0 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKAPROFORMA FOR REGISTRATION OF...

7/28/2019 0 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKAPROFORMA FOR REGISTRATION OF SUB

1/19

0

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Ms. DIMSEY. R. MARAK

M. Sc. Nursing 1st

year

Obstetrics & Gynaecological Nursing

Year 2009-2010

PADMASHREE INSTITUTE OF NURSING

BANGALORE


2/19

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FORDISSERTATION

1 NAME OF THE

CANDIDATE AND

ADDRESS

Ms Dimsey. R. Marak

1st year M.Sc. Nursing

Padmashree Institute of Nursing,

Bangalore.

2 NAME OF THE

INSTITUTION

Padmashree Institute of Nursing,

Bangalore.

3

COURSE OF STUDY

AND SUBJECT

1st

year M. Sc. Nursing

Obstetrics & Gynaecological Nursing

4DATE OF ADMISSION

TO COURSE

19th

June 2009

5 TITLE OF THE STUDY Assessment of effectiveness of Structured

Teaching Programme on knowledge regarding

gestational hypertension among primigravida

mothers.


3/19

2

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Pregnancy is a time of great anticipation, when a woman is very aware that a

new life is growing within her for the next nine months and hence they are highly

motivated to remain as healthy as possible, so that she can give her baby the best

start in life. Pregnancy is an excellent opportunity to develop good health habits;

she can use these habits to keep the period of pregnancy safe and beautiful and also

healthy for the rest of her life.1

Certain physical conditions have specific implications for the pregnant

women, her foetus and newborn. All pregnant women are at risk of complications

like hypertension, anaemia, under nutrition, obesity, diabetes mellitus, abortion and

intrauterine death, premature labour, Rh incompatibility in foetus and post

maturity.

Hypertension is one of the common complications met with in pregnancy and

contributes significantly to maternal and foetal/neonatal morbidity and mortality.

Hypertension in pregnancy is defined as a diastolic blood pressure of 90 or moreand systolic blood pressure level of 140 mm Hg or higher after 20 weeks of

gestation in women with previously normal blood pressure.

Hypertensive disorders predispose the women to serious complications,

including abruptio placenta, thrombocytopenia, disseminated intravascular

coagulation, acute renal failure, hepatic failure, pulmonary oedema, adult

respiratory distress syndrome and cerebral haemorrhage2.

The major classifications of hypertension in pregnancy are;

Pre-eclampsia: It is a pregnancyspecific syndrome in which hypertensiondevelops after 20 weeks of gestation in a previously normotensive women,is

characterized by the presence of hypertension and protienuria.

Eclampsia: Preeclampsia when complicated with convulsion and or coma. Chronic hypertension: Chronic hypertensive disease is defined as the presenceof hypertension of any cause antedating or before the 20

th

week of pregnancy andits presence beyond the 42 days after delivery.
http://www.pregnancy-period.com/pregnancy.htmlhttp://www.pregnancy-period.com/pregnancy.html


4/19

3

Preeclampsia or eclampsia superimposed on chronic hypertension: It is definedas protienuria developing during pregnancy in a woman with chronic hypertension.

Gestational hypertension: Gestational hypertension is the onset of hypertensionwithout protienuria on at least two occasions at least 6 hours apart after the 20th

week of gestation in women known to be normotensive before pregnancy3.

Gestational Hypertension is a type of high blood pressure that occurs during

pregnancy. It is a sustained rise in blood pressure to 140/90 mmHg or more on at

least two occasions for four or more hours after 20 weeks of pregnancy to the first

week after delivery. It is caused by an unknown set of factors that uniquely access

during pregnancy and doesnt require free existing high blood pressure to develop.

The incidence of gestational hypertension is higher in multipara and in twin

pregnancy. Gestational hypertension before 30 weeks is frequently severe,

advances to preeclampsia and has a guarded perinatal prognosis whereas after 34

weeks it is usually a benign condition that rarely becomes severe, does not progress

to preeclampsia, and therefore results in uniformly good prenatal outcome.

