A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATION, EDUCATION AND COMMUNICATION REGARDING POST PARTUM HEMORRHAGE AMONG POST NATAL MOTHERS IN SELECTED HOSPITAL AT BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SUBMITTED BY

CHANDRAWATI CHAUHAN

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of the candidate and address CHANDRAWATI CHAUHAN

Harsha Collage of Nursing,

Nelamangala,

Bangalore

2 Name of the institution Harsha Collage of Narsing,

Nelamangala, Bangalore

3 Course of the study and subject 1st YEAR M.Sc NURSING

OBSTETRICAL AND

GYNECOLOGICAL NURSING

4 Date of Admission 06/07/2009

5 Title of the topic A STUDY TO EVALUATE THE EFFECTIVENESS OF INFORMATION, EDUCATION AND COMMUNICATION REGARDING POST PARTUM HEMORRHAGE AMONG POST NATAL MOTHERS IN SELECTED HOSPITAL AT BANGALORE.

.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

All women lose some blood as the placenta separates from the uterus and immediately

afterward. And women who have c-sections generally lose more than those who give birth

vaginally. But because the amount of blood in your body increases by almost 50 percent during

your pregnancy, your body is well prepared to deal with this expected blood loss.

Normal bleeding just after childbirth is primarily from open blood vessels in the uterus, where

the placenta was attached. (If you had an episiotomy or tear during birth, you may also bleed

from that site until it's stitched up.)

As the placenta begins to separate, these vessels bleed into the uterus. After the placenta

is delivered, the uterus usually continues to contract, closing off these blood vessels.

Unfortunately, some women bleed too much after birth and require special treatment. This

excessive blood loss is called a postpartum hemorrhage (PPH) and it happens in up to 6 percent

of births. Occasionally, cervical lacerations, deep tears in your vagina or perineum, or even a

large episiotomy may be the source of a postpartum hemorrhage. A ruptured or inverted uterus

may cause profuse bleeding, but these are relatively rare occurrences.

Finally, a systemic blood clotting disorder may cause a hemorrhage. (A clotting disorder

may be an inherited condition or it may develop during pregnancy as a result of certain

complications, such as severe preeclampsia or HELLP syndrome or a placental abruption.) And a

hemorrhage itself can cause clotting problems, leading to even heavier bleeding1.

Postpartum hemorrhage is defined as a loss of blood in the postpartum period of more

than 500 mL. The average, spontaneous vaginal birth will typically have a 500 mL blood loss. In

cesarean births the average blood loss rises to 800-1000 mL. There is a greater risk of

hemorrhage in the first 24 hours after the birth, called primary postpartum hemorrhage. A

secondary hemorrhage occurs after the first 24 hours of birth2.

Hemorrhage is not something that we want to think about when it comes to giving birth.

In fact, 95% of births will not have a problem with hemorrhage. However it is important to know

the risk factors for hemorrhage and discuss your personal risk factors with your doctor or

midwife

Global health experts know what it takes to address the world’s leading cause of maternal

mortality: prevent postpartum hemorrhage. Postpartum hemorrhage, or excessive bleeding after

childbirth, kills an estimated 150,000 women each year. In developing countries, where most

births occur in homes or local clinics, the interventions needed to treat postpartum hemorrhage—

emergency referrals, obstetric care, blood transfusion, and surgery—are often out of reach.

Treatment simply is not available for the majority of women3.

Defining postpartum hemorrhage (PPH) refers to amount of blood loss in execass of

500ml following birth of baby is problematic and has been historically difficult. Waiting for a

patient to meet the postpartum hemorrhage criteria, particularly in resource-poor settings or with

sudden hemorrhage, may delay appropriate intervention. Postpartum hemorrhage is traditionally

defined as blood loss greater than 500 mL during a vaginal delivery or greater than 1,000 mL

with a cesarean delivery. However, significant blood loss can be well tolerated by most young

healthy females, and an uncomplicated delivery often results in blood loss of more than 500 mL

without any compromise of the mother's condition. The addition of "a 10% drop in hemoglobin"

to the definition provides an objective laboratory measure.  Signs and symptoms of hypovolemia

(lightheadedness, tachycardia, syncope, fatigue and oliguria) are also of limited utility as they

can be late findings in a young and otherwise healthy female. As a result, any bleeding that has

the potential to result in hemodynamic instability, if left untreated, should be considered

postpartum hemorrhage and managed accordingly.

