PRAGYAN CLLEGE OF NURSING

BHOPAL, M.P

DISSERTATION PRESENTATION
Preeclampsia is a one of the commonest
disorder that happens only during
Pregnancy and that post partum period that
equally effect both mother and the fetus,
It nearly effects 5-8% of all pregnancies
which rapidly progress characterized by
Hypertension and proteinuria.
Clinical manifestations of pre-
eclampsia includes Swelling, sudden
weight gain, headache and vision
changes, these symptom are Consider
as a cardinal that indicates the danger
of pre-eclampsia
During pregnancy hypertensive disorders found
mainly in two condition as Per existing primary
or secondary chronic hypertension; it may be
present in the Form of new–onset hypertension in
second half pregnancy .Preeclampsia occur after
20 week of gestation and may last up to 6 week
of post partum; in few case it may Happen earlier
than 20 week remedy to diagnose and manage
pre-eclampsia is to Deliver proper prenatal care.
The two outdated terms for preeclampsia are pregnancy
induced Preeclampsia hypertension and toxemia, lading
cause of maternal and neonatal Morbidity and mortality
is the preeclampsia and other hypertensive disorder of
Pregnancy, on the basis of an overall estimation these
issues are responsible for 76,000 maternal and 5000,00
infant mortality each year. 6.9% is the prevalence rate of
hypertension in pregnancy. This rate is mainly
Associated with few factors such as history of cesarean
section, preterm delivery and Hypertension in previous
pregnancy.
BACKGROUND
OF
THE STUDY
According to the reporting done on the may 01,
2013 by foundation of Preeclampsia on an
average 800 females die due to pregnancy or
labor related Complication around worldwide.
To words this mortality rate major contribution
is laid down by developing Countries. High
maternal mortality rate in few area of world
indicate in equities in Access to health care
services and health differentiation between
economically stable Those who are unstable.
In the develop countries like US, Canada and
western, Europe prevalence of pre-eclampsia
accounts for 2-5% whereas in developing countries
it increase to 4%.
Incidence rate differentiation is drives by the
diversity of definition and Creation such as
procedures, test and their methodologies. Each year,
about 10 Million women develop pre-eclampsia
worldwide. 76,000 women loss there life Each year
due to pre-eclampsia and related hypertensive
disorders
Incidence rate differentiation is drives by the
diversity of definition and Creation such as
procedures, test and their methodologies. Each
year, about 10 Million women develop pre-
eclampsia worldwide. 76,000 women loss there
life Each year due to pre-eclampsia and related
hypertensive disorders.
Neonates also equality gets affected as a result it
is being estimated that Nearly 500,000 babies
die. Another fact that in developing countries, a
women is Seven time more likely to develop
pre-eclampsia than a women in a developed as
Early as possible.
 NEED
OF
THE STUDY
According WHO (2011),
Conducted that exact goal of all the slandered
guidelines to enhance the overall quality of care
and outcomes of health that are selected to the
elevated level of blood pressure. International
community and local health care services
should implement these guidelines which is one
of the key step that has to be undertaken. In
order to some this issue the WHO dep. Of
reproductive health and research has
formulated.
.
 A very specific action plan that has to be
properly adopted communicated and
implemented at all levels of health care services.
In addition to this action plan/framework, the
WHO technical consultation team has proposed
many recommendations that has to be followed
for prevention and treatment of pre-eclampsia
and eclampsia.
According United States Health Care System
(2012)
Survey report revealed that maternal
morbidity and mortality is occurring due to
pre-eclampsia has increased the chances of
an adverse event from 4.6 % to 10.1 %for
mothers and from 7.8 % to 15.4% for
infants. The cost burden per infant is
depending on gestational age, ranging from
150,000 at 26 weeks gestational age 1311 at
 According NCBI (2014)
 According NCBI (2014), a cohort study on nor we gain
was conducted. Preeclampsia was recorded in 3-8% of
all pregnancies .Risk for still birth was found to be
3.6/1000 overall and 5.2 /1000 among pregnancies with
pre-eclampsia. Overall the risk of still birth was clearly.
Increase with preeclampsia in early pregnancy, the fetal
condition start getting compromised when preeclampsia
becomes clinically apparent remark by high relative risk
of fetal death among pregnancy.
 Diagnosed with pre eclampsia in the pre term period in evident
in all research studies being conducted on this issue. In the
background to all statistic globally available shows that
preeclampsia the condition for higher maternal mortality rate in
India as well as most of the developing countries. Investigator
during her clinical duty in community health centers and sub
center observed that the most of these deaths are due to delay in
initiating first line management and referred. The ANMs need
reinforcement to carper-eclamptic women on the basis of above
background the investigator decided to do descriptive study by
providing pectoral flow chart to each ANM and at center on
topic maintained below.
 PROBLEM STATEMENT