Early gestational hypertension shares with preeclampsia a high incidence of

poor placentation with histologic evidence of placental ischemia and hemodynamic

changes characterized by vasoconstriction and decreased cardiac output. In late

gestational hypertension the fundamental hemodynamic changes are increased

plasma volume, increased cardiac output and normal peripheral vascular resistance.

The fundamental problem behind early gestational hypertension is poor

placentation, while late gestational hypertension corresponds to a poor maternal

adaption to the physiologic changes of pregnancy.

Gestational hypertension may resolve spontaneously after the baby is born, in

which case the condition is referred to as transient hypertension. If the blood

pressure remains elevated after delivery, the diagnosis becomes chronic

hypertension4.

The management of gestational hypertension include advices to the mother to

change the life style with salt restricted diet, bed rest, proper exercises and avoiding

stress. Antenatal mothers need to be advised to go for proper antenatal visit and


5/19

4

support for hospitalization in order to prevent from complications of hypertension

and counsel the women and her family about the danger signs indicating

preeclampsia5.

6.2 NEED FOR THE STUDY:

Hypertensive disorders are the most common medical complications reported

during pregnancy. Women younger than 20 or older than 35 years, with gestational

hypertension have significantly higher morbidity rates. Hypertension in pregnancy

also increases the womens risk for caesarean birth. Hypertensive disorder constitute

almost 7- 15% of all pregnancies, 22% of all perinatal deaths and 30% of all maternal

deaths6.

Gestational hypertension is the most frequent of the hypertensive conditions of

pregnancy with prevalence rate between 6% - 15% in nulliparas and 2% - 4% in

multiparas. The condition is more frequent in obese women and in women with

multiple gestations, diabetes, and chronic hypertension and with a history of

preeclampsia7.

In rural India, women often report for antenatal care only in the latter half of

pregnancy, hence their earlier blood pressure status is often not known. The majority

of reports state that hemorrhage, hypertensive disorders in pregnancy, and sepsis are

the chief indications for admission for critical care obstetric practice. Complicated

hypertensive disorders in pregnancy account for over 20% of these admissions. The

incidence of pre term births, birth asphyxia, and low Apgar scores are reported to be

higher in the hypertensive group.

Maternal and perinatal morbidity are increased in women with gestational

hypertension. Also, women with mild gestational hypertension have an increased

incidence of obstetrical interventions such as induction of labour and caesarean

section. Women with severe gestational hypertension have a higher incidence of

preterm birth and small for-gestational-age newborns than in those with mild

preeclampsia8.


6/19

5

The most frequent complication of gestational hypertension is its progress to

preeclampsia that is heralded by the development of protienuria. Approximately 15%-

25% of women with gestational hypertension develop preeclampsia and this risk

varies with gestational age.

The concern is that gestational hypertension may develop into the more serious

preeclampsia or eclampsia syndrome, therefore urine checking for protein should be

done and blood pressure is monitored closely at each physician visit. If the blood

pressure increases to a level that might endanger the women or her foetus, the

physician will be prescribe antihypertensive drugs for the patient9.

Kumar. Majhi et al., reporting from a referral hospital in Calcutta reported that

the incidence of gestational hypertension was 44.6% of cases and primipara accounted

for 88.7%, the caesarean section rate was 10.5% and maternal mortality rate was

11.28% for gestational hypertension of these 48.7% was due to eclampsia. The

perinatal mortality rate was 39.9% and the incidence of low birth weight and maternal

outcome was better in the actively managed cases10

.

The researcher working as a staff nurse in the antenatal ward has seen patients

having complications of delivery due to gestational hypertension. The researcher hasalso noted that these patients had inadequate knowledge regarding the problem and the

complications that can arise if left untreated. All these prompted the researcher to

select the following topic for study.