Postpartum hemorrhage can be divided into 2 types: early postpartum hemorrhage,

which occurs within 24 hours of delivery, and late postpartum hemorrhage, which occurs 24

hours to 6 weeks after delivery. Most cases of postpartum hemorrhage, greater than 99%, are

early postpartum hemorrhage. With many women delivering outside of hospitals and early

postpartum hospital discharge being a growing trend, postpartum hemorrhage that presents to the

emergency department may be either early or late4.

The POPPHI team works closely with a range of partners to share information and,

ultimately, increase use of the prevention measures. For example, the project is working with the

International Federation of Gynecology and Obstetrics and the International Confederation of

Midwives to promote AMTSL among their member associations, which include both physicians

and midwives. Working with other partners—particularly Rational Pharmaceutical Management

Plus (RPM Plus) and Access to Clinical and Community Maternal, Neonatal, and Women’s

Health Services—the project is also identifying opportunities to create synergies and maximize

impact5.

High-quality evidence suggests that active management of the third stage of labor reduces

the incidence and severity of PPH. Active management is the combination of (1) uterotonic

administration (preferably oxytocin) immediately upon delivery of the baby, (2) early cord

clamping and cutting, and (3) gentle cord traction with uterine countertraction when the uterus is

well contracted (ie, Brandt-Andrews maneuver).

6.2 NEED FOR THE STUDY

“Every minute around the world 380 women become pregnant, 190 women face

unplanned or unwanted pregnancies, 110 women experience pregnancy related complications, 40

women have unsafe abortions, 1 woman dies.”

The World Health Organization states that every minute, at least one woman dies from

complications related to pregnancy or childbirth – that means 529 000 women a year.

Unavailable, inaccessible, unaffordable, or poor quality care is fundamentally responsible.

Postpartum hemorrhage accounts for of 34% and 31% of women dying from

complications related to pregnancy or childbirth in Africa and Asia, respectively. The primary

intervention shown to reduce the incidence of postpartum hemorrhage is active management of

the third stage of labor (AMTSL).[iv] A safe, cost-effective, and sustainable intervention and a

practice that can save facilities money, according to studies conducted in Guatemala, Vietnam,

and Zambia[v],[vi].The International Confederation of Midwives (ICM) and the International

Federation of Gynecology and Obstetrics (FIGO) issued two joint statements in 2003 and 2006

stating that every woman should be offered active management of the third stage of labor as a

means of reducing the incidence of postpartum hemorrhage6.

Although accountable for only 8% of maternal deaths in developed countries, postpartum

hemorrhage is the second leading single cause of maternal mortality, ranking behind

preeclampsia/eclampsia. Globally, postpartum hemorrhage is the leading cause of maternal

mortality. The condition is responsible for 25% of delivery-associated deaths, and this figure is as

high as 60% in some countries. International initiatives to improve outcomes have invested in

training birth attendants (traditional or otherwise) and nurse midwives on the active management

of the third stage of labor (the period immediately after delivering of the infant). Most efforts

focus on uterine atony, which is the primary cause of postpartum hemorrhage. This has included

education on manual techniques to increase uterine contraction-retraction and making

pharmacologic uterotonic agents (oxytocin and misoprostol) more available.

world health organization estimate that, of the 529000 maternal death occurring every

year, 136000 or 25.7 % take place in India where two third of maternal death occur after

delivery, post partum hemorrhage being the most commonly reported complication and leading

cause of death ie 30%7.