 A study to assess the knowledge regarding

government of India referral Protocol of mild
pre-eclampsia among ANM s at selected
CHC Bhopal (M.P.).
OBJECTIVE
The objective the study were to;-
Assess the knowledge regarding GOI referral protocol
of mild pre-eclampsia Among ANMs.
 Associate knowledge on GOI referral protocol of mild
pre-eclampsia among ANMs with their selected
demographic variable.
 Disseminate information regarding GOI referral
protocol of mild preeclampsia through pictorial chart. .
ASSUMPTION

1. ANM’s must have studied about mild pre-

eclampsia during their basic course.
2. ANM’s must be having basic knowledge
of mild pre-eclampsia.
3. Information chart on mild pre-eclampsia
will enhance knowledge of ANM’s
 OPERATIONAL DEFINITION
 Assess: in present study assess refers to
evaluating knowledge of ANM,s on Referral
protocol of mild pre-eclampsia through structured
questionnaire.
 Government of India referral protocol of mild

pre-eclampsia; it refers to Guidelines on

treatment and referral regarding mild pre –
eclampsia published. By government of India and
need to be followed at sub center and primary
Health center by ANM’s.
 cont
 Mild pre eclampsia: in this study
meaning of mild –pre eclampsia is as
Stated in government of India referral
protocol where blood pressure of Pregnant
women ranges from 140/90 to 110 mmHg
 ANM’s: In present study it refers to a person who
has completed eighteen Month revised
multipurpose (finale) or two year ANM course,
registered Under M.P. State nursing council and
working within selected community Health center.
 Pictorial flow chart: pictorial flow chart in present

study refers to an Illustrative pictorial flow chart

and management and referral of mild pre
Eclampsia cases from health centers which is
excusive prepared by the Investigators for ANM’s
DELIMITATION
The study was delimited to:
The study was delimited to ANM s of
primary health center and sub center under
selected CHC.
 assessment of knowledge with the written
response as elicited by structured
knowledge questioner in Hindi.
 CONCEPTUAL FRAMEWORK
INPUTPROCESS THROUGHPUT OUTPUT

Government of India Obtaining in information

protocol for demographical variable of Continue
management and ANM. reinforcement through
Assessment of knowledge Pictorial flow chart
referral of mild GOI protocol made for management
preeclampsia become Concert GOI protocol on & referral of
published for ANM. mild pre-eclampsia
Selected pre-eclampsia and referral in Pictorial flow chart
demographical pictorial chart ready reference for
Disseminate of pictorial chart mild pre-eclampsia
variable to ANM.

FEED BACK
Feedback not include
Figure-1.1: Conceptional frame work based on Von Bertanlffy General system modal
 THEORETICAL REVIEW OF LITERISK
FACTORS OF PRE ECLAMPSIA RATURE
 Definition:
 Classification
 Incidence
 Risk factors of pre eclampsia
 Management
 EMPIRICAL REVIEW OF LITERATURE
The review of literature for the present study is
organized under the Following heading :-

 Literature related to pregnancy induce

hypertension.
 Literature related to incidence of preeclampsia.
 Literature related risk factor of preeclampsia.
Literature related to complication of
preeclampsia
literature related to the management of pre-