Early identification of women at risk for Gestational hypertension may help

prevent some complications of the disease. A health teaching programme should be

developed together with the woman and her family to assist them in coping with the

impact of high risk pregnancy Education about the warning symptoms, having regular

prenatal visits and adapting to proper home care management are essential because

early recognition may help women receive treatment and prevent worsening of the

disease11

.


7/19

6

6.3 STATEMENT OF THE PROBLEM

A study to assess the effectiveness of Structured Teaching Programme on

knowledge regarding gestational hypertension among primigravida mothers in a

selected Maternity Hospital, Bangalore.

6.4 OBJECTIVES

1. To assess the pre-test knowledge regarding gestational hypertension amongprimigravida mothers.

2. To assess the post-test knowledge regarding gestational hypertension amongprimigravida mothers.

3. To compare the mean pre-test and posttest knowledge regarding gestationalhypertension among primigravida mothers.

4. To associate the pre test knowledge regarding gestational hypertension amongprimigravida mothers with their selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

1. EffectivenessIt refers to the outcome of structured teaching program in improving the

knowledge regarding gestational hypertension.

2. Structured teaching programmeA systematically arranged teaching programme regarding gestational

hypertension- its definition, aetiology and risk factors, clinical features,

complications, management and prevention provided by means of instructional

aids.

3. KnowledgeIt refers to the level of understanding and awareness regarding

gestational hypertension.


8/19

7

4. Gestational hypertensionIt refers to a sustained rise of blood pressure to 140/90 mm of Hg or

more on at least two occasions four or more hours apart beyond the 20th week

of pregnancy or during the first 24 hours after delivery in a previously

normotensive woman.

5. Primigravida motherIt refers to a mother who is pregnant for the first time.

6.6 ASSUMPTIONS

1. The primigravida mothers may have inadequate knowledge regarding

gestational hypertension.

2. The structured teaching programme may improve the level of knowledge

regarding gestational hypertension among primigravida mothers.

3. The primigravida mothers knowledge regarding gestational hypertension may

vary with their selected demographic variables.

6.7 RESEARCH HYPOTHESIS

H1:There will be a significant difference between the mean pre test and post test

knowledge regarding gestational hypertension among primigravida mothers.

H2: There will be a significant association between pre test knowledge regarding

gestational hypertension among primigravida mothers with their selected

demographic variables.

6.8 REVIEW OF LITERATUREA prospective study was conducted with an objective to evaluate the perinatal

outcome amongst mothers admitted with hypertensive disease during pregnancy at the

Department of Pediatrics and Obstetrics of Maharaja Yeshwantrao Hospital, Indore

over a period of one year. The study sample comprised of 405 cases admitted as

hypertensive disorders of pregnancy and 100 cases admitted as full term normal

pregnancy in labor and without any complication during pregnancy were taken as

controls. The outcome findings revealed that the frequency of hypertensive disorders


9/19

8

in pregnancy was 7.49%. Twenty two (5.4%) mothers had twin deliveries. Out of

these 405 cases, majority were due to toxaemia of pregnancy, i.e ., pre-eclampsia 204

(50.4%) and eclampsia-43 (10.6%). One hundred and thirty two (30.9%) births needed

intervention in the form of forceps application or caesarean section and foetal distress

was the indication in 47 (35.6%) of these cases and low birth weight prevalence was

high. Hence they concluded that there exist a relation between frequency of

gestational hypertension and perinatal complications12

.

A descriptive study was conducted among 153 antenatal mothers attending the

OPD of a co-operative hospital, Malappuram, Kerala to determine the knowledge

level of antenatal mothers regarding gestational hypertension and its complications

arising for both mother and the foetus. Samples who were selected using convenient

sampling technique were administered a structured questionnaire to evaluate the

knowledge level. The study findings showed that among the respondents, only few

mothers (21%) were having good knowledge regarding gestational hypertension, its

manifestations (19%), need for medical intervention (37%), its complications (11%)

and its prevention (9%).The mothers with adequate knowledge were educated than the

others. And it was concluded that an extensive health teaching is required to improvethe level of knowledge about this condition among the antenatal population

13.

