RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.
PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT
FOR DISSERTATION.
1.

NAME OF THE CANDIDATE

MS. SURIYA BAGUM

AECS MAARUTI COLLEGE OF NURSING,

2.

NAME OF THE INSTITUTION

AECS MAARUTI COLLEGE OF NURSING. NO. 99,

AND ADDRESS

NEAR AECS MAARUTI DENTAL COLLEGE OFF

BANNERGHATTA

ROAD,

KAMMANAHALLI,

3.

COURSE OF THE STUDY AND

BANGALORE-560 076.
1ST YEAR M. SC., (NURSING) OBSTETRIC AND

4.

SUBJECT
DATE OF ADMISSION TO

GYNECOLOGY NURSING.
30TH JUNE, 2008

5.

COURSE
TITLE OF THE TOPIC

A STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED

TEACHING

PROGRAM

ON

ASSESSMENT OF FETAL WELL BEING AMONG

ANTENATAL MOTHERS IN SELECTED HOSPITAL,
BANGALORE.

INTRODUCTION:

Becoming pregnant is the happiest moment in a womans in life. The birth of a baby
is a momentous occasion. Tiny detail of the experiences surrounding the whole event
is etched in the memory forever.

Looking forward to the arrival of the healthy baby is every prospective parents
dream. It can be true by giving education regarding well being of the fetus. If fetus is
healthy, newborn will be healthy and healthy newborn will progress to healthy child
which reflects the nations wealth. A well developed child contributes to the National
welfare and is precious resources of the Nation. 1

Fetus is developing human in uterus after the completion of 8 th gestational week. So

fetal period which begins at 8th week following ovulation or 10 weeks after the onset
of the last menstrual period and ends in delivery. At 8 th week embryo can be
recognized as human one and measures about 4 cm. When a woman is pregnant, she
worries about babys health thats perfectly normal and natural.2

Fetal well being describes the fetus whose growth is appropriate for length of
gestation and who has normal form and structure, metabolic functions and adequate
oxygenation and perfusion. Now a days, tests for fetal well being are available that
provide information and reassurance to mothers regarding well being of the fetus
Learning a little about each tests help the mother to feel more comfortable. So fetal
well being assessment means how is baby doing. Common Fetal well being tests are
fetal movement count, non stress test and biophysical profile.3

The concept of fetal well being aims at assuring satisfactory growth and well being of
the fetus throughout the pregnancy, screening out the high risk cases and adverse
maternal and intrauterine factors which may effect the healthy growth of the fetus,
detecting early in pregnancy those congenital abnormalities or inborn metabolic
disorders which are not compatible with life or may lead to chronic ill health of the
offspring.4

There may be some doubts in mothers mind regarding tests of fetal well being i.e.
What the tests measures.
Where the tests are given
Who is usually tested?
Where the tests are performed
How they are conducted.
Leaning a little about each test help the mother to feel more comfortable.

6. BRIEF RESUME OF INTENDED WORK

6.1 NEED FOR THE STUDY :

During the last couple of decades, the fetus in uterus has been considered as second
patient, the mother being the first. The fetus usually faces much greater risks of
serious mortality and morbidity .As such simultaneously with good maternal care
during pregnancy and labor, the fetal health in uterus should be supervised with equal
vigilance. The occasional mishap or even the birth of handicapped child is challenge
far medical professional, so there is need to assess fetal well being.5

A study conducted and results shown that the global burden of neonatal deaths is 5
million of which 3.2. Million deaths occur during first week of life. Almost quarter of
burden of neonatal mortality is shared by India with there babies dying every minute
and every fourth baby born being low birth weight. 6

Geographical variation occurs in neonatal mortality rate, more than half of the burden
of neonatal deaths is shared among three large States [UP 26 percent, MP 13.7
percent, Bihar 12 percent].

Sepsis, asphyxia and Prematurity are the primary

causes of neonatal deaths in India.