eclampsia.
 Literature related to the level of knowledge

of pre-eclampsia among ANM’s

1. Literature related to pregnancy
induce hypertension
 Monika Muti (2015), has done an-analytic
cross sectional study PIH Prevalence rate was
found to be 19.4% women those suffered were
three prone to Deliver a LBW baby 4.13 three
time more likely to have still birth and 4 time
having More risk to have a baby with apgar
score below 5 result should that there was no
Significantly significant difference in those
women delivered before 37 week of Question
Study concluded that delay in seeking care
and shortage of resource were major
reported challenges in proper management
of PIH and worldwide, it was found that10
% of all pregnancies are complicated by
hypertension, with eclampsia and
preeclampsia being major causes maternal
and prenatal morbidity and mortality.
 2. Literature related to incidence of
pre-eclampsia.
Punam, D Sechdeve (2010),had completed
study to find the incidence of Pre- eclampsia of
preeclampsia and eclampsia in Taiwan between
1998-2010 it was Conducted to find the
association between age and incidence of pre-
eclampsia and Eclampsia results showed the
relative risk
Pre-eclampsia in different age group as followed –
aged < 20years, 25-29 years, 30-34year, 35 -39 years
and 40 years result finding conducted that the
incidence of preeclampsia was low in 20-24 year age
and scored in the 35 year age group there should be
affordable and accessible antenatal care service who
can really overcome dangers of shortcomings.
 3. Literature related to risk factor of
preeclampsia.
 Hernandez-diaz, sonia (2005), did a study to
assess the risk of preeclampsia in first and
subsequence pregnancy; wither preeclampsia is
more common in first pregnancies or in multiple
pregnancy. Result have shows 31.9% of women
had preeclampsia in previous two pregnancies,
1% was for those women having preeclampsia
associated with delivery
 0.42 in primi-parous women, 0.11%
multipurpose without of pre-eclampsia and
6.8 % and 12.5 % in women who had one
or two previous pregnancies study
conclude the fact that having history of pre
eclampsia in one pregnancy is a poor
predictor of all future issue.
 4. Literature related complication of preeclampsia

 Nankali (2013), did a study to find all the

maternal complications associated with
preeclampsia in pregnancy in which delivery
route, presence of eclampsia placental abruption
and coagulopathy were considered as the
important factors, among which placental
abruption contributed to 7.7% of total cases and
coagulopathy contributed to 10.6%.
Abebe tekeste (2015), conducted a study in
dessie referral hospital ethiopia to assess
prevalence and factors associated with pre-
eclampsia among pregnant women attending
antenatal care. Pre-eclampsia is considered
as one of the 109 important reason of
maternal death rate in ethiopia.
 This etiology of MMR is connected with multiple
factors which been really made this disease as a
continuous challenge. Another study on cross-
sectional basis was conducted in dessie referral
hospital between August and September 2013 in
which all pregnant women attending antenatal
clinic were included. A total of 490 pregnant ladies
were involved in the study. Approximately 2,89,000
women died across the world due to Pregnancy
related cause in the year 2013
Out of which majority 99% of deaths
Happened in developing nations. Results
have also shown that 60 to 80% of all
Maternal deaths are occurring due to five
major complications namely PPH, Puerperal
sepsis, hypertensive disorder of pregnancy,
unsafe abortion and obstructed Labor.
Literature related to the level of knowledge of
pre-eclampsia among ANMs
 Umesh charanthimath (2016), reported that in

India, hypertensive disorders of pregnancy and

post partum hemorrhage contribute to 40% of all
maternal deaths and most of these death happen
in PHC where they lack essential Equipment's,
medications and have very limited access to
specialist care. Community health care worker
are considered as key workers of basic maternity
care and the
 Quality of care which they provide depends on
level of knowledge and skills This study actually
aimed to understand the level of knowledge of
community health care Workers who are belonged
to Karnataka, India. This study is also focusing on
the Treatment approaches being adopted by
various community health workers to resolve This
problem. Study findings have definitely helped to
have a focused planning to Build strength and to
identify the gaps.
Given by different cadres of community
health workers regarding origin of HTN
and Seizures in pregnancy. According to
ANM and staff nurses, in order to have a
Control on HTN they encouraged rest,
decreased salt intake, iron supplementation
And tetanus vaccination.
 They also have awareness of the need of
administering mgso4. Overall study conclusion
suggested that these workers have lack of
knowledge regarding etiology of pre-eclampsia
but their basic knowledge and skills can be
strengthened to effectively manage the
hypertensive disorders of pregnancy in their
communities.
6. Literature related to Management of pre-
eclampsia
Kate E. Duhig (2015), described in her study that out of
287 women Recruited before 35 weeks gestation, 7 had a
still birth. All of the pregnancies were Complicated by still
birth that occurred in low PIGF group, often weeks before
fetal Death. The most important area of clinical impart for
PIGF is in “point of care” Testing in women which will be
posing a diagnostic challenge to the clinician. This Test had
a substantial impact on use of health resource. This test has
the ability to do The risk stratification in women having
suspected pre-eclampsia
 Angiogenic markers, particularly PIGF has the
ability to predict and diagnose pre-eclampsia.
Women will be getting impacted with this
disease till there will be some effective
treatment. Strict control of BP may affect the
risk of stroke and the present substandard care
which is associated with maternal mortality rate.
In recent years, the threshold for delivery has
decreased and the risk/benefit of earlier elective
delivery is under evaluation, anyhow the use of
mgso4 has turned to be a big protective strategy
for pre-term baby from different neurological
insults and it also provides a low threshold to be
used in case of pre-term pre-eclampsia.
CRITERIA FOR SAMPLE SELECTION

