A pre experimental study to assess the effectiveness of planned

teaching programme on knowledge regarding minor disorders and

its management among antenatal mothers in selected hospital
mukerian, Punjab.

Objectives
a) To assess the pretest on knowledge regarding minor disorders and its
management among antenatal mothers in selected hospital Mukerian,
Punjab.
b) To assess the effectiveness of planned teaching programme on knowledge
regarding minor disorders and its management among antenatal mothers in
selected hospital Mukerian, Punjab.
c) To assess the posttest on knowledge regarding minor disorders and its
management among antenatal mothers in selected hospital Mukerian,
Punjab.
d) To find out the association between pretest and posttest knowledge
regarding minor disorders and its management among antenatal mothers
with selected demographic variables.
 CHAPTER-1 BACKGROUND OF THE STUDY

1.1 INTRODUCTION
Every Pregnancy is a unique experience for the women and each Pregnancy that the women
experience will be new and uniquely different. Pregnancy is a long and very special journey for
the woman. It is a journey of dramatic Physical, Psychological and social change of becoming a
mother for the new born child. The majority of discomforts experienced during Pregnancy can
be related to either hormonal changes or the Physical changes related to growing fetus.1

The anatomical, physiological and biochemical adaptations to pregnancy are profound. These
changes that the female body undergoes during pregnancy begin soon after fertilization and
continue throughout gestation. These changes occur in response to physiological stimuli
provided by the fetus and placenta. These changes may be unpleasant as well as worrying but
they are rarely a cause for alarm as most of these changes are usually normal. These so called
minor disorders or ailments of pregnancy can be troublesome on a day to day basis. Nevertheless
these minor ailments are considerably improved by offering a proper explanation and with
simple treatments 2

Minor disorders of pregnancy are a series of commonly experienced symptoms related to effect
of pregnancy hormones and the consequences of enlargement of the uterus as fetus grow during
pregnancy. Common disorders are backache constipation Frequency of micturition heartburn
nausea and vomiting varicose vein ankle oedema and haemorrhoids.3. During pregnancy, the
rapidly rising hormones such as estrogen, progesterone, and prolactin change maternal body into
a suitable enviorment for the fetus and may cause some symptoms in the mother called as minor
disorders these are effectively manage at home.4

Nausea and vomiting are common symptoms of pregnancy affecting approximately 70% of
women onset from 4-8 weeks. The cause of these symptoms is thought to be due to the presence
of hCG, which is present during the time that the nausea and vomiting is most prevalent,
although oestrogen and progesterone are also thought to have some influence ginger may be of
help in reducing the symptoms. 5

Backache or lumbosacral strain is a common complaints of pregnant women . The likely causes
are altered mechanics to counterbalance the forward growth of the uterus and the softening of the
ligaments and the muscles which support the weight carrying joints of the pelvic girdle.
Sepration of the symphysis pubis may occur and rarely intervertebral disc may herniate.
Management rest in acute phaseand Hot water bottle6
 Constipation is common during pregnancy. Almost three out of four pregnant women will
experience constipation and other bowel issues. An increase in the progesterone hormone during
pregnancy causes the relaxation of your body’s muscles. That includes your intestines. And
slower moving intestines means slower digestion. This can lead to constipation. Hormonal
changes, pressure on the womb, and the iron inA diet high in fiber helps prevention constipation.
It also supplies pregnant women with vitamins and antioxidants.7

Cramps are quite common , usually in the leg. They are worst at night The cause of leg cramps in
pregnancy is not known, but has been attributed to deficiency of vitamin B1 and decreased level
of calcium .It may be due to ischemia or changes in pH or electrolyte status .It may be helpful to
make gentle leg movements,sleep with the foot end of the bed elevated by 20 to25 cm and take
vitamin B complex. 8

Heartburn is a burning pain as a result of acid reflux in the lower oesophagus of a pregnant
women . The cardiac sphincter relaxes as a result of progestrone hormones and forces the
stomach contents to regurgitate. It usually affects 30-80%0f pregnant women in the third
trimester (Rayner and Micell2005) resulting in sleep disturbance and inadequate
eating.Treatment of heartburn includes elimination of greasy food items,citrous and fizzy drinks
from the diet. Lifestyle modifications such as raising the head of the bed about 6 inches,sleeping
on left side, and avoiding reclining for 2-3 hours after a meal.9.

