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2011-2013
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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE – II
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6 BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
Carroli, Belizen and Stamp, (1999) stated the rationale for episiotomy that, it
depends largely on the need to minimize the risk of severe spontaneous, maternal
trauma and to speed up delivery, and to minimize fetal distress.
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Tryrac, Panel el al., (2007) stated that, the routine use of episiotomy
decreases the risk of moderate anterior perineal laceration, and reduces the chance
of perineal tears. The incidence of episiotomy is increased in the following
circumstances like primiparity, Asian women, forceps and vacuum deliveries
(Murphy, Maureen (2007). The outcome of episiotomy is found that delayed wound
healing due to wound separation or clinical infection (Mary McGuiness and
Kathleen 2005)
Sitz bath is the form of water bath, which is coming back into popularity as
a low risk. Sitz bath-term comes from the German verbs “sitzen” meaning to sit.
The sitz bath is a European tradition in which only the pelvis and abdominal area
are placed in the water .It helps for women after child birth whether or not had an
episiotomy.
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6.1
A wound affects the first line, of our body’s defense system, the skin. When such
takes place, a plethora of symptoms may appear like, bleeding, swelling, redness, pain and
tenderness, fever with infection, heat, stiffness, discoloration, scabbing, itching and scar
formation. Wounds on skin and other soft tissues, trigger a self-healing process of our
body which is summarizes to the scientific term “inflammation”. This process increases
collagen production below the skin (dermis). Then, follows the regeneration of the outer
skin layer.5
“harm of vaginal birth” as more women in developing countries deliver their babies
routine episiotomy has no demonstrable benefit for the infant or mother, but causes
The world health organization has taken a clear stand against routine
practicing clean delivery and effective postnatal care. Midwives have an important
role in the care of episiotomy wound after child births (WHO statistics, 2007).
physical well being.Aua, Saxton, and Sue Markwell, (1998) experimentally proved
that sitz bath plays an important role in providing the thermal and mechanical
effects and administering the curative treatment. The powerful thermal impressions
transmitted inward and by the profound vascular impression made through the
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dilatation of the surface vessels, heat production, the oxidation of nitrogen, and
metabolisms are quickened under the influence of the elevated temperature of the
water. The effect is to enhance the pelvic circulation, reduce swelling tissues,
reduce itch, soothe sore vaginal tissues and helps in episiotomy healing. Medicated
herbs and antiseptic solutions can also added in the sitz bath to reduce the growth
Sitz bath is a simple and cost effective and easy method of treating
episiotomy wound in the hospital as well as in home settings. As its takes less time,
sitz bath is not a routine practice in our O G ward settings in spite of it being cost
effective and less time consuming. During this procedure care giver can talk and
communicate with the mothers which may reduce the fear and may relieve the pain
and increases comfort, during the postnatal days. The postnatal mother can do this
independently in the home settings when they get discharged from the hospitals
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6.2 REVIEW OF LITERATURE
INTRODUCTION
identify what is known and what is unknown about the topic. The major goals of
review of literature are to develop a strong knowledge base to carry out research
episiotomy
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A study was conducted on “Does episiotomy prevent perineal
trauma’ the objective of the study to assess the efficacy of episiotomy to prevent
perineal tear, urinary incontinence, faecal incontinence and genital prolapse. Result
shows that the routine use of episiotomy did not prevent severe perineal tears. It
decreased the risk of moderate anterior perineal lacerations. The risk of severe
perineal tears during episiotomy increased in the following circumstances prim
parity, Asian women, instrumental deliveries (Tayac et al., 2007).
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minutes and this procedure should repeated three to five times a day.
Aua, Saxton and Sue Markwell (1998) stated that sitz bath is a
medicine free solution providing relief to the discomfort of hemorrhoids, fistulas,
anal fissures, episiotomies and other infections. A sitz bath (also called a hip bath)
is hydrotherapy that increases the blood flow to the pelvic and abdominal
areas. Sitz baths have become extremely popular in hospitals and are especially
given to women after childbirth.
Romberger, (2005) Reported that portable bath or sitz bath are often
prescribed by doctors as this type of therapy gives much relief from the discomfort
and promotes a more rapid healing of the vaginal and rectal areas following
incisions at the time of childbirth or rectal surgery.