General practitioners and obstetricians are

performing more thorough checks to try to detect the fetuses that are likely to be at
increased risk. These investigations do not replace clinical examination but provide
the fine tuning of assessment. The mothers still needs someone who can talk to her
and discuss about fetal well being.8

A history of stillbirth also increase the risk of other adverse pregnancy outcomes in
the subsequent pregnancies such as placental abruption, cesarean delivery, preterm
delivery and low birth weight infants, mothers can usually feel there babies moving in
there wombs from 16 to 20 weeks. 9 A decrease in normal fetal movement may be a
sign that the baby is struggling for some reason. 1 Ante partum fetal surveillance and
fetal movement counting are mainstays of post still birth pregnancy management. So
our challenge really is to reach out to all mothers and provide them basic antenatal
care including education regarding Fetal well being also.10

A study conducted and presented the strategy to prevent stillbirths like Institute
ongoing risk assessment of each individual woman for unexplained risks including
obesity, maternal age below 35 years, decrease fetal movement, vigilance of fetal
growth including fetal growth chart, kick count.11

Congenital malformations remain the common cause of prenatal deaths and accounts
for 10 to 15percent in developing countries like India.12 A study show that nearly 26
million infants are born each year, of whom 1.2 million die completion of 4 weeks
and 1.7 million die before reaching first birthday due to lack of adequate antenatal
care.13

The review of literature and working area created an insight in the investigators mind
that the assessment of fetal well being is effective in identifying babies with time to
intervene. Hence the investigator design a study to asses the effectiveness of
structured teaching program on assessment of fetal well being among antenatal
mothers of selected hospital, Bangalore.

6.2.

Review of literature

A study was conducted called fetal movement counting for fetal well being. Four
studies involving 71370 women were involved. All trials show different type of
counting. Women in the formal fetal movement counting group had significantly
fewer visits to the hospital and antenatal than those women randomized to hormone
analysis (relative risk 0.26,95 percent confidence interval 0.20 to 0.35) as there were
fewer APGAR score less than seven in five minutes for women randomized to
hormone analysis is (relative risk 1.72, 95 percent confidence interval 1.01 to 2.93).
There was significantly higher compliance with Cardiff count to ten methods than
with the formal fetal movement counting method.14

A study conducted called fetal movement versus non stress test performed by the
attending staff and patients. A total of 283 NST were performed in 200 patients.
Fetal movement counting was recorded by the attending staff and by the patients on
41 and 170 occasions respectively, results showed that best correlation between fetal
movement counts by attending staff with NST was with criteria of 3 or more fetal
movements within 10 minutes. Best correlation between fetal movement counts by
patients with NST was found with 1 fetal movement within 2 hours. the results
suggests the usefulness of fetal movement count performed either by attending staff or
patients as a cheap and effective method of screening for good fetal well being in
places where NST is not readily available.15

A study conducted on 2974 women with high risk pregnancy on monitoring the
babys well being with biophysical profile and conventional monitoring (CTG) only

No significant differences were found between the groups in prenatal deaths (relative
risk 1.33, 95 percent confidence interval 0.60 to 2.98) or in APGAR score less than
seven at five minutes (relative risk 1.27, 95percent confidence interval 0.85 to 1.92).
Combined data from the high quality trials suggest an increased risk of caesarean
section in the Biophysical profile group[relative risk 1.60, 95percent confidence
interval 1.05 to 2.44, n = 280, interaction test P=0.03].16
A study conducted called Fetal Biophysical profile and non-steers test. A literatur
review 735 patients with high risk pregnancies referred for fetal biophysical profile
(375 patients) and a non-stress test (360 patients) Biophysical profile resulted in
higher positive predictive value in regards to APGAR scores and results did not
demonstrate significant differences when compared with non stress test.17

There is ongoing international research collaborate to improve pregnancy outcome

through better understanding of reduced fetal activity.