Constipation prevalence rates were 24% (95% confidence interval [CI] 16-33%), 26% (95% CI
17-38%), 16% (95% CI 8-26%), and 24% (95% CI 13-36%) in the first, second, and third
trimesters and 3 months postpartum, respectively. Additionally, irritable bowel syndrome (by
Rome II criteria) prevalence rates were 19% (95% CI 12-28%), 13% (95% CI 623%), 13% (95%
CI 6-23%) and 5% (95% CI 1-13%) in the first, second, and third trimesters and 3 months
postpartum, respectively.17 (Bradley et.al, 2007)

Constipation, heartburn, and haemorrhoids are common gastrointestinal complaints during

pregnancy. Constipation occurs in 11-38% of pregnant women. Although the exact prevalence of
haemorrhoids during pregnancy is unknown, the condition is common, and the prevalence of
symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women. The
incidence of heartburn in pregnancy is reported to be 17-45%18. (Vazquez, 2008)

Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf
muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third
trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the
women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain
(37%).Musculoskeletal dysfunctions and general discomforts very commonly affect the activities
of daily living of pregnant women. Understanding the common discomforts during various
trimesters of pregnancy will help to develop a comprehensive program for prevention and
cure.19 (Ramachandra et. al, 2015
Haemorrhoids are swollen veins near the anus and are usually asymptomatic during pregnancy It
is secondary to reduce venous return due to weight of the gravid uterus compressing on the
pelvic veins . Treatment is not necessary in asymptomatic women .Dietary modifications and
prevention of constipation helps prevents symptoms. Symptoms include pain and intermittent
bleeding. Treatment is mainly conservative. This includes local anesthetics for pain management.
Local anaesthetics combined with corticosteroids can be used if there is no symptomatic relief .12

During pregnancy, a woman’s body changes in many waysThese changes can sometimes be
uncomfortable, but most of the time they are normal. They can occur at any time during the
pregnancy. Most of the minor disorders during pregnancy can be minimised with good education
and prompt treatment. You should also know about some remedies that are dangerous for
pregnant women and hurtthe baby 13

1.2 NEED FOR THE STUDY

Pregnancy is a creative and productive period in the life at a woman. It is one of the vital events,
which needs special care from conception to postnatal period. Every mother wants to enjoy the
nine months period with the baby inside her; the joyful experience of the pregnancy is not always
joyful. Sometimes it is associated with problems of varying severity. Minor disorders are one
among those problems, which causes discomfort to the mothers during pregnancy Although
such disorder are often termed as minor disorder they are far form, the minor for women who
experience it.14

An explorative descriptive study was conducted on maternal awareness of pregnancy normal and
abnormal signs in two maternity centres in Jordan. The study revealed that the commonest
complaints of the studied group during their pregnancy were nausea and vomiting, fatigue, back
pain, heartburn and vaginal discharge. Out of 340 women, the most common complaints during
the current pregnancy is leg cramps (75 women), followed by nausea and vomiting (56 women),
only 3 women complained breast problems during current pregnancy As regards management of
the current complaints relatively high percentages of mothers used home remedies to manage
low back pain, nausea and vomiting, breast problems, and constipation (73.7%, 73.2%, 66.7% &
65.4%) respectively. The use of home remedies for these signs was high. The study
recommended the need to include information about abnormal signs of pregnancy by health care
providers, particularly the maternity nurses and midwives as a routine care during antenatal
visits.15 (Amasha & Heeba, 2013)

There has been a plenty of studies regarding the epidemiology of pregnancy- related low back
pain. Rates range from 25% to 90%, with most studies estimating that 50% of pregnant women
will suffer from low back pain. One third of them will suffer from severe pain, which will reduce
their quality of life. The majority of women are affected in their first pregnancy. 80% of women
suffering from low back pain claim that it affects their daily routine and 10% of them report that
they are unable to work. Pregnancy related low back pain usually begins between the 20th and
the 28th week of gestation, however it may have an earlier onset. The duration varies. A study
about low back pain in Netherlands shows that 38% of women still have symptoms at 3 months
postpartum and 13.8% at 12 months. low back pain during pregnancy is considered to be the
most important risk factor for postpartum low back pain and the existing literature supports low
back pain as the leading reason for sick leave, as far as pregnant working women are
concerned.16 (Katonis et. al, 2011)

One hundred three women were enrolled with mean (+/-standard deviation) age of 28 (+/-5)
years; 54% were nulliparous and 92% white. Constipation prevalence rates were 24% (95%
confidence interval [CI] 16-33%), 26% (95% CI 17-38%), 16% (95% CI 8-26%), and 24% (95%
CI 13-36%) in the first, second, and third trimesters and 3 months postpartum, respectively.
Additionally, irritable bowel syndrome (by Rome II criteria) prevalence rates were 19% (95% CI
12-28%), 13% (95% CI 623%), 13% (95% CI 6-23%) and 5% (95% CI 1-13%) in the first,
second, and third trimesters and 3 months postpartum, respectively.17 (Bradley et.al, 2007)