The study was reported that effects of heat and cold on the perineum
after episiotomy / laceration (Hill 2004). Tool was used to evaluate the effects of
heat and cold on the perineum during the first 24 hours after delivery. Ninety
patients were randomly assigned to one of three treatment groups. Treatment
consisted of 30 subjects applying a warm perineal pack, 30 applying a cold
perineal pack and 30 taking a warm sitz bath. Analysis of variance indicated no
differences in the REEDA scale of these treatments.
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6.3 STATEMENT OF PROBLEM:
A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF
MEDICATED AND NON MEDICATED SITZ BATH IN EPISIOTOMY
HEALING ON POSTNATAL MOTHERS ADMITTED IN SELECTED
GOVERNMENT HOSPITAL. BANGALORE
1. To assess the episiotomy status before and after the sitz bath
episiotomy healing.
6.5 HYPOTHESIS
H02 : There will be significant association between the episiotomy wound healing
and selected demographic variable such as age, education, occupation, family
income per month and parity.
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6.6.2 NON MEDICATED SITZ BATH:
Non Medicated Sitz bath refers to sitting in plain warm water only deep
enough to cover hip and buttocks.
6.6.3 MEDICATED SITZ BATH:
Medicated Sitz bath refers to sitting in Betadine 10% added plain warm
water only deep enough to cover hip and buttocks.
6.6.4 EPISIOTOMY
A Surgically planned incision on the perineum and the posterior vaginal wall
during the second stage of labour..
6.7 ASSUMPTIONS
Medicated sitz bath is more effective in episiotomy wound healing.
6.8 DELIMITATIONS:
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MATERIALS AND METHODS
7.1
SOURCE OF DATA
RESEARCH DESIGN
7.1.2
RESEARCH APPROACH
SETTING:
POPULATION
The populations in this study will comprise all post natal mothers with
SAMPLING PROCEDURE
SAMPLE SIZE
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7.2.2 INCLUSION CRITERIA
The criteria for sample selection are,
disorders etc.
SELECTION OF TOOL
Tool consists of two parts. First part consist of assessment, second part
consist of protocol for medicated and non medicated sitz bath.
Section B: Episiotomy wound will be assessed through REEDA scale. The REEDA
scale consist of 5 main area of assessment such as redness, edema of the perineal
area, ecchymosis of the perineal area, discharge from wound and approximation of
the edges.
Part II: Protocol will be prepared for administration of medicated and non
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7.3.1 medicated sitz bath.
SCORING PROCEDURE
The REEDA scale consist 5 major assessments area. Each assessment area will be
given a minimum score of 0 and maximum score of 3. The total REEDA score
ranged from 0 to 15. As the score increases, it will indicate higher rate of infection.
If the score decreases, it shows the evidence of healing process.
7.4
conducting the study. Thorough interview will be conducted about the demographic data
and medical record will be refer for the information regarding type of delivery and birth of
7.5
PILOT STUDY
10 samples will be selected and a study will be conducted to find out the feasibility.
7.6
descriptive statistics. To meet the objectives and to compare the data between two
groups the investigator will be used descriptive and inferential statistics such as
7.7
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DOES THE STUDY REQUIRE ANY INVESTIGATION OR
HUMANS OR ANIMALS?
Yes, the medicated and non medicated sitz bath will be provided for the
INSTITUTION?
Consent will be taken from the selected hospital authority and permission
will be taken from the study subjects before the collection of data.
8.
LIST OF REFERENCES
4. Anupama Dutta.Evaluate the effectiveness of moist and dry heat application on healing
health care, The Journal of brigger institute publication, volume 10, issue (2) 45-78
6. Gentz, Brend, A (2001) Alternative thearapy for the management for Pain in labour
and delivery, Jouranal of clinical obstetrics and gynecology, Volume 44 (4) 704 – 732.
87, 408-412.
9. Gentz, Brend, A (2001) Alternative thearapy for the management for Pain in labour
and delivery, Journal of clinical obstetrics and gynecology, Volume 44 (4) 704 – 732
10. Low Angeles (2005) Sitz Bath is form of water therapy, medical journal of malsia.
11. D.C.Dutta.Text book of obstetrics”, 6th edition, published by new central book of
agency, 2004,p.
14. Buchman, D.D Jonson,Kate.K. (2004), Complete Book of Water healing, I edition,
15. Adrle Pilitter (2007). Materanal and Childbirth Nursing, care of the child bearing and
17. F. Ganez.S.R. Griffiths R. (2007) Water Bath for Health AND Beauty, 2 edition,
element Publications.
21. www.medline.com
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10. REMARKS OF THE GUIDE
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.6 SIGNATURE
12.2 SIGNATURE
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