Research Proposal – Obstructive And Gynaecology Nursing

Presented by : Ms. THATCHAYANI

Department : MSC (N) 2ND YEAR

College : SRI AUROUBINDO COLLEGE

 INTRODUCTION
THERE ARE HARD DAYS IN MOTHERHOOD BUT LOOKING AT YOUR
SLEEPING BABY REMINDS YOU WHY ITS ALL WORTH IT

Episiotomy sutures can cause considerable discomfort and pain for postpartum women because
the perineum is vascular and an extremely tender area and the muscle of the perineum is involved
in many ordinary activities such as sitting, walking, standing, squatting,urinating defecating etc.
PillitteriA(2013)presence of pain entails difficulties to practice motherhood .and perform daily
activities such as self care ,breastfeeding and newborn care. Recent studies have evidence that it
is cause for pain which then interferes with physical and mental wellbeing ,as well as with social
activities
- CHANG et I.,(2011)

The typical healing time for an episiotomy is around 4 to 6 weeks depending on the size
of incision and the type of suture material used to closed the wound. LYNDA(2009) the
delay in perineal healing leads to increasing the complications such as bleeding, pain,
discomfort, dyspareunia and anxiety. Although these problems are not acute or life
threatening, their potential impact on daily function of episiotomy wound can lead the
puerperal sepsis is one of the major cause of maternal morbidity and mortality.

- FRASER$COOPER( 2014 )
NEED FOR THE STUDY :

Worldwide there isconsiderable international variation in the rate of

episiotomy. The rate is of 15% in England,13%in Scotland,10% in wales and
22% in northern Ireland,it is 8% in Holland,14%in England,50% in the USA
and 99% in eastern Europe.
- ROYALC.,(2004)
In united states,percentages of episiotomies performed out of all
vaginal deliveries is 19.4%.episiotomy rates were higher among white women
(32.1%)then African American women(11.2)
- HENRIKSEN.,(1992)

In India the overall rate of episiotomy is 40.6%. among that midwives

performed episiotomy rate21.4% then faculty 33.3%and providers 55.6%.
- ROBINSON,,(2000)

In NewDelhi ,episiotomy rates differ according to care provider. to

care provider. The episiotomy rate among midwives was 25%and 40% among
medical doctors .younger doctors are also less to perform an episiotomy than
older doctors: one study found the rate of episiotomies performed by residents
to be 17%, while the rate among doctors in private practice was 66 %
- J.Rank.,(2008)
STATEMENT OF PROBLEMS:

A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF POVIDONE-

IODINE SITZBATH VERSSA POTASSIUM PERMANGANATE SITZBATH ON
EPISIOTOMY PAIN WOUND HEALING AMONGPOSTNATAL MOTHERS IN
SELECTED HOSPITAL

OBJECTIVES OF THE STUDY:

 To assess the level of episiotomy pain and wound healing before and after
administration of povidone iodine sitzbath and potassium permanganate
among postnatal mothers undergone normal vaginal delivery in experimental
group 1 and 2
 To assess the effectiveness by comparing the post interventional level of
povidone iodine sitzbath and potassium permanganate sitzbath on episiotomy
pain wound healing postnatal mothers undergone normal vaginal delivery in
experimental group1 and 2
 To associate the post interventional level of episiotomy pain and wound healing
among postnatal mothers undergone normal delivery with selected
demographic and clinical variables
HYPOTHESES:

 H1: there will be a significant difference between the pre and post interventional
level of episiotomy pain and wound healing among postnatal mothers
undergone normal vaginal delivery in experimental group 1 and 2
 H2: there will be a significant difference between post interventional level of
episiotomy pain and wound healing among postnatal mothers undergone
normal vaginal delivery in experimental group 1 and 2
 H3: there will be significant association between post inerventional level of
episiotomy in and wound healing among postnatal mothers undergone normal
vaginal delivery with selected demographic and clinical variables

ASSUMPTION:

 Episiotomy wound produce pain and discomfort among postnatal mothers

 Povidone iodine sitzbath many heal the episiotomy wound healing quicker than
potassium permanganate sitzbath
 Potassium permanganate sitzbath and povidone iodine sitzbath may not
produce any side effects to the patient
OPERATIONAL DEFINITION:

COMPARATIVE STUDY :
 Comparative studies are investigations analyze and evaluate with quantitative and
qualitative methods a phenomenon and facts and different areas, subjects and
objects to detect similarities and difference.
 Comparison of potassium permanganate and betadine solution are used for
promotion of wound healing of client with episiotomy
EFFECTIVENESS:
 Effectiveness is the capability of producing a desired result or the ability to produce
desired output. The degree to which the level of episiotomy wound healing and pain
is reduced after the povidone – iodine sitz bath and potassium permanganate sitz
bath it is measured by REEDA scale and visual analog scale

POVIDONE-IODINE SITZBATH:
 Povidone iodine sitzbath is a bath perineal area/ buttocks are submerged in 4 liters
of warm water and povidone iodine solution for 10 ml added for a period of 20
minutes for three consecutive days during morning and evening to promote
episiotomy wound healing and relieving pain

POTASSIUM PERUMANGANATE:
 Potassium permanganate is an inorganic compound with the chemical formula
KMnO
 It is a purplish black crystalline salt that dissolve in water as k+ and Mno-4 an
intensely pink to purple solution
SITZBATH:
 A sitzbath is a warm water bath you sit in to relive discomfort in your perineal
region socking this area in warm water relaxes your anal spincture which
helps increase blood flow through your anal tissue this promotes healing and
reducing the pain itching and irritation felt due to various health condition

EPISIOTOMY PAIN:

 Episiotomy pain is the pain experienced by the postnatal mothers due to

interference with tissue integrity and presence of episiotomy suture line which
is assessed by using the visual analog scale .

