4 percent of the intermittent group and 19.1 percent |

| |of the indwelling group developed urinary tract infection; 39.2 percent mothers with intermittent catheterisation had postoperative |

| |urinary retention whereas indwelling group had no other urinary problems. The researcher further concluded that indwelling |

| |catheterisation was favourable method for mothers in post caesarean section17. |

| |A prospective study was conducted to assess the urinary incontinence in pregnancy and puerperium among 123 mothers in Louisiana. The |

| |result revealed that 70 percent mothers had urinary incontinence after the delivery. Urinary incontinence increased after the |

| |delivery but this phenomenon decreased in the puerperium. The researcher concluded that pregnancy and child birth trauma are important |

| |factors in the development of urinary incontinence among mothers18. |

| |A descriptive study was conducted to assess the prevalence of postpartum urinary incontinence among postnatal mothers in the United |

| |State of America. The result revealed that 95 percent mothers had postpartum urinary incontinence. The researcher further concluded that|

| |the prevalence of postpartum incontinence was high after the caesarean section19. |

| |A comparative study was conducted to assess urinary tract infection common after preterm and full term delivery among 200 women in |

| |Kathmandu. Out of each 100 preterm and 100 full term deliveries 31 preterm had urinary tract infection and only nine full term delivery |

| |had urinary tract infection. The researcher concluded that the mothers who had preterm delivery got urinary tract infection than the |

| |mother who had full term delivery20. |

| |6.3 Statement of the problem |

| |“A descriptive study to assess the knowledge on urinary complications among postnatal mothers in a selected primary health centre at |

| |Mangalore, Dakshina Kannada, Karnataka, with a view to develop a health education pamphlet.” |

| |6.4 Objectives of the study |

| |The objectives of the study are: |

| |Determine the pre-existing knowledge of postnatal mothers on urinary complications. |

| |Find the association between knowledge of postnatal mothers on urinary complications and selected variables. |

| |Develop and distribute a health education pamphlet on urinary complications to postnatal mothers. |

| | |

| |6.5 Operational definitions |

| |Knowledge: In this study, it refers to the correct responses given by the postnatal mothers to the items in the closed-ended structured |

| |knowledge questionnaire regarding urinary complications which are scored and added to quantify their knowledge. |

| |Urinary complications: In this study, urinary complications refers to the mothers who have complaints of urinary retention, urinary |

| |incontinence, and urinary tract infection which occurs in the postpartum period. |

| |Postnatal mother: In this study, it refers to mothers who had undergone caesarean section or normal vaginal delivery irrespective of |

| |parity who are registered and attending postnatal clinics under the selected rural primary health centre at Mangalore. |

| |Health education pamphlet: In this study, it refers to a self-learning printed material prepared by the investigator in English and |

| |Kannada which includes meaning, causes, risk factors, types, and treatment modalities on urinary complications in postpartum, which will|

| |be distributed at the end of data collection. |

| |PHC: Primary health centre (PHC) is the basic first line unit providing primary healthcare. In this study, PHC refers to Suratkal PHC, |

| |under Mangalore taluk which is easily reachable and is about 16 km away from the college. |

| |6.6 Assumptions |

| |The investigator assumes that: |

| |Postnatal mothers may have some knowledge regarding urinary complications during postnatal period. |

| |Selected variables of the postnatal mothers may influence their knowledge towards urinary complications during the postnatal period. |

| |6.7 Delimitations of the study |

| |The study is delimited to: |

| |Postnatal mothers who are residing under the selected PHC area at Mangalore. |

| |Data collection period is limited to two months. |

| |Assessment of knowledge based on the responses given to the items in the structured interview schedule regarding urinary complications. |

| |6.8 Variables |

| |In this study, the selected demographic variables are age, educational status of mother, socioeconomic status, number of delivery, mode |

| |of delivery, duration of labour, catheterisation and source of information. Dependent variable includes knowledge level of postnatal |

