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Ms. RAMYA T S
1STYEAR MSc NURSING
OBSTETRICAL AND
GYNAECOLOGICAL NURSING
2012-2014
SHREE SIDDAGANGA INSTITUTE
OF NURSING SCIENCES AND
RESEARCH CENTRE, B.H.ROAD,
TUMKUR-572102
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
1
NAME OF THE
CANDIDATE AND
ADDRESS
Ms. RAMYA T S
I YEAR M.SC.NURSING
SHREE SIDDAGANGA INSTITUTE OF
NURSING SCIENCES AND RESEARCH
CENTRE, B.H.ROAD, TUMKUR-572 102
2
NAME OF THE
INSTITUTION
SHREE SIDDAGANGA INSTITUTE OF
NURSING SCIENCES AND RESEARCH
CENTRE, B.H.ROAD, TUMKUR.-572 102.
3
COURSE OF STUDY
AND SUBJECT
MASTER OF SCIENCE IN NURSING
OBSTETRICAL AND GYNAECOLOGICAL
NURSING
DATE OF ADMISSION
10-07-2012
STATEMENT OF THE
PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS
OF STRUCTURED TEACHING PROGRAMME
ON KNOWLEDGE REGARDING RADICAL
VAGINAL TRACHELECTOMY AS A
FERTILITY PRESERVATION IN CERVICAL
CANCER AMONG FINAL YEAR BSC NURSING
STUDENTS IN SELECTED NURSING
COLLEGES IN TUMKUR.
4
5
1
6.0 BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
"Motherhood is priced Of God, at price no man may dare To lessen or
Misunderstand."
--Helen Hunt Jackson
Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity, reproductive health addresses the
reproductive processes, functions and system at all stages of life.1
Reproductive health is defined as a state of physical, mental, and social wellbeing and not merely the absence of disease or infirmity in all matters relating to the
reproductive system and its function and process. It implies that people are able to
have a satisfying and safe sex life, are informed about to have access to safe,
effective, affordable and acceptable methods of family planning as well as other
methods of their choice for regulation of fertility which are not against the law, are
able to have access to appropriate health care services that will enable women to go
safely through pregnancy and child birth and provide couples with the best chance of
having healthy babies. 2
Cancer is an oncogenes regulate cell growth in a positive fashion. Oncogenes
include transforming genes of viruses and normal cellular genes that are activate by
mutation to promote cell growth to a partly malignant behavior. It needs one
mutational event for its gain of function.3
2
The last fifty years have seen an exploration in our understanding of this most
fundamental of diseases and new discoveries are occurring on an almost weekly basis.
A trend analysis of the data on cancer incidence for the period 1975-2008 has
demonstrated that the overall occurrence of cancer is increasing among females. The
most common cancers among females is cervical cancer and breast cancer.4
Cervical cancer is defined as an abnormal cell proliferation in the cervix or
abnormal cell growth in the cervix.3
Cervical cancer in women is the second most common cancer worldwide, next
only to breast cancer. In India, cervical cancer is the most common women related
cancer, followed by breast cancer. Every year about 500,000 new cases of cervical
cancer are diagnosed worldwide and are responsible for about 280000 deaths, and
80% of total deaths occur in developing countries.5
Cancer prevalence in India is estimated to be around 2.5 million with 8,00,000
new cases and 5,50,500 deaths occurring each year due to this disease. Moreover, the
prevalence rate of cervical cancer in India is 40% against global rate of about 20%.
According to the Tribune survey of India, cervical cancer is most common in South
India and highest in Chennai.6
The cervical cancer treatment including surgery, radiation therapy, and
chemotherapy can cause infertility in patients. Infertility is the diminished ability or
the inability to conceive and have offspring. The experience of infertility can be
extremely stressful and associated with a range of psychiatric problems in infertile
women. Generally, some of the risk factors which may lead to psychiatric problems
3
are repeated unsuccessful treatment of infertility, low socio-economic status, lack of
partner support, life events etc.7
Recent advances in the management of gynecological cancer have resulted in
women experiencing improved prognosis and survival rates. However, premenopausal
women who have not completed childbearing phase the prospect of impaired or loss
of fertility. The fertility is improved through surgical technique and advances in
assisted reproductive technology have made it possible for some women to achieve a
successful pregnancy, to ensure fertility concerns in women with gynecological
cancer are addressed, oncology nurse require an understanding of the impact of
treatment of fertility and an awareness of available fertility preservation method.8
Radical vaginal trachelectomy is the removal of the uterine cervix and
adjacent tissues was originally introduced in 1987 by Dr.Daniel Dargent. He
performed
a laproscopic pelvic lymphadenectomy and
a radical
vaginal
trachelectomy. In a short period of time, several centers presented studies regarding
slightly modified radical vaginal trachelectomy. The choice for abdominal or vaginal
route as well as laparotomy or laparoscopic approach depends mainly on the
surgeon’s preferences and level of expertise. Robert –assisted laproscopy is also
rapidly increasing as a possibility in fertility-sparing surgery for early cervical cancer.
The oncological safety of these procedures in the treatment of early invasive cervical
cancer is well established in many retrospective studies and is associated with an
acceptable live birth rate.9
4
6.2 NEED FOR THE STUDY
Cervical cancer is the leading cancer among women in terms of incidence
rates in 02 out of the 12 population based cancer registries (PBCRs) in India, and has
the second highest incidence rate after breast cancer in the rest of the PBCRs. The
incidence of cervical cancer is highest in Chennai, a metropolitan city in the south and
lowest in Thiruvanathapuram, the capital of Kerala (National cancer registry
programme and world health organization). There is a high incidence belt in the north
eastern districts of Tamil nadu, as well as in two districts in the North-eastern region
of the country.10
Cervical cancer ranks as the 2nd most frequent cancer among women between
15 and 44 years of age in Kenya. Women in England and Northern Ireland and
currently offered cervical cancer screening at 03 to 05 year intervals between ages 25
and 64. In Wales, screening for women is offered between the ages of 20 and 64 every
three years. In Scotland, women are offered screening every three years between the
ages of 20 and 60.11
India has a population of 366.58 million women ages 15 years and older who
are at risk of developing cervical cancer. The current estimation indicates that every
year 134420 women are diagnosed with cervical cancer and 72825 die from the
disease. Cervical cancer ranks as the 1st most frequent cancer among women in India
and the 1st most frequent cancer among women between 15 and 44 years of age.