In the first study by Sadeghi and colleagues, among 18 134 women undergoing delivery,

141 patients with postpartum hemorrhage were identified in Tehran’s Akbarabadi and Firoozgar

hospitals. This represents a frequency of 1%. Of these occurrences, 90% occurred in patients

undergoing normal spontaneous vaginal delivery and 10% in patients undergoing Cesarean

section. About two-thirds of cases of postpartum hemorrhage occurred in the first and second

pregnancies. While 91% of cases were early cases of postpartum hemorrhage, 9% were late.

Approximately two-thirds of cases of postpartum hemorrhage were mild, and one-third was

either moderate or severe. The etiologies of postpartum hemorrhage in this study were uterine

atony (38%), retained products of conception (38%), lacerations (8%), prolonged stage 3 of labor

(4%), puerperal infection (1.4%), uterine rupture (1.4%), placenta accreta/increta (1.4%),

hematoma (1.4%), etc8.

Two cases of postpartum hemorrhage among 5601 patients undergoing delivery in

Tehran’s Arash hospital between 2001 and 2002. Here, a frequency of 1.3% postpartum

hemorrhage was observed over 3 years. The most common etiologies were uterine atony (60%),

lacerations (23%) and retained products of conception (16%). Of those patients with postpartum

hemorrhage, 77% and 70%, respectively were between 20 and 35 years of age and between 38

and 40 weeks of gestational age. Nulliparity and multiparity were almost evenly distributed, and

two-thirds of patients underwent normal spontaneous vaginal delivery, in contrast to 32% who

underwent Cesarean section. Four patients delivered macrosomic babies (5.4%). Multiple

gestation was present in two patients (2.7%) but polyhydramnios was present in only one of

them. One patient had a previous history of postpartum hemorrhage. The duration of labor was

normal in 88% of patients, prolonged in 11% and short in 1%. One-third of patients were

induced by oxytocin and no induction method was used in the remaining two-thirds9.

The United States Cesarean rate in 2004 was 29.1%. Look at the sharp comparison with

the farm according to farm midwifery centre the birth completed at home is emergency transport

of delivery is 1.3%, vaginal birth is 98., cesarean section is 2% , the cases with preeclamsia is

1%, the cases with post partum hemorrhage is 2%10.

The maternal mortality ratio (MMR) in Africa is at crisis level. African women of

reproductive age have the highest death risk from maternal causes in the world, with an average

of 830 deaths per 100,000 live births. As it currently stands, the United Nations Millennium

Development Goal to reduce maternal mortality in Africa by 75 percent by 2015 is a far-reaching

target11

Maternal mortality is high (281/100,000). Demographic Health Survey (2006), almost

half of which is a result of postpartum hemorrhage (PPH)12.

This study describes the results of Morbidity and Performance Assessment (MAP)

conducted to provide insight into the medical factors contributing to maternal and newborn

morbidity and mortality in a rural district of northern India, and to use these insights to develop a

locally appropriate, community-based safe motherhood program The MAP study was based on

verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a

family member) participated in the study. This article describes a subsample of women who

reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor

knowledge of danger signs; poor problem recognition during labor, birth, and the immediate

postpartum period; and a low level of health seeking that was consistent with poor recognition.

Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs

were generally not associated with problem recognition and health seeking. The case fatality rate

was 4%. These findings suggest an urgent need to understand the phenomenon of problem

recognition and to integrate this into the design of interventions to reduce delays in health

seeking13

A study conducted on trends in postpartum hemorrhage in high resource countries and a

review and recommendations from the International Postpartum Hemorrhage in collaborative

Group researchers reviewed available data sources on the incidence of PPH over time in

Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was

available, the incidence of PPH was stratified by cause.The results of the study was observed an

increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the

USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to

immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage

in Australia, Canada, the UK and the USA14

Most studies quote an incidence of around 5%,15 but a figure of 12% of vaginal deliveries

was recorded in one Australian tertiary referral hospital.16

The Active Management of the Third stage of Labour; prophylactic oxytocics should be

routinely used in the third stage of labour as they decrease the risk of PPH by 60%17 For most

women syntometrine ( ergometrine 0.5mg with 5mg.i.u oxytocin) is the drug of choice. Oxytocin

alone (10i.u) is preferred by some clinicians in women with hypertension.