A retrospective cohort study was conducted to assess the effects of gestational

hypertension on infant mortality in triplets stratified by gestational age at birth, using

the linked 19952000 US birth/infant death database. Generalized estimating

equations were used to evaluate the observed association. The results revealed that

gestational hypertension was associated with lesser neonatal mortality (95%), post

neonatal mortality (95%) and infant mortality (95%) in triplets. whereas the

association was not significant in late preterm or in full-term triplets. The study

concluded that gestational hypertension is associated with a decreased risk of infant

mortality in triplets. This effect varies with gestational age at birth14

.

A retrospective case control study was performed over a period of 5 years

whose data were retrieved from hospital records. All teenage mothers (aged 1319

completed years at delivery) delivering in the University Hospital were taken as cases.

The results showed that majority of the teenagers were primigravida (83.2%).


10/19

9

Complications like gestational hypertension (11.4%), pre-eclamptic toxemia (PET)

(4.3%) eclampsia (4.9%) and premature onset of labor (26.1%) occurred more

comonly in teenagers compared to controls. The study concluded that teenage

pregnancy was associated with a significantly higher risk of gestational hypertension,

PET, eclampsia, premature onset of labor, fetal deaths and premature delivery15

.

The prospective cohort study was conducted to investigate whether gestational

hypertension is more common in first pregnancies. 763 primiparous mothers who had

their first births between 2004- 2007 were taken for study. The result showed that the

risk of gestational hypertension was 4.1% in the first pregnancy and 1.7% in later

pregnancies overall. The study concluded that early onset gestational hypertension

might be associated with a reduced likelihood of a future pregnancy and with more

recurrences than late onset gestational hypertension when there are further

pregnancies16

.

The potential study was conducted to evaluate potential associations between

maternal shift work and long working hours during pregnancy and gestational

hypertension. The stratified systematic sampling was used to 24 200 post-partum

women from the Taiwan in 2005. The study findings revealed that there was noassociation between employment status and gestational hypertension. The study

concluded that there was no convincing evidence that maternal shift work or long

working hours had a higher risk of gestational hypertension17

.

A case-control study of 250 pregnant women with hypertension and 400

pregnant women without this complication who presented to Safdarjang Hospital in

New Delhi, India was conducted. 200 cases (80%) and 372 controls (93%) were

primigravidae. As expected, the result findings were that prevalence of adverse

outcomes was significantly higher in cases than controls: preterm delivery, 28.8% vs.

3%; need for labor induction, 52.8% vs. 3.25%; caesarean section delivery, 14.8% vs.

3.5%; and need for special nursery care, 40% vs. 6.75%. 4.8% of infants of mothers

with hypertension were stillborn, compared with 0.25% of infants of controls; overall

perinatal mortality rates were 14.8% and 1%, respectively. Hence the study concluded

that maternal hypertension contributes to an estimated 22% of all perinatal deaths and


11/19

10

this risk could be reduced by optimum antenatal care and timely increased use of

obstetric interventions18

.

A retrospective cohort study was conducted to evaluate the effect of different

types of pregnancy-induced hypertension on foetal growth. The study which had 128

samples examined the effect of the various types of hypertension in pregnancy, on

gestational age, preterm birth, birth weight, low birth weight, and intrauterine growth

restriction. The results showed that gestation was 0.6 week shorter in women with

gestational hypertension than in normotensive women (P < .01). The study concluded

that preeclampsia increases the risk of intrauterine growth restriction and low birth

weight19

.

The prospective study was conducted to observe the effect of the antioxidant

lycopene (carotenoid found in tomatoes and berries) on the occurrence of gestational

hypertension and intrauterine growth retardation (IUGR) in primigravida women

among 251 primigravida women selected by randomized controlled trial. The study

revealed that gestational hypertension developed significantly less in women in the

lycopene group than in the placebo group (8.6% vs. 17.7%, P=0.043 by chi-square

test), mean fetal weight was significantly higher in the lycopene group. The results ofthe present study concluded that the antioxidant lycopene reduces the development of

gestational hypertension and intrauterine growth retardation in primigravida women20

.