Constipation, heartburn, and haemorrhoids are common gastrointestinal complaints during

pregnancy. Constipation occurs in 11-38% of pregnant women. Although the exact prevalence of
haemorrhoids during pregnancy is unknown, the condition is common, and the prevalence of
symptomatic haemorrhoids in pregnant women is higher than in non-pregnant women. The
incidence of heartburn in pregnancy is reported to be 17-45%18. (Vazquez, 2008)

Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf
muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third
trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the
women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain
(37%).Musculoskeletal dysfunctions and general discomforts very commonly affect the activities
of daily living of pregnant women. Understanding the common discomforts during various
trimesters of pregnancy will help to develop a comprehensive program for prevention and cure.19
(Ramachandra et. al, 2015)

Shaheen kausar (2006) conducted a study to determine the frequency of backache, its causes
and to assess the efficacy of various treatment modalities used for the management of backache
in pregnancy. The location of the study was outpatient department of obstetric services, Jinnah
Hospital, Lahore. Patients attended to the antenatal OPD during February 2004 were asked about
history of backache. A further information was obtained from patients who had history of
backache. A total 918 ladies with complete data were recruited. Four hundred and thirty-two
(47.05%) reported one or more significant episodes of back pain during their pregnancy. Of these
96 (22.22%) noted ongoing back pain at the time they became pregnant leaving a true incidence
rate of 36.60%20.

Servey J, Chang J.(2014) conducted study on the medication-taking behaviour of pregnant

women during the first two trimesters of pregnancy was assessed to ascertain whether they were
appropriately using over-the-counter (OTC) preparations during pregnancy. 578 (55.7%) women
completed and returned a questionnaire, of which 248 (42.9%) reported using one or more
medications to treat one of the six common ailments listed in the questionnaire. The majority of
medicines purchased were for heartburn and indigestion and which are considered safe to use
during pregnancy. However, there were seven (1.9 %) reports of women using oral
decongestants which are deemed inappropriate. This study suggests that most women are using
available information to make appropriate decisions about OTC medicine use during pregnancy.
However, warnings pertaining to the use of oral decongestants may need to be more prominent
or woman may need better education on how to interept them.21

Pregnancy is a biological function and an integral part of the social and environmental activity,
bringing joy to the mother and family. Most women are healthy during pregnancy and do not
have serious health concerns. Mother may have minor physical symptoms throughout their
pregnancy that are considered normal pregnancy changes. It is important for mother to be aware
about these minor disordersbecause most of the minor disorders during pregnancy can be
minimised with good education and awareness and that awareness prevent further complications

A descriptive co relational study conducted on nausea, vomitting and nutrition in pregnancy by

glenda L,Marlene B, Patti V, AprilG. The purpose of study was to conduct a descriptive analysis
of pregnant women to examine the relatioship of nutrient intake and related variables to nausea
and vomitting in pregnancy . Study shows that 50 to 80% of pregnant women be expected to
experience nausea and vomitting

While working in obstetrics and gynaecology area as a student, investigator felt that there is a
great need to check and provide knowledge regarding minor disorders and its management.
1.3 RESEARCH PROBLEM:
A pre experimental study to assess the effectiveness of planned teaching programme on
knowledge regarding minor disorders and its management among antenatal mothers in
selected hospital mukerian, Punjab

1.4 OBJECTIVES:

a) To assess the pretest on knowledge regarding minor disorders and its management among
antenatal mothers in selected hospital Mukerian, Punjab.

b) To assess the effectiveness of planned teaching programme on knowledge regarding

minor disorders and its management among antenatal mothers in selected hospital Mukerian,
Punjab.

c) To assess the posttest on knowledge regarding minor disorders and its management
among antenatal mothers in selected hospital Mukerian, Punjab.

d) To find out the association between pretest and posttest knowledge regarding minor
disorders and its management among antenatal mothers with selected demographic variables.

1.5Aim of study

To assess the effectiveness of planned teaching programme on knowledge regarding minor

disorders and its management among antenatal mothers in selected hospital mukerian, Punjab.
1.6OPERATIONAL DEFINITIONS:

EFFECTIVENESS: In this study, Effectiveness refers to the outcome of the planned teaching
programme on knowledge regarding minor disorders and its management during pregnancy
among antenatal mothers.

KNOWLEDGE: In this study, it refers to knowledge regarding minor disorders and its
management among antenatal mothers which is assessed by Structured knowledge questionnaire.

PLANNED TEACHING PROGRAMME:

MINOR DISORDERS: Minor disorders refers to the common problems that occurs During
pregnancy such as nausea, vomiting, fatigue, frequency of micturition, heartburn, constipation,
vaginal discharge, backache, hemorrhoids, leg cramps, edema, varicose veins which can affect
the daily activities of mother.

MANAGEMAENT: In this study, Management refers to the knowledge of home remedies on

minor ailments during pregnancy such as nausea, vomiting, fatique, frequencyof
micturition,heartburn,constipation,vaginaldischarge,backache,hemorrhoids,legcramps,edema,vari
cose veins which the mother can practice at home.