Postpartum hemorrhage (PPH) is the main cause of maternal mortality. Yet, even though

solutions have been identified, governments and donor countries have been slow to implement

programs to contain the problem. While poverty and low educational level remain the underlying

cause of PPH, the current literature suggests that active management of the third stage of labor

can prevent it. The International Confederation of Midwives (ICM) and the International

Federation of Gynecology and Obstetrics (FIGO) are attempting to address the chronic PPH

crisis by educating their members on best practices and on troubleshooting where resources are

inadequate. Some studies found oxytocin to be preferable to misoprostol in settings where active

management is the norm. However, secondary clinical effects may prove more troublesome with

oxytocin than with misoprostol, and misoprostol may prove to be more practical and equally

effective in low-resource settings. Two new interventions are also proposed, the anti-shock

garment and the balloon tamponade18

Severe bleeding after childbirth is the largest cause of maternal mortality, accounting for

at least one-quarter of maternal deaths worldwide. An estimated 550,000 women die every year

of maternal causes. Among these, an estimated 125,000–150,000 deaths are from PPH. In Asia,

PPH contributes to an even higher proportion of maternal mortality, and some countries report

that as many as 45% of maternal deaths are linked to PPH19.

All the study shows that hemorrhage during the labour is more common. But blood lose more

than 400 ml, leads to more complication that should be prevented. So postnatal mothers have

knowledge, motive the researcher to do this study.

6.3 REVIEW OF LITERATURE

Review of related literature is an integral component of any study or research project. It

enhances the depth of the knowledge and inspires a clear insight into the crux of the problem.

Literature review throws light on the studies and their findings reported about the problem under

study

A study conducted on the impact of primary postpartum hemorrhage in "near-miss"

morbidity and mortality in a tertiary care hospital in North India. Aim was to assess risk factors,

mortality and "near-miss" morbidity in early PPH.: Retrospective analysis of 178 women with

early PPH (within 24 h of delivery) over 4 consecutive years in a tertiary care hospital in North

India. All case sheets of patients identified by labor record registers as having early PPH were

reviewed by the same person to identify the actual impact of condition. The data was analyzed

by chi-square analysis. Conclusion was both "near-miss" morbidity and mortality in early PPH

reflect the level of obstetric care in the developing world. These need to be reduced by

strengthening peripheral delivery facilities, active 3rd stage management and early referral20

A study conducted on Prevalence and risk factors for obstetric haemorrhage in 6730

singleton births after assisted reproductive technology in Victoria Australia. This retrospective

cohort study compared the prevalence of ante partum hemorrhage (APH), placenta praevia (PP),

placental abruption (PA) and primary. post-partum hemorrhage (PPH) in women with singleton

births between 1991 and 2004 in Victoria Australia: 6730 after IVF/ICSI, 24 619 from the

general population, 779 after gamete intrafallopian transfer (GIFT) and 2167 non-ART

conceptions in infertile patients. Risk factors for haemorrhages in the IVF/ICSI group were

examined by logistic regression. Conclusions of the study was obstetric hemorrhages are more

frequent with singleton births after IVF, ICSI and GIFT21.

A study explained trends in maternal mortality due to hemorrhage This study analysis of

records of over a period of 20 years from April 1982 to March 2002 reveals that it was a

contributory cause of maternal mortality in 19.9% of cases. The majority of deaths, (65%) had

occurred within 24 hours of admission and in 47.5% of cases there was severe anaemia on

admission; 17.5% had died due to an atonic PPH, which was the largest category, followed by

ruptured uterus (15%), abruptio placenta (15%) and retained placenta (12.5%). Deaths due to

obstetric haemorrhage because of a ruptured uterus, retained placenta and abortion have

decreased from 22.22% between 1982 and 1987 to zero in the last 5 years and an increase

was seen in deaths due to haemorrhage because of gestational trophoblastic neoplasia and

ectopic pregnancy, from 1.69% to 4.87%, unclassified haemorrhage 1.96% to 7.31% and

placenta praevia from zero between 1982 and 1987 to 4.87% between 1997 and 200222