A cohort prospective study was carried out in l96 patients with the diagnosis

of gestational hypertension at the time of the interruption of the pregnancy to

determine how many patients progressed to chronic hypertension. The results showed

that thirteen patients (6.6%) with diagnosis of gestational hypertension progressed to

chronic hypertension. It was found that advanced age , high body mass index and the

antecedent of hypertensive disease in a previous pregnancy were significantly

associated with the progression to chronic hypertension. The study concluded that

overweight, advanced maternal age and the antecedent of hypertensive disorder in a

previous pregnancy are the variables associated with the progression from gestational

hypertension to chronic hypertension21

.


12/19

11

7. MATERIAL AND METHODS OF STUDY

7.1 SOURCE OF DATA

The data will be collected from the primigravida mothers in a selected

Maternity Hospital, Bangalore.

7.2 METHODS OF DATA COLLECTION

i. Research designQuasi experimentalOne group pre test and post test design

22.

ii.

Research variable

Dependent variable: Knowledge regarding gestational hypertension among

primigravida mothers.

Independent variable: Structured teaching programme regarding gestational

hypertension among primigravida mothers.

Demographic variable: Age, education, religion, occupation, income, food

pattern, type of family, gestational weeks and sources of information

iii. SettingThe study will be conducted in a selected Maternity Corporation

Hospital, Bangalore.

iv. PopulationThe population of the study will be the primigravida mothers who are

admitted in a selected Maternity Hospital, Bangalore.

v. SampleThe sample consists of 60 primigravida mothers who fulfill the inclusion

criteria in a selected maternity hospital, Bangalore.


13/19

12

vi. Criteria for sample selection:Inclusion criteria

The study includes

1. Primigravida mothers with gestational hypertension admitted in theselected Maternity Hospital, Bangalore.

2. Primigravida mothers who can understand Kannada or English.Exclusion criteria

The study excludes

1. Primigravida mothers who are not available at the time of data collection.2. Primigravida mothers who are not willing to participate in the study.

vii. Sampling technique

Non probability convenience sampling technique

viii. Tool for data collection

A structured questionnaire will be developed as a tool for data

collection. It will consist of the following sections.

Section AConsists of demographic variables which give baseline information

such as age, education, religion, occupation, income, food pattern, type of

family, gestational weeks and sources of information.

Section BStructured questionnaire related to knowledge regarding gestationalhypertension among primigravida mothers.

ix. Methods of data collection:After obtaining the official permissions from the hospital authorities and

informed consent from the samples, the investigator will collect data pertaining

to demographic variables. The remaining data will be collected in the following

three phases-


14/19

13

Phase I- Pre-test will be conducted to assess the knowledge regarding

gestational hypertension among primigravida mothers.

Phase II- On the same day, structured teaching programme will be conducted

regarding gestational hypertension among primigravida mothers by using

instructional aids.

PhaseIII- Post test will be conducted with the same questionnaire after 7 days,

of planned teaching programme.

x. Plan for data analysis

The data collected will be analysed using descriptive and inferentialstatistics.

Descriptive statistics:

Frequency and percentage distribution will be used to describe the

demographical variables. Mean and standard deviation will be used to analyze

the knowledge among primigravida mothers.

Inferential statistics:

Pairedt test will be used to compare the pre test and post test knowledge

regarding gestational hypertension among primigravida mothers.

Chi-square test will be used to analyze the pre test knowledge regarding

gestational hypertension among primigravida mothers with their selected

demographic variables23

.

x. Projected outcome

The Structured Teaching Programme will improve knowledge regarding

gestational hypertension among primigravida mothers. It will help

primigravida mothers for early prevention and detection of gestationalhypertension.