Acc. to FEMINA (Fetal

Movement Intervention Assessment) 50 percent of affected mothers waited more than

24 hours without any fetal activity before contacting health professionals, 1 in 3
waited more than 48 hours, unexplained stillbirth represents 25-60 percent of all fetal
death, and 52 percent of unexplained stillbirths have intra-uterine growth restriction.18

PROBLEM STATEMENT:

A study to assess the effectiveness of structured teaching program on assessment of

fetal well being among antenatal mothers in selected hospital, Bangalore.

6.3.

OBJECTIVES:

1. To assess the knowledge of antenatal mothers regarding assessment of fetal

well being.
2. To develop and implement structured teaching program on assessment of fetal
well being.
3. To assess the knowledge of antenatal mothers after structured teaching
program on assessment of the fetal well being.
4. To asses the effectiveness of structured teaching program among antenatal
mothers on assessment of fetal well being.
5. To find out association between knowledge of antenatal mothers and selected
demographic variables

6.4.

OPERATIONAL DEFINITIONS:

Asses: Refers to evaluating the knowledge of antenatal mothers on assessment of

fetal well being.
Knowledge: Refers to correct responses of antenatal mothers on assessment of fetal
well being.
Effectiveness: Refers to gain in knowledge after implementing structured teaching
program on assessment of fetal well being as determined by significant difference in
past knowledge.

Structured Teaching Program: refers to planned instructions to impart knowledge

using relevant teaching methods on assessment of fetal well being.
Fetal Well Being : Refers to process of assessment of normal growth, development,
normal activity, viability and maturation of fetus in uterus by using relevant fetal well
being tests i.e. baby kick count, non stress test and biophysical profile which include
fetal breathing movements, fetal movements, fetal tone, fetal reactivity, qualitative
amniotic fluid volume.
Antenatal Mother: Refers to mothers who are pregnant and in between 12 weeks to
40 weeks of pregnancy and attending selected antenatal out patient departments.

6.5.

HYPOTHESIS:

H1 - There is significant improvement in knowledge of antenatal mothers on

assessment of fetal well being after structured teaching program than before
structured teaching program.
H2- There is association between selected demographic variables and knowledge of
antenatal mothers on assessment of fetal well being.

6.6 VARIABLES OF THE STUDY

Independent Variables:
Structured teaching program on assessment of fetal well being.
Dependent Variables:
Knowledge of antenatal mothers on assessment of fetal well being.
Demographic Variables:
Age, educational status, occupation, income, type of family, Parity, mass media.

7.1.

MATERIAL AND METHODS:

Sources of Data: Antenatal mothers in between 12 weeks to 40 weeks of pregnancy

attending antenatal outpatient departments of selected hospital, Bangalore.
Research Approach: Experimental approach.
Research Design: Quasi experimental pretest, post test one group design
Research setting: Antenatal out patient department setting.
Population:

Antenatal mothers who are in between 12 weeks to 40 weeks of

pregnancy, attending antenatal out patient departments.

Sampling Technique: Simple Random Technique
Sample Size: 50 samples

INCLUSION CRITERIA:
1.

Antenatal mothers who are attending antenatal outpatient department in selected

hospital, Bangalore.

2.

Antenatal mothers who are willing to participate in study.

3.

Antenatal mothers who will present during data collection.

DELIMITATION:
This study is limited to antenatal mothers who are in between 12 weeks to 40 weeks
of pregnancy.
TOOLS OF DATA COLLECTION:
PART-A: Socio demographic profile.
PART-B: Structured interview schedule on assessment of fetal well being.

7.2.

METHOD OF DATA COLLECTION:

10

A structured interview schedule will be used to collect the data .A prior formal
permission will be obtained from the college or institute authority for conducting the
study. An informed consent will be obtained from the subject. The process of study
will be explained to the subjects.