This study was conducted in a sub divisional hospital of eastern Himalayan region among

5,273 pregnant women over a period of 8 years. There were 29 deaths, the maternal mortality

rate was 55 per 10,000. Septic abortion was encountered in 4 among them. Direct obstetric cause

was responsible in 72.41% of cases and indirect cause in 27.59% cases. Sepsis, both puerperal

and postabortal resulted in 24.14% followed by postpartum haemorrhage in 20.69%. Two of

these cases were associated with inversion of the uterus. Preeclampsia caused 10.34% and

eclampsia 6.9% of the deaths. Among the indirect causes severe anaemia and pulmonary

tuberculosis accounted for 10.34% and 6.9% respectively. Infective hepatitis was the cause in

6.9% cases. Only 17% of the cases were booked and the rest were unbooked. Majority of the

cases (62.07%) belonged to the age group of 20-30 years. Primigravida constituted 41.38% of

the cases23.

An article explained in a 10-year retrospective study of maternal deaths at RA Kar

Medical College, Calcutta there were 651 maternal deaths with 410 in first 5-year period and 241

in second 5-year period. The leading causes of deaths were due to abortion, toxaemia,

haemorrhage (antepartum and postpartum) and jaundice in pregnancy. Direct causes were

responsible for death in 77.6% cases, indirect causes in 17.5% cases and unrelated causes in

4.9% cases. Majority (557) were unbooked and mostly multigravida (434) cases. Most of them

(251) were in the age group of 20-25 years. Haemorrhage was the single most common cause to

claim 188 lives. It was also noted that 155 deaths occurred within 12 hours of hospital

admission24.

A study investigated the risk factors for postpartum hemorrhage among Saudi women.

Objective of the study was to identify health-related risk factors for the development of post

partum hemorrhage (PPH) in Saudi women and to estimate the incidence of primary

A case-control study was conducted between July 1, 2007 and June 30, 2008 at King Abdulaziz

Medical City, Riyadh, Saudi Arabia. One hundred and one patients with PPH and 209 control

patients were included. Bivariate associations between the different risk factors for the

development of PPH were studied. Multivariate logistic regression analysis to identify significant

risk factors for the occurrence of this obstetrics complication was carried out Conclusion of the

study was risk factors for developing PPH among Saudi women are comparable to other reported

studies with a greater influence of parity, presence of APH, multiple gestation, CTG

abnormalities and prolonged third stage of labor. There is a need for patient education on family

planning and antenatal care, physician education on active management of the third stage, and

correct estimation of blood loss25.

An article explained on B-Lynch Brace Suturing in primary post-partum hemorrhage

during cesarean section. Primary atonic post-partum hemorrhage during lower segment cesarean

section, which was not controlled by ecbolics--oxytocin, methylergometrine, 15-methyl-

prostaglandinF2alpha--was managed by applying a B-Lynch Brace Suture. The test of potential

efficacy was the control of hemorrhage by bimanual uterine compression. Six primigravida

patients at their term gestation, who underwent emergency cesarean section, all except one under

spinal anesthesia, received this type of suture. Interestingly, in every case hemorrhage was

controlled successfully with the compression suture. None of them received blood or blood

products transfusions or developed disseminated intravascular coagulopathy. Postoperative

recovery was good and all patients are in follow-up to assess their future reproductive activity.

B-Lynch Brace Suturing is an invaluable procedure for the control of atonic primary post-partum

hemorrhage following cesarean delivery26

A study explained the Hypo gastric artery ligation for post-partum hemorrhage Objective

of the study was bilateral ligation of hypo gastric arteries (BLHA) experience in the post-partum

hemorrhage management. Retrospective study conducted between January 2001 and December

2008. Researcher collected all the patients who had undergone a BLHA in case of post-partum

Hemorrhage Conclusion of the study was BLHA is an interesting and effective option in the

management of severe post-partum hemorrhage. Technique learning is recommended especially

in case of non availability of uterine artery embolization27.