15/19

14

7.3 Does the study require any investigations or interventions to the

patients or human beings or animals?

Yes, Structured Teaching Programme will be administered regarding

gestational hypertension as intervention for the primigravida mothers.

7.4Has ethical clearance been obtained from your institution?

Yes, permission will be taken from the concerned authorities in the selected

Maternity Hospital. Informed consent from the samples will be obtained.

Confidentiality and privacy of data will be maintained.


16/19

15

8. LIST OF REFERENCES

1. http://www.indiaparenting.com/articles/data/art06_004.shtmlBasavanthappa. Textbook of Midwifery and Reproductive Health Nursing:

Prenatal nursing-II.Nursing of pregnancy at risk. 1st

ed.New Delhi: Jaypee

brothers Medical; 2006.

2. D.C. Dutta. Text book of obstetrics.6th ed.Calcutta: New central bookagency;2004.

3. Fernando Arias. Shirish N Daftary. Amarnath G Bhide. Practical guideto high-risk pregnancy and delivery. 3

rded .New Delhi: Elsevier;2008.

4. Managing hypertension in pregnancy.http://dr-healthguide.blogspot.com.5. Elizabeth Jean Dickason.Martha Olsen Schult. Bonnie Lang Silverman.

Maternal Infant nursing care. St. Louis, Missouri: Mosby.1990.

6. Diane M.Fraser.Margaret A. Cooper. Myles Textbook for Midwives. 14 th ed.London New York :Churchill Livingstone; 2004.

7. N.Jayne Klossner.Introductory maternity nursing. 1st ed .Philadelphia:Lippincott Williams & Wilkins;2006.

8. Annamma Jacob .A comprehensive textbook of mifwifery.1st ed. NewDelhi:Jaypee Brothers;2005.

9.Kumar. Mahji, Sarathy Chakraborthy. Gestational hypertension present scenario inreferral hospital Calcutta. Journal of obstet gynaecol India 2000; 50 (14) 128-

132.

10. Deitra Leonard Lowdermilk,Shannon E.Perry. Maternity & Womens HealthCare.9 ed Missouri : Mosby Elsevier.2007

11. Pregnancy, perinatal period and outcome, women's health IJOG, April 2008.http://uk.reuters.com/article/healthNews/idUKLAU48349220080404

12. Bindhu T, Sreenidhi L, Shobhana B. Knowledge about gestational hypertensionamong antenatal mothers. Internet journal of obstetrics and gynecology 2006;

volume 7 (11): Available from URL, http://www.maternalhealth.net/poc/doc.
http://www.indiaparenting.com/articles/data/art06_004.shtmlhttp://dr-healthguide.blogspot.com/http://dr-healthguide.blogspot.com/http://whatyouneedtoknow.co.in/news/?tag=pregnancyhttp://whatyouneedtoknow.co.in/news/?tag=womens-healthhttp://uk.reuters.com/article/healthNews/idUKLAU48349220080404http://www.maternalhealth.net/poc/doc.http://www.maternalhealth.net/poc/doc.http://www.maternalhealth.net/poc/doc.http://uk.reuters.com/article/healthNews/idUKLAU48349220080404http://whatyouneedtoknow.co.in/news/?tag=womens-healthhttp://whatyouneedtoknow.co.in/news/?tag=pregnancyhttp://dr-healthguide.blogspot.com/http://www.indiaparenting.com/articles/data/art06_004.shtml


17/19

16

13. X.K.Chenab, S.W. Wenabc, G.N. Smithd, Q. Yangab, M.C. Walkerabc.Pregnancy-induced hypertension and infant mortality in triplets 2007. Volume

98(1). Available from URL http://www.ijgo.org/article

14. Sengupta B, Mondal M, Deb S. Teenage pregnancy- A socially inflicted healthhazard. Indian Journal of Community Med 2009;34- 31:http://www.ijcm.org.in