METHOD OF DATA ANALYSIS:

1. The investigator will organize the data in a master sheet
2. Frequencies and percentages for the analysis of data will be calculated.
3. Descriptive statistics: mean, median, mode, standard deviation.
4. Inferential Statistics: Paired `t` test to draw the significant differences between
pretest and post test knowledge score and `chi` test to determine the
association between demographic variables and knowledge level.

7.3

Does the study require any investigation of intervention to be

conducted on patients or human or animals? If so please describe
briefly.
No, it is an educational intervention and carries minimal risk.

7.4 Has ethical clearance been obtained from institution in case 7.3?
Yes, informed consent will be obtained from the institution, authorities and subjects.
Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the
study will be maintained with honesty and impartiality.
8.

REFERENCES:

11

1. Bang AT, Bang RA, Battue SB. Neonatal care .Government medical college,
Nagpur 2004.P.119-20.
2. Dutta D.C. Text book of obstetric. and Gynecology. 5th ed. Calcutta 2001.P.10304.
3. Pearson J.F, Weave J.B. Fetal activity and fetal well being. Br. Med (1976).P. 2930
4. Sandusky E, Yaffe H. Daily fetal movement recording and fetal progress.
Obstetric and Gynecology (1973).P.187-93.
5. Registrar General of India, Sample Registration System, Statistical Report, 2000.
6. Nair MKC .Neonatal survival. Indian Pediatric 2004 .P.1201-02
7. Brenner. B, Mandel H, Lazier N, Younis. J, Rathbart. H, Ohel G. Activated protein
C resistance can be associated with recurrent fetal loss. Br. J. Hematological
1997.P.55.
8. Crewel WH and Manchester. A preventable cause of fetal death. A.M.J. Obstetric,
Gynecology. 346-47.
9. Bang AT, Bang RA, Battue SB. Neonatal care .Government medical college
Nagpur 2004.P.119-20.
10. Russell. P, Atkinson K and Krishna L .Recurrent reproductive failure due to severe
placental vilitis of unknown etiology. J. Reprod. Med. P. 93-8.
11. Chen CP, Yang YC, Su TH, Chen Cy, Ape. Fetal deaths. Hematological 2002.P.
1118-19.
12. Fox H. Pathology of the Placenta. 4th ed. London: Saunders.P.113-14
13. Grant A, Valentine C, et. Al. Routine formal fetal movement counting and risk of
anti partum late death in normally formed singleton pregnancy. Lancet 1989.P.
345.

12

14. Neldam. S. Fetal movements as an indicator of fetal well being .Dan med Bull
1983.P.274.
15. Fro en JF. A kick count fetal movement counting and the cancelled progress in
antenatal care.P.13-24
16. J. Periapt, H Finberg, A.B.Johnson. The biophysical profile literature review and
reassessment of its usefulness in the evaluation of fetal well being.

The

biophysical profile literature review and reassessment of its usefulness in the

evaluation of fetal well being. Obstetric. and gynecology 1986.P.343-44.
17. Lalar JG, Fawole B, Alfirevic Z, Devane D.Biophysical profile for fetal
assessment in high risk pregnancies. Reviews 2007, issue 4.
18. FEMINA study [ Femina Movement Intervention Assessment]
Available from URL: www.pubmed.net and www.medline.net

SIGNATURE OF THE
CANDIDATE

13

10

REMARK OF THE GUIDE

This is quasi experimental study

which is appropriate in assessing
the

effectiveness

of

structured

teaching program on assessment of

fetal well being among antenatal
mothers.
11

NAME AND DESIGNATION OF

A. GUIDE
B. SIGNATURE

MRS. P. GIRIJAMBA DEVI.

HEAD OF THE
DEPARTMENT
OBSTETRIC AND
GYNAECOLOGY
AECS MAARUTI
COLLEGE OF NURSING,
BANGLORE.

C. CO-GUIDE
D. SIGNATURE
E. HEAD OF DEPARTMENT

MRS. P. GIRIJAMBA DEVI.

F. SIGNATURE
12

A. REMARKS OF PRINCIPAL

SIGNATURE

14

15