A study conducted on Arterial balloon occlusion of the internal iliac arteries for treatment

of life-threatening massive postpartum hemorrhage in a series of 15 consecutive cases. Objective

of the study was to evaluate arterial balloon occlusion of the internal iliac arteries for treatment

of life-threatening massive postpartum hemorrhage. Retrospective cohort study at a tertiary

referral perinatal centre in a teaching hospital in the Netherlands. All patients who delivered in

this hospital between January 1998 and January 2008 were included in the study. A retrospective

analysis of all cases of postpartum hemorrhage was performed. All 15 consecutive cases of

massive postpartum haemorrhage were selected from an electronic database. The patients with

massive postpartum haemorrhage (blood loss>5000ml) and the patients with postpartum

haemorrhage treated with arterial balloon occlusion of internal iliac arteries were analyzed.

Conclusion of the study was arterial balloon occlusion of the internal iliac arteries is a safe and in

most cases effective procedure for treatment of massive life-threatening postpartum

hemorrhage28.

A study investigated Benefit of misoprostol for prevention of postpartum hemorrhage in

cesarean section Objectives of the study was to assess the benefit of sublingual misoprostol in

addition to standard oxytocin in the prevention of post-partum hemorrhage at caesarean section.

This was a prospective randomized controlled clinical trial conducted from March to June 2007

at our department of obstetrics-Sousse-Tunisia, including 250 single low risk pregnant women

undergoing caesarean section at gestational age>32 weeks gestation. Patients were randomly

assigned to receive at cord clamping either sublingual 200microg misoprostol (Cytotec) with

20UI intravenous oxytocin (Oxytocin): bolus 10UI and infusion 10UI in 500ml Ringer Lactate):

Group I, or only oxytocin at the same dose: Group II. The main outcome was total blood loss

assessed by decrease in perioperative hematocrit. Secondary outcomes included measured

collected blood loss; drop in hemoglobin level, additional oxytocin, side-effects and

postoperative complications. Conclusions of the study was sublingual misoprostol (in addition to

oxytocin) is effective in prevention of post-partum hemorrhage at caesarean sections when

compared to oxytocin alone, without major side-effects.

Larger studies are needed to confirm our results29.

STATEMENT OF THE PROBLEM

“a study to evaluate the effectiveness of information, education and communication

regarding post partum hemorrhage among post natal mothers in selected Hospital at

Bangalore.”

6.4 OBJECTIVES OF THE STUDY

1. Assessing the knowledge regarding post partum hemorrhage among post natal mothers in

terms of pretest.

2. Evaluate the effectiveness of information, education and communication regarding post

partum hemorrhage by comparing pretest score on post test knowledge score

3. Find out the association between knowledge score on post test knowledge score and

selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

1) Effectiveness: Refers to the extent to which the information, education and

communication on post partum hemorrhage has achieved the desired effect in improving the

knowledge of post natal mothers as assessed by structured questionnaire

2) Information, Education and Communication: Refers to systematically planned group

instructions by lecture cum discussion method designed to provide information regarding

post partum hemorrhage such as meaning, causes, diagnosis, clinical manifestation, treatment

and prevention

3) Post Partum Hemorrhage: refers to amound of blood lose in excess of 500 ml following

birth of baby.

4) Post Natal Mother: Refers the interval extending from the birth of the baby and till 6

weeks after.

5. Evaluation: Evaluation is the process of determining what extent the educational

objective are being realized.

6.6HYPOTHESIS

H1: There is a significant deference in the knowledge score on post partum hemorrhage in the

post test knowledge score than the pretest knowledge score among post natal mothers.

H2: There is a significant association between knowledge score and demographic variable

6.7 ASSUMPTION

The post natal mothers will have inadequate knowledge regarding post partum

haemorrhage

The planned teaching programme improves the knowledge of mothers regarding post

partum haemorrhage.