 Inclusive criteria
1. ANM’s who were willing to
take part.
2. ANM’s who were present at
the time of data collection.
3. ANM’s who are having at-least
one year experience.
Exclusive criteria
1. ANM’s who were not willing to take part.
2. ANM’s who were not present at the time of
data collection.
3. ANM’s who did not have 1 year experience
 RELIABILITY OF THE STUDY
 The reliability of the tools is established
by using split half method and karl
Person formula .The reliability coefficient
of structured knowledge questionnaire
Was(r=0.81)which showed that the tools
is highly reliable.
 VALIDITY
 The tool was sent to the expert from
community health nursing department for
tool validation and were return with minor
suggestion and modification .According of
the expert tools valid.
PROCEDURE OF DATA COLLECTION
Considering ethics written permission has
been obtained from the administrative
authority of the center prior of the data
collection and informed consent has been
obtained from the respondents study. A
total of 40 ANM were selected as a sample
in the selected CHC Gandhi Nager Bhopal
(M.P)
 Investigator have given pictorial chart regarding
management of pre-eclampsia referral protocol to 40
ANM’s the purpose of the study enhance the
knowledge and practice in CHC regarding referral
protocol management of pre-eclampsia. The
investigators collected data for final study from 40
ANM who fulfilled the inclusive criteria. The time
taken to complete the questionnaire is around 30
minutes and given pictorial chart size 22x26” to given
CHC and distribution sample of chart to ANM in same
day.
Section-A: frequency the finding of the study is
organized according to of the objective of the
study. It was edited, analyzed, interpreted and
presented in the form of the table and figure.
The data presented under the following heading.
And percentage distribution of the management
of pre eclampsia referral protocol among
ANM’s in term of demographic variable.
.
Section–B: Assessment of level of knowledge
regarding management of pre eclampsia
referral protocol among ANM’s.

Section-C: Associate level of knowledge

regarding management of pre eclampsia
referral protocol among ANM.s with their
selected demographic variable
Frequency and Percentage
Distribution of the ANMs
According to their
Demographic Variables.
 N=40
S. Demographic Frequency Percentage
No Variable (f) (%)
1 Age of the ANMs
20-29 9 22.5%
30-39 16 40%
Above 40 15 37.5%
2 Education
High school 4 22.5%
High secondary 27 40%
Above high sec. 9 37.5%
S . Demographic Variable Frequency Percentage
No (f) (%)
3 Professional Qualification

ANMs (1 ½ yare ) 25 62.5%

ANMs(2year) 15 35.5%
4 Area of work
CHC 22 55%
PHC 15 37.5%
S . Demographic Variable Frequency Percentage
No (f) (%)
5 Year of clinical
experience
1-10 year 23 57.5%
11-20 year 14 35%
Above 21 3 7.5 %
 SECTION–B
Assessment of Pre-Interventional
Level of Knowledge Regarding
Management of Preeclampsia.
Score Grading Pre Test Knowledge Mean Sd

Frequency Percentage

1–6 Poor 0 0%

7 - 12 Average 2 5%

13-18 Good 30 75% 16.12 6.16

19-24 V. Good 8 20 %

25-30 Excellent 0 0%
 SECTION–C
ASSOCIATE THE KNOWLEDGE
SCORES MANAGEMENT OF PRE-
ECLAMPSIA AMONG ANMS WITH
THEIR SELECTED DEMOGRAPHIC
VARIABL
S. Demography Poor Average Good V. Excellent Df Chi-square
No variable Good
1. Age (in year )

a) 20-29 0 0 11 5 0 04
15.13*
b) 30-39 0 0 08 1 0

c) Above 40 0 2 11 2 0

2. Educational Status

a) High school 0 0 03 01 0

b) High sec 0 0 21 07 0 04 13.4*

c) Above H.sec 0 02 06 0 0
S. Demography Poor Average Good V. Excellent Df Chi-square
No variable Good
3. Professional Qualification
02
a) ANM ½ year 0 1 12 02 0 2.38
b) ANM 2Year 0 1 18 06 0