ANTENATAL MOTHERS:

1.7 HYPOTHESIS

H1 - There is a significant difference between the pretest and post test level of knowledge
regarding minor disorders and its management among antenatal mothers.

H2: There is a significant association between level of knowledge regarding minor disorders
and its management with selected demographic variables..

1.8 DELIMITATIONS:

Study is limited to:

study is limited to antenatal mothers.

Sixty antenal mothers only.

Antenatal mothers who are willing to participate.

 CHAPTER II

REVIEW OF LITERATURE

The review of literature is traditionally considered as a systematic critical review of the most
important published scholarly literature on a particular topic
REFERENCES

1 Fraser, D.M., Cooper M.A. (2009). Myles Textbook for Midwives. (15th
edition). Elsevier Fraser, D.M., Cooper M.A. Myles Textbook for
Midwives. (sixth edition). Page229
2 Padubidri,V.A.E.(2006)Text book of Obstetrics. New Delhi: B.I
publications Pvt.Ltd
3 J Medforth,sue,B.Oxford handbook of midwifery.2nd edition.Oxford
university publications.110-1116
4 Lata Gururani, Atul k, Journal Med Sci PublicHealth;684-687.
5 Fraser, D.M., Cooper M.A. Myles Textbook for Midwives. (sixth
edition). Page2296
 6 Sisir k C, M Narayanaswamy .Midwifery.New Delhi: : B.I publications
Pvt.Ltd page 47.
7 https://www.healthline.com/health/pregnancy/constipation-remedies#1
8 Annamma Jacob. Textbook of midwefery and gynecological nursing.
(3rd edition).page 103
9 GK sandhu.Obstetric and midwefery. lotous publisher. 90.
10 https://www.babycenter.com/0_varicose-veins-during-
pregnancy_271.bc
11 Dc dutta Textbook of obstetrics. 7th edition.central book
publishers(p)ltd,2004.100-101
12 Shirish s sheth . Essentials of obstetrics. JP brothersMedical Pub 9
(p)Ltd. 164.
13 http://www.open.edu/openlearncreate/mod/oucontent/view.php?id=42&
printable=1
14 SamahAbdElhaliem. IOSR Journal of Nursing a nd Health Science.
Volume 7, PP 07-15
iosrjournals.org/iosr-jnhs/papers/vol7-issue1/Version-1/B... · PDF file
15 Amasha, A. H., & Heeba, F. M. (2013). Maternal Awareness of
Pregnancy Normal and Abnormal Signs: An Exploratory Descriptive
Study. IOSR Journal of Nursing and Health Science. 2(5): 39-45
Retrieved from
http://iosrjournals.org/iosr-jnhs/papers/vol2-issue5/H0253945.pdf?id=8240
16 Katonis, P., et al. (2011). Pregnancy-related low back pain. Hippokratia
medical journal. 15 (3): 205-210 Retrieved From
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306025/pdf/hippokratia-15-205.pdf

17 Bradley, C.S., Kennedy, C.M., Turcea, A.M., Rao, S.S., Nygaard, I.E.
(2007) Constipation in pregnancy: prevalence, symptoms, and risk
factors. Hippokratia medical journal. 15(3): 205±210. Retrieved From
http://www.ncbi.nlm.nih.gov/pubmed/18055731/
18 Vazquez, J.C. (2008) Constipation, haemorrhoids, and heartburn in
pregnancy British Medical journal: Clinical Evidence. 110(6):1351-
1357. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907947/
19 Ramachandra, P., Maiya, G., Kumar, P., Kamath, A. (2015) Prevalence
of Musculoskeletal Dysfunctions among Indian Pregnant Women.
Journal of Pregnancy. 1 - 4. Retrieved From
http://www.hindawi.com/journals/jp/2015/437105/
20 Shaheen kausar, A. T., & Sheikh, S. (2006). Backache in pregnancy.
Biomedica, 22.
21 https://www.ncbi.nlm.nih.gov/pubmed/25369643
22

SPN COLLEGE OF NURSING, MUKERIAN

RESEARCH WORK
Subject: RESEARCH WORK

SUBMITTED TO:
:- MR. NEERAJ HANS

Asst. Professor

CHILD HEALTH NURSING

SUBMITTED BY:
MS Nancy jaswal

M.sc 1st year

SPN COLLEGE OF NURSING, MUKERIAN

RESEARCH WORK
Subject: RESEARCH WORK

SUBMITTED TO:

Mrs. Simranjeet Kaur

Asst. Professor

OBSTETRICS & GYNECOLOGICAl NURSING

SUBMITTED BY:

MS Nancy jaswal

M.sc 1st year

Reference