RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES



SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

Miss. PRAMEELA.M.C.

1ST YEAR M.Sc. NURSING

OBSTETRICS AND GYNAECOLOGICAL NURSING

2011-13

SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE B. H.ROAD,

TUMKUR- 572102.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

| | | |

|1. |NAME OF THE CANDIDATE AND ADDRESS |MS.PRAMEELA.M.C. |

| | |I YEAR M.SC.NURSING |

| | |SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD,|

| | |TUMKUR-572102. |

| | |SHREE SIDDAGANGA INSTITUTE OF NURSING SCIENCES AND RESEARCH CENTRE, B.H.ROAD,|

|2. |NAME OF THE INSTITUTION |TUMKUR.-572 102. |

| | |MASTER OF SCIENCE IN NURSING |

|3. |COURSE OF STUDY AND SUBJECT |OBSTETRICS AND GYNAECOLOGICAL NURSING |

| | |28.07.2011 |

|4. |DATE OF ADMISSION TO THE COURSE | |

|5. |STATEMENT OF THE PROBLEM | |

| | |A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING |

| | |PROGRAMME ON KNOWLEDGE REGARDING GENITAL PROLAPSE AND ITS MANAGEMENT |

| | |AMONG MENOPAUSAL WOMEN IN SELECTED RURAL AREAS AT TUMKUR. |

BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“Health should mean a lot more than escape from death or for that matter, escapes from diseases”.

K.PARK.

Health is presented not as just the absence of disease, but as an active optimization of each individuals potential new knowledge about women’s bodies and minds has changed our understanding of what affects the health of a blending of biology, culture and the choice we make its time to get organized around the four major factors that intersect again over a person’s lifetime; risk, prevention, detection and control.1

Reproductive health, as defined by the World Health Organization, is a state of physical, mental, and social well-being in all matters relating to the reproductive system at all stages of life. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this definition are the rights of men and women to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice, and the right to appropriate health-care services that enable women to safely go through pregnancy and childbirth.2

Prolapse literally means "to fall out of place", from the Latin “prolabi” meaning "to fall out". In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum.3

Genital prolapse occurs when the network of muscles, ligaments and skin that holds the vagina in its correct anatomical position weakens. This causes the vagina to prolapse slip or fall from its normal position. Female genital prolapse is characterized by a portion of the vaginal prolapse protruding from the opening of the vagina.The condition usually occurs when the pelvic floor collapses as a result of child birth. There are different prolapses as such Cystocele, Enterocele, Rectocele, Urethrocele, Uterine prolapse, Vaginal vault prolapse. 4

Genital prolapse is a common and costly morbidity for women and its incidence has been increasing as the population ages. The estimated lifetime risk of surgery for prolapse or incontinence is 11%, with one of three patients requiring more than one surgical repair. Pathogenesis of genital prolapse is the result of the weakness of any or all of the pelvic support structures, that is, levatorani muscle, connective tissue, uterosacral and cardinal ligaments, and rectovaginal fascia. Thus, an isolated pelvic defect is rare. 5

Prolapse is the descent of uterus, cervix, or vaginal vault. Genital prolapse affects millions of women; approximately 200,000 inpatient surgical procedures for prolapse are performed annually in the United States. 11 to 19 percent of women will undergo surgery for Genital prolapse or incontinence by age 80 to 85 years, and 30 percent of these women will require an additional Genital prolapse or incontinence surgery. Anterior vaginal wall prolapse without apical prolapse is uncommon, and apical prolapse repair should be included in the majority of pelvic reconstructive surgery procedures.6

Genital prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. The womb (uterus) is the only organ that actually falls into the vagina. When the bladder and bowel slip out of place, they push up against the walls of the vagina. While prolapse is not considered a life threatening condition it may cause a great deal of discomfort and distress. 7

In genital prolapse during antenatal period the effective care includes relaxation exercises, to prevent premature bearing down efforts, pelvic floor exercises and surgical correction to place the herniated mass on position is the treatment of genital prolapse such as anterior colporrhaphy, calpoperineorrhaphy, repair of enterocele, fothergill’s operation, vaginal hysterectomy with pelvic floor repair, repair of vault prolapse.

Conservative management for women with prolapse in comparison with no treatment or other treatment options such as mechanical devices or surgery. Pelvic floor muscle training in an outpatient setting may reduce severity of prolapse in mild-to-moderate cases. Special exercises, called Kegel exercises, can help strengthen the pelvic floor muscles, Vaginal pessary is also a treatment and Estrogen replacement therapy.8

Women who have experienced a change in reproductive system and disorders require a holistic approach to meet their physical, emotional needs. Genital prolapse is a gynaec disease condition that calls for immediate attention with regard to management. Hence, it becomes imperative to provide a teaching programme on genital prolapse and its management and evaluates its effectiveness among menopausal women.