4. Working area

a) SC 0 01 16 05 0

b) PHC 0 01 11 03 0 04 65.95*

c) CHC 0 0 03 0 0
S. Demography Poor Average Good V. Excellent Df Chi-square
No variable Good
5. Working experience

1-10 year 0 01 17 05 0
04 14.00*
11-20 year 0 01 10 03 0

Above 21 0 0 03 0 0
year
MAJOR FINDING OF THE STUDY
 Regarding with respect of age, most of the
ANM age group 22-29, (9) ANMs, 22.5%, 30-
39,(16) ANMs, 40 %.40 above 37.5%, above 40
(15).
 The data related the education qualification

High school (4) 10%, higher Secondary (27)

ANM 67.5%, above higher secondary (9) ANM
22.5%.
 While considering professional qualification 37.5%
2year course of ANMs,18 month 63%, professional
qualification course.

 The data further revels that most of them 1-10 year 21

ANMs, 57.5%, 14 ANMs, 35% having 11-20 year
experience. Above 21 experience 5 ANMs.7.5%.

 Majority of the selected ANMs .sub center, 22 ANMs,

55%, primary health Center 15ANMs, 35.5%,
community health center 3 ANMs,7.5%.
 FINDING RELATED TO
ASSESSMENT OF KNOWLEDGE
In relation to the finding of the study mean
knowledge score is 16.6 shows And stander
division is 6. 16 finding in the study shows in
sufficient knowledge Core of ANM’s worker
for management of pre eclampsia referral
protocol.
 CONCLUSION

 As an inference to the present study with regards

to the age of the ANM's workers. Most of the
ANM’s workers 16 ANM’s 40%.Belong the age
group from 30-39.
 In this study most of the anm.27 higher secondary

education 67.5%.
Inthis study most of ANM's professional
qualification (27), 63% completed 18 month
ANM’s course.
 Around more than ANM’s worker (21) 57.5%

have 10 years experience.

 Most of the ANM’s 22 (55%) was working in sub

center.
 DISCUSSION
 The study deals with the discussion of the result of the data
analysis based on Objective of the study, review of literature
and the hypothesis in relation to similar Study conduct by the
other researcher. Pre–eclampsia common complication during
Pregnancy but lack of knowledge and malpractice maternal
death rate incidence was High.
 In present study to improve the ANM’S knowledge

management of Pre Eclampsia GOI referral protocol .Its help

enhance the knowledge, skill and quality of Care in CHC.

 IMPLEMENTATION

 Nursing practice: In present study showed that

most of the ANM’S had good knowledge and
Practice on referral protocol in term pre-eclampsia.
This type of guidelines and Protocol can be used for
ANM’s to improve the cognitive, affective and
psychomotor domains of ANM’S Working in CHC
to improve the holistic nursing care by Continues
reviewing.
Nursing Research

By conducting research by formulating new

theories, research could improve The knowledge,
skill and attitude of the ANM’s and ultimately, the
status and standard of midwifery practice.
Researcher should be conducted bring about new
techniques In improving the skill in managing
maternity service and improve nursing care
Practice. New trends in emergency obstetric care
should be include in the farther Researcher .
 LIMITATION

 The finding of the study could not be generalized

because of small sample size .
 . limited time was available for data collection.
 Study was restricted post test.
 RECOMMENDATION

 A similar study can be replicated on a large scale.

 Similar study with the use of new technology could be

conducted in other department.

 A study can be made by using video to give more

practical knowledge Regarding protocol.

 ANM’S requested for regular in service which conduct

could help to up grade their knowledge & practice

 BIBLIOGRAPHY

1. Bhaskar, N. (2015). Midwifery and Obstetrical Nursing,

Bangalore, EMMESS medical Publishers.
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Reproductive Health Nursing: New Delhi, Jaypee Publication.
3 Beischer, N. (1997), Obstetrics and the newborn An illustrated
Textbook, 3rd edition, London, W B Saunders Company
publishers.
4 Bennet,V (1999) Mylese text book of midwifery. (13th edition)
Edinburg: Churchill Livingstone
5 Dutta D.C. (2004), a textbook of Obstetrics. Kolkata, New Central
Agency Publication.