6.8 PROJECTED OUTCOME

The structured teaching programme will enhance post natal mother’s knowledge

regarding post partum haemorrhage

6.9 DELIMITATION

The data collection period is limited to 6 weeks

Assessment of knowledge is measured by one observation only

Teaching strategy is delimited to lecture method only

6.10 VARIABLE

Dependent variable of this study is the knowledge of post natal mothers regarding post

partum haemorrhage

Independent variable is information, education and communication on post partum

haemorrhage

Demographic variables in this study are Age, education, occupation, religion, and

family income, number of delivery, number of death, number of live children, type of

family and source of information.

7MATERIALS AND METHODS

The study is designed to determine the effectiveness of information, education and

communication on prevention of post partum haemorrhage among post natal mothers

in selected Hospital at Bangalore.

7.1METHOD OF COLLECTION OF DATA

SAMPLING TECHNIQUE

7.1SOURCE OF DATA

All mothers aged 20-35 in selected Hospital at Bangalore.

7.1.1RESEARCH APPROACH AND DESIGN

On experimental study of one group pre-test and post test design with evaluative approach.

7.1.2SETTING OF THE STUDY:

The study will be conducted the selected Hospital at Bangalore.

7.1.3POPULATION

The population of the study composed by all post natal mothers aged 20-35in selected

Hospital at Bangalore.

7.2METHODS OF DATA COLLECTION:

By self administered questionnaire.

7.2.1SAMPLING PROCEDURE.

These samples will be selected by simple Random sampling technique.

7.2.2SAMPLE SIZE

The proposed sample size of the study is 60 mothers.

SAMPLING CRITERIA

7.2.3INCLUSION CRITERIA

Post natal mothers who are willing to participate.

Post natal mothers who are present at the time of data collection.

7.2.4 EXCLUSION CRITERIA

Post natal mothers who are not understand Kannada or English

Post natal mothers who are not willing to participate

7.2.5 TOOL FOR DATA COLLECTION

Tool for data collection in the study is structured knowledge questionnaire. It consist two

part, part 1 and part 2.

Part 1 – items on demographic variable like Age, education, occupation, religion, and

family income, number of delivery, number of death, number of live children, type of

family and source of information.

Part 2 – structured knowledge questionnaire to elicit knowledge of post natal mothers

regarding post partum haemorrhage

7.2.6PROCEDURE FOR DATA COLLECTION

The data will be collected with the prescribed time period in selected hospitals.

Permission will be obtained from higher authorities

Purpose of the study will be explained to the respondents

Pre test will be conducted using structured knowledge questionnaire. Subsequently

information, education and communication will be given on the day.

On the seventh day post test will be conducted. Proposed data collection period will

be 30 days.

7.2.7METHOD OF DATA ANALYSIS AND INTERPRETATION

The researcher will use appropriate statistical technique for data analysis and present in

the form of tables and diagrams. Knowledge will be assessed by frequency and percentage

distribution. Level of knowledge will be assessed with mean and standard deviation.

Association between demographic variables and knowledge on postpartum hemorrhage will

be assessed with chi square test.

7.2.8DURATION OF STUDY

Duration of study of this study is 30 days.

7.2.9 PROJECTED OUTCOME

The information, education and communication will enhance post natal mothers

knowledge regarding post partum hemorrhage.

7.3 Does the study require any investigation to be conducted on the patient

or other human beings or animals?

NO.

7.4 ETHICAL CLEARANCE

The main study will be conducted after approval of the research committee.

Permission will be obtained from the concern head of the institution. The purpose and

after details of the study will be explained to the study subjects and as informed

concerned will be obtained from them. Assurance will be given to the study subject on

the confidentiality of the data selected from them.

Information consent will be taken from nurses who are willing to participate in the study

8. BIBLIOGRAPHY

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11. http://www.news-medical.net/news/2006/03/27/16912.aspx

12. http://www.jsi.com/NFHP/Docs/TechnicalBriefs/

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9 Signature of candidate

10 Remarks of the guide

11 Name and designation of (in block letters

11.1 Guide

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

12 12.1 Head of the Department

12.2 Signature

13 13.1 Remarks of the Chairman or

Principal

13.2 Signature