About 7.9% of women in the general population are estimated to harbor cervical HPV
infection at a given time and 82.5% of invasive cervical cancer is attributed to HPVs
16 or 18.12
5
A survey conducted in Bangalore city supported this observation. In 1982,
32.4% cervical cancer cases per 100,000 populations were reported every year in
Bangalore, which decreased to 27.2, 18.2, and 17.0% in 1991, 2001, and 2005 years,
respectively.13
Nowadays the treatment of gynecological cancer is possible through surgery,
radio therapy and chemotherapy which lead to high remission and long term survival
rates. In these curved patients, quality of life is increasingly important mean while the
ability to produce and raise normal children is considerable (partoidge 2004 ) now a
day’s delaying childbearing for social and financial reasons leads to more women
suffering from fertility threats due to early stage cancer being discovered (Maltaris
2006). The patient may suffer from premature menopause and infertility which may
impact her quality of life and self-esteem significantly.14
Cervical cancer treatment removes the uterus, fallopian tubes or ovaries,
radiation therapy; some chemotherapy medicines can also cause infertility. In India
cervical cancer is the second most cancer in women and accounts for about 25% to
33% of all cancer. Women with stage 1 cervical cancer who desire future fertility,
hysterectomy had a impact on fertility. In India, incidence of female infertility at least
two million of annual cases. 15
Over the past decade, the treatment of cervical cancer has evolved with an
increased emphasis on preservation of fertility. There has been a gradual
abandonment of radical surgical procedures in favor of more conservative techniques
in an effort to decrease morbidity and preserve fertility without compromising overall
survival.
Radical
vaginal
trachelectomy
(RVT)
with
laparoscopic
pelvic
lymphadenectomy is a fertility-preserving procedure that has recently gained
6
worldwide acceptance as a method of surgically treating small invasive cancers of the
cervix. Since the original description of RVT by Daniel Dargent in 1994, over 500
cases of utilization of this technique have been reported in the literature, with over
100 live births reported following this procedure. The morbidity associated with RVT
is low, with a tumor recurrence rate of 5% and a mortality rate of 3%. The current
literature indicates no difference in the rate of recurrence with this technique
compared with radical hysterectomy when proper selection criteria are used.
Combining RVT with laparoscopic sentinel lymph-node biopsy can further reduce the
duration, extent, and complications of surgery.16
Over a last 15 years, Radical vaginal tarchelectomy has been recognized as a
valuable fertility-preservation option for young women with early stage disease.
Sonoda and others recently published an interesting 16 year study examining all
women undergoing a Radical vaginal tarchelectomy. These results indicated that a
substantial proportion of patients with early stage disease may quality for this fertility
preserving procedure.17
In the light of above incidence and prevalence, the researcher found that it is
desirable to have at least knowledge regarding radical vaginal trachelectomy. The
investigator through her community field experiences have observed so many women
having a complain of infertility. By seeing all the above things investigator felt that
there is need for assessing the knowledge for students regarding radical vaginal
trachelectomy as a fertility preservation technique.
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6.3 REVIEW OF LITERATURE
An observational study was conducted on Radical abdominal trachelectomy
is a safe and fertility preserving option for women with early stage cervical cancer in
Department of Gynaecological oncology, Turkey. The data obtained from medical
and pathological records of the 08 patients who undergone Radical abdominal
trachelectomy. The study results shown that among 08 patients, 03 patients had late
post-operative complications, 03 patients became pregnant which resulted in 03 live
births and the spontaneous pregnancy rate was 50%. The study concluded that Radical
abdominal trachelectomy is a reliable surgical option for a patient with early stage
cervical cancer who wants to preserve fertility.18
A descriptive study was conducted to analyze the reproductive outcomes of
patients undergoing fertility-preserving radical trachelectomy (RT) for the treatment
of early-stage cervical cancer. This study analyzed data of 105 patients who
undergone
fertility-sparing
surgery
with
radical
trachelectomy,
pelvic
lymphadenectomy. The study results shown out of the 105 patients who undergone
RT, out of 105 patients 66 patients (63%) were nulliparous, 35 women were actively
attempting conception 06 months after surgery, and 23 (66%) women were successful
in conceiving: there were 20 live births, 03 elective terminations, and 4 spontaneous
miscarriages. Four patients had 02 pregnancies each, and delivered their second
pregnancy between 32 and 36 weeks. The study concluded that majority of women
who attempted to conceive after radical trachelectomy were successful, and most of
their pregnancies resulted in full-term births. Assisted reproduction played an
important role in select women.19
8
An observational study was conducted regarding radical trachelectomy and
fertility outcomes in patients with early-stage cervical cancer. The study analyzed the
published literature in search of all articles addressing obstetrical results in patient
undergoing radical trachelectomy for cervical cancer. The study result shows that, a
total of 520 patients had been reported to have undergone a radical vaginal
trachelectomy. Approximately 43% of patients who undergo a radical trachelectomy
subsequently attempt to become pregnant, and 70% of these women are successful at
achieving a pregnancy. The study concluded that Radical trachelectomy is safe and
feasible and pregnancy outcomes are very