6.2 NEED FOR THE STUDY

Knowledge is a key to a healthy life; And Education is a powerful medicine.

K.PARK

Genital prolapse is a common and handicapping form of pelvic floor dysfuntion. To explain its genesis as a result of endopelvic connective tissue weakness, the collagen state was analyzed in women with and without genital prolapse. Punch biopsies from the Para urethral ligaments were obtained during the operation from 22 women undergoing surgery for genital prolapse. As controls, similar biopsies were taken from 13 women who underwent gynecologic surgery for other benign reasons. Collagen concentration as hydroxyproline and its extractability by pepsin digestion were studied in relation to age by multiple regressions, two-way anova, Levene's test, and Student's t-test. Histological examination was also performed.9

In the Women's Health Initiative Study, 41% of women aged 50-79 showed some degree of Genital prolapse. 34% had a cystocele, 19% a rectocele and 14% uterine prolapse. Prolapse is the most common reason for hysterectomy in women aged over 50 and accounts for 13% of hysterectomies in women of all ages. In the UK, genital prolapse accounts for 20% of women on the waiting list for major gynaecological surgery. About 1 out of 10 women experience uterine prolapse.10

The incidence of genital prolapse shows that half of parous women loose pelvic floor support, resulting in some degree of prolapse, and that of these women 10-20% seek medical care. The life time risk of undergoing an operation for prolapse or incontinence by the age of 80 years is 11%. Reoperation is required in 29% of cases and the time interval reduces between each successive operation.11

The incidence of hospital admission with prolapse is 2.04 per 1000 person-years of risk. Age, parity, calendar period and weight were significantly associated with risk of an inpatient admission with prolapse after adjustment for principal confounding factors. The incidence of prolapse which required surgical correction following hysterectomy was 3.6 per 1000 person-years of risk. The cumulative risk rises from 1% three years after a hysterectomy to 5% 15 years after hysterectomy.12

Gynaecological problems related to childbearing were studied in 1010 married women of the semi-nomadic Qashqa'i tribe. The most common problems were cystocele (56.0%), uterine prolapse (53.6%) and rectocele (40.4%). The prevalence of other problems such as cervical erosion and inflammation, urinary incontinence and dyspareunia was found to be between 24% and 40%. Early age at marriage and childbearing, high parity and poor access to medical facilities are considered to be the most important factors leading to these high prevalence rates, although the lifestyle of the women in this community could also be a major contributing factor. 13

A study was conducted on Menopause leading to increased vaginal wall thickness in women with genital prolapse: impact on sexual response. The vaginal wall was thicker in the postmenopausal than premenopausal group (2.72 +/- 0.72 mm and 2.16 +/- 0.43, P = 0.01, and 2.63 +/- 0.71 mm and 2.07 +/- 0.49 mm, P = 0.01, for the anterior and posterior walls, respectively). These thicknesses seem to be due to the muscular layer, which was also thicker in the postmenopausal group The vaginal epithelium was thinner in the middle segment than in the proximal one in the posterior wall (0.17 +/- 0.07 mm, 0.15 +/- 0.05 mm, 0.24 +/- 0.09 mm, P = 0.02). There was no correlation between coital pain, vaginal wall thickness, and estradiol levels in either group. It was concluded that the vaginal wall is thicker after menopause in women with genital prolapse. In this study, vaginal thickness and estrogen levels were not related to sexual dysfunction.14

A clinical study conducted one in four women complained of genital prolapse, and one in four were diagnosed with genital prolapse. There was a strong correlation between self-reported and diagnosed genital prolapse, 95.1% of Achhami women, and 98.3% of the Doti women who reported genital prolapse were also diagnosed with genital prolapse. Over one fifth of women reported the onset of prolapse before the age of 20 years, 44.2% were between 20-29 years. The mean number of years suffering from genital prolapse was 10. The impact of genital prolapse on the daily life is dramatic: 88.6% of women reported difficulty lifting, 82% difficulty sitting, 79% difficulty walking, and 65.5% difficulty standing. Other complaints included backache (55%), burning upon urination (49%), and painful intercourse (41.1%). 15

A research study was conducted on effectiveness of planned teaching programme on temporary family planning method among primigravida mothers attending antenatal clinic in jayanagar general hospital Bangalore and the findings indicated that in experimental group the mean post test knowledge score was 61.3%.This indicated that the planned teaching programme is significantly effective in increasing the knowledge among the staff nurse. 16

In the light of the above incidence and description , researcher found it is desirable to have at least knowledge for menopausal women regarding a genital prolapse and its management. By seeing all the above things the researcher finds there is a utter “need for the study” to come out with the best results for the menopausal women population.

6.3 REVIEW OF LITERATURE

A cross sectional analytical community based study carried out amongst women of reproductive age. A total of 267 participants were selected by systematic random sampling .The prevalence of uterine prolapse was found to be 24.7%. Analysis of the data using chi square revealed knowledge level (p value ................
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