| |mothers on urinary complications. |

| |6.9 Hypotheses |

| |The hypothesis will be tested at 0.05 level of significance. |

| |H1: There will be significant association between knowledge score of the postnatal mothers on urinary complications and the selected |

| |variables as measured by chi-square. |

|7. |Material and methods |

| |7.1 Source of data |

| |The data will be collected from 60 postnatal mothers who fulfil the inclusion criteria and willing to participate in the study. |

| |7.1.1 Research design |

| |The research design is typical descriptive survey design. It involves description of knowledge and practice of postnatal mothers on |

| |urinary complications which will be collected using a closed ended structured interview schedule. |

| |7.1.2 Setting |

| |Setting is the physical location and condition in which data collection takes place. Mangalore taluk has a population of 8,89,479 with |

| |an area of 115.16 square km. The Mangalore taluk has 21 PHCs and Suratkal PHC have 12 sub-canters with a population of 61,210. The study|

| |will be conducted at Suratkal PHC which is easily reachable and is about 16 km away from the college. |

| |The PHC is selected for the study on the basis of geographical proximity, feasibility of conducting study, and availability of the |

| |sample. |

| |7.1.3 Population |

| |In this study, the postnatal mothers who are residing the selected PHC area are the target population. The postnatal mothers who are |

| |visiting the selected PHC are the accessible population. |

| |7.2 Method of data collection |

| |7.2.1 Sampling technique |

| |In this study, 60 postnatal mothers who fulfil the inclusion criteria would be the sample. |

| |7.2.2 Sample size |

| |The sample size for the present study will be 60 postnatal mothers. |

| |7.2.3 Inclusion criteria for sampling |

| |Postnatal mothers who are: |

| |In the age group of 20-35 years. |

| |Attending postnatal clinics in the selected PHC at Mangalore. |

| |Available at the time of data collection and able to understand Kannada. |

| |Within 42 days postpartum period. |

| |7.2.4 Exclusion criteria for samplings |

| |Postnatal mothers who: |

| |Have postpartum complications like postpartum blues, postpartum haemorrhage, etc. |

| |Postnatal mothers who work as health professionals. |

| |7.2.5 Instruments intended to be used |

| |In this study, the knowledge of postnatal mothers will be assessed using a closed-ended structured interview schedule about urinary |

| |complications. |

| |7.2.6 Data collection method |

| |Phase I |

| |Approval of Institutional Review Board and the permission from concerned authority of the selected PHC will be taken before conducting |

| |the study. Development, validation, pre-testing, and reliability of the tool will be done. The pilot study will be conducted in the |

| |selected PHC at Mangalore. |

| |Phase II |

| |The investigator will introduce herself, explain the objectives of the study, and obtain written consent from postnatal mothers for |

| |maximum cooperation. Data collection will be done by assessing of the knowledge of postnatal mothers on urinary complications in |

| |postpartum period using a closed-ended structured interview schedule. |

| |Phase III |

| |Organisation, analysis of data, and interpretation of results will be done. Data collection will be completed within two months in the |

| |PHC. At the end of the data collection, a well designed health education pamphlet will be distributed based on the knowledge score |

| |regarding urinary complications among postnatal mothers. |

| | |

| |7.2.7 Plan for data analysis |

| |The data will be analysed by the following steps: |

| |Organising the data in a master sheet. |

| |Frequency and percentage of data will be calculated for describing selected variables such as age, educational status of mother, socio |

| |economic status, number of delivery, mode of delivery, duration of labour, catheterisation, and source of information. |

| |Mean, mean percentage, and standard deviation will be used to present the knowledge scores on urinary complications. |

| |Chi-square test will be used to find the association between knowledge and selected variables such as age, educational status of mother,|

| |socio economic status, number of delivery, mode of delivery, duration of labour, catheterisation, and source of information. |

| |Analysed data will be presented in the form of tables and graphs. |

| |7.3 Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe |

| |briefly. |

| |Yes. A well designed health education pamphlet will be distributed among postnatal mothers. |

| |7.4. Has ethical consideration been obtained from the institution in case of the above? |

| |Ethical clearance has been obtained from the research committee of the institution. |

| |Informed consent from the sample will be taken at the time of data collection. |