EPISIOTOMY WOUND HEALING:

 Episiotomy wound healing indicates the degree to which the level of redness,
edema, ecchymosis, discharge and gapping of episiotomy wound is
reduced after sitzbath which is assessed by using REEDA scale
POSTNATAL MOTHER:
 Postnatal mother refers to the woman in after 2 hours of vaginal delivery with
episiotomy.
DELIMITATIONS:
THE STUDY IS LIMITED TO:
 Data collection period is for 4 weeks
 The study is limited to only 40 samples
 The study Is limited to two hospital

METHADALOGY :
RESEARCH APPRORCH AND DESIGN:
 Research adopted for this study was quantitative approach
DESIGN:
 Two group experimental design
SETTING OF THE STUDY :
 The study was conducted among postnatal mothers with episiotomy wound in
NIRMALA HOSPITAL AND PRIYANKA HOSPITAL AT KARUR .

POPULATION AND SAMPLING :

 The population for the study were postnatal mothers with episiotomy wound at
Nirmala hospital and Priyanka hospital in karur

SAMPLE TECHNIQUE AND SAMPLE SIZE:

 Non probability convenient sampling technique was used in this study ,the
sample size for the study was 40 postnatal mothers .
INCLUSION CRITERIA:
 The samples who are willing to participate in the study
 postnatal mothers who had normal vaginal delivery with right or left mediolateral
episiotomy
 postnatal mothers who had instrumental delivery with episiotomy.
 Mother those who are physically fit .
 Those who understand the Tamil language.

EXCLUSION CRITERIA:
 Postnatal mothers with infected perineum and sexually transmitted disease
INSTRUMENTAL AND TOOLS OF DATA COLLECTION :
PART -1: DEMOGRAPHIC VARIABLES:

 This section consisted of ten items pertained to postnatal mothers namely age,
religion, educational status ,occupational ,monthly income. Type of family place of
residence source of information type of episiotomy and state of parity.
DEMOGRAPHICAL VARIABLES :
1 . Age in year
18-27 years
28-35years
2. Educational status
A) Higher secondary
B) Graduates
3.Occupational
A) Private sectors
B) House wife
4. Marrital status
A) Married
5. Type of family
A) Nuclear family
B)Joint family
6. Family income
A) 10,000- 20,000
B) 20,000 - 35,000
7. Obstetrical score
A) Primi
B) Muliti
8. Mode of delivery
A) Normal vaginal delivery
B) Vacuum assisted delivery
9. place of living
A) Urban
B) Rural
PART-2:
 The standardized Reeda scale was used assess the wound healing process.

PART-3:
 The standardized visual analog pain scale to assess level of pain for postnatal
mothers .

SCORING AND INTERPRETATION FOR REEDA SCALE:

 The standardized Reeda scale was used by the investigator reviewing literature in
text books of obstetrical and from the electronic sources this tool is considered to be
a reliable tool for assessment of episiotomy wound healing .
 There were totally 5 aspects in the REEDA SCALE for assessing the episiotomy
wound healing status among postnatal mothers.
 Each assessment area such as Redness, edema, ecchymosis, discharge and
approximation of the wound .were given as minimum scores of one and maximum
scores of three
THANK YOU
The interpretation of REEDA SCALE score is as follows

POINTS REDNESS EDEMA ECCHYMOSIS DISCHARGE APPROXIMATIO

N

0 NONE NONE NONE NONE NONE

1 WITH 0.25 CM LESS THAN 1 CM WITH IN 0.25CM SERUM SKIN SEPRATION

INCISION FROM INCISION BILATERALLY OR 3 MM OR LESS
BILATERLLY 0.5CM
UNILATERALLY

2 BEYOND 0.5CM 1-2CM FROM 0.25-1CM SEROSANGUINEO SKIN AND

OF INCISION INCISION BILATE0.5-RALLY US SUBCUTANEOUS
BILATERALLY OR 2 CM FAT SEPRATION
UNILATERALLY

3 BEYOND 0.5CM GREATER THAN GREATER THAN 1 BLOOD SKIN AND

OF INCISION 2CM FROM CM BILATERALLY PURULENT SUBCUTANEOUS
BILATERALLY INCISION OR 2 CM FAT AND FASCIAL
UNILATERALLY SEPRATION
Scoring :
• No infection 0
• Mild infection 1-5
• Moderate infection 6-10
• Severe infection 11-15
•PAIN SCALE:
 Pain scale having 4 categories for assessing the level of pain postnatal mothers this
tool was used by the investigator reviewing literature in text books of obstetrical and
gynecological nursing and also from the electronic source .

Interpretation of pain scale score is as follow:

• NO PAIN :0
• MILD PAIN :1-3
• MODERATE PAIN :4-6
• SEVERE PAIN :7-10
Thank you