15. Hypertension a crisis in primi?http://www.ncbi.nlm.nih.gov/pubmed16. Kulkarni R, Chauhan S, Shah B, Menon G, Puri C. Long working hours and

hypertension, India. Indian J Community Med 2007;32 (2)59-63

17. Devi G U, Udaya R. Unusual accompaniments if gestational hypertension:http://www.ncbi.nlm.nih.gov/pubmed

18. Xu Xiong, Dr P H. Damon Mayes, Nestor Demianczuk, D. David, M. Olson,Sandra T. Davidge . Impact of pregnancy-induced hypertension on fetal growth

2005. Available from URL, http://www.ijgo.org/article/S0020 sciencedirect.

com

19. Ashok Kumar, Tej Singh, Sriparna Basu. Sulekha Pandey and V. Bhargava .Neonatal outcome available from:URL http://www.springerlink.com/content

20. Romero, Muro. Unidad Medica de AltaEspecialidad, [email protected].

21. Denise F. Polit, Cheryl Tatano Beck. Nursing research: generating and assessingevidence for nursing practice. 8

thedition. New Delhi: Wolters Kluwer; 2008.

22. P.S.S. Sundar Rao and J Richard. Introduction to biostatistic and researchmethods. 4

thedition. New Delhi: Prentice-Hall of India; 2008.
http://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/articlehttp://www.ncbi.nlm.nih.gov/pubmedhttp://www.ncbi.nlm.nih.gov/pubmedhttp://www.ncbi.nlm.nih.gov/pubmed%20%20/19700491?ordinalpos=52&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ijgo.org/article/S0020http://www.springerlink.com/contentmailto:[email protected]:Romero%20Guti%C3%A9rrez%20G,%20Muro%20Barrag%C3%A1n%20SA,%20Ponce%20de%20Le%C3%B3n%20AL.Unidad%20M%C3%A9dica%20de%20Alta%20Especialidad,%20Hospital%20de%20Gineco-Pediatr%C3%ADa%20No.%2048,%20Leon,Guanajuato,%20M%C3%A9xico.%[email protected]:Romero%20Guti%C3%A9rrez%20G,%20Muro%20Barrag%C3%A1n%20SA,%20Ponce%20de%20Le%C3%B3n%20AL.Unidad%20M%C3%A9dica%20de%20Alta%20Especialidad,%20Hospital%20de%20Gineco-Pediatr%C3%ADa%20No.%2048,%20Leon,Guanajuato,%20M%C3%A9xico.%[email protected]:Romero%20Guti%C3%A9rrez%20G,%20Muro%20Barrag%C3%A1n%20SA,%20Ponce%20de%20Le%C3%B3n%20AL.Unidad%20M%C3%A9dica%20de%20Alta%20Especialidad,%20Hospital%20de%20Gineco-Pediatr%C3%ADa%20No.%2048,%20Leon,Guanajuato,%20M%C3%A9xico.%[email protected]:[email protected]://www.springerlink.com/contenthttp://www.ijgo.org/article/S0020http://www.ncbi.nlm.nih.gov/pubmed%20%20/19700491?ordinalpos=52&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmedhttp://www.ijgo.org/articlehttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/article/S0020-7292(07)00148-8/abstract#aff2http://www.ijgo.org/article/S0020-7292(07)00148-8/abstracthttp://www.ijgo.org/article/S0020-7292(07)00148-8/abstract


18/19

17

9. Signature of the candidate :

10. Remark of the guide :

11. Name and designation of guide: Mrs. M. Sundaram

Associate Professor

11.2 Signature :

11.3 Co guide : Ms. Subashini. GAssistant Professor

11.4 Signature :

11.5 Head of the department : Mrs. M. Sundaram

11.6 Signature :

12.1 Remarks of the principal :

12.2 Signature :


19/19

18

0 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKAPROFORMA FOR REGISTRATION OF...

Documents

Transcript of 0 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKAPROFORMA FOR REGISTRATION OF...