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|8. |References |

| |Myles textbook for midwives. 13th ed. Philadelphia: Churchill Livingstone Publications. |

| |Postpartum period. [online]. Available from: [URL]:. |

| |Kearney R, Culner A. Postpartum voiding dysfunction. [online]. Available from: |

| |URL: |

| |Urinary retention. [online]. Available from: URL:. |

| |Urinary tract infection. [online]. Available from: URL: |

| |Park K. Textbook of preventive and social medicine. 9th ed. Jabalpar: Banarsides Bhanot Publishers. |

| |Urinary incontinence. [online]. Available from: URL:. |

| |Yip SK, Sahota D, Pang MW, Chang A. Postpartum urinary retention. Acta Obstet Gynecol Scand 2004;83:881-91. |

| |Implication of urinary incontinence. [online]. Available from: URL:. |

| |Urinary incontinence in India. [online]. Available from: URL: |

| |Schwartz MA, Wang CC, Eckert LO, Critchlow CW Risk factors of urinary tract infection. [online]. Available from: |

| |URL:. |

| |Liang CC, Chang SD, Chang YL, Chen SH, Chueh HY, Cheng PJ. Postpartum urinary retention. [online]. Available from: |

| |URL: |

| |Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Urinary incontinence after vaginal delivery or caesarean section. [online]. Available|

| |from: URL: |

| |Burgio KL, Zyczynski H, Locher JL, Richter HE, Redden DT, Wright KC. Urinary incontinence during postpartum period. [online]. Available |

| |from: URL: urinary_incontinence_in_the_12_month_postpartum.14.aspx |

| |Kekro AN, Vijayand S, Dasguptha R, Kekre N. Urinary retention after the vaginal delivery. [online]. Available from: |

| |URL: |

| |Teo R, Punter J, Abrams K, Mayne C. Factors associated with urinary retention. [online]. Available from: |

| | clinically-overt-postpartum-urinary-retention- |

| |after-vaginal-delivery-a-retrospective-casecontrol-study/. |

| |Tangtrakul S, Taechaiya S, Suthutvoravat S, Linasmita V. Urinary tract infection in postpartum period. [online]. Available from: |

| |URL:. |

| |Thorp JM, Norton PA, Wall LL, Kuller JA, Eucker B, Wells E. Postpartum urinary incontinence. [online]. Available from: |

| |(99)70546-6/abstract. |

| |Thom DH, Rortveit G. Postpartum urinary incontinence. [online]. Available from: |

| |Susman E. Postpartum urinary tract infection. [online]. Available from: URL: |

| |urinary-tract-infection-common-after-pre-term-delivery-presented-aafp |

|9. |Signature of the candidate | |

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|10. |Remarks of the guide | |

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|11. |Name and designation of (in block letters) |

| |11.2 Guide |PROF. (MRS.) K. SHANTHAKUMARI |

| | |H.O.D, OBSTETRICS AND GYNAECOLOGICAL NURSING, |

| | |DR. M. V. SHETTY COLLEGE OF NURSING, KAVOOR, VIDYANAGAR, MANGALORE -575 |

| | |013. |

| |11.2 Signature | |

| |11.3 Co-guide (if any) | |

| | Signature | |

|12 | Head of the department |PROF. (MRS.) K. SHANTHAKUMARI |

| | |H.O.D, OBSTETRICS AND GYNAECOLOGICAL NURSING, |

| | |DR. M. V. SHETTY COLLEGE OF NURSING, KAVOOR, VIDYANAGAR, MANGALORE -575 |

| | |013. |

| |12.2 Signature | |

|13. |13.1 Remarks of the Chairman and Principal |

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| |13.2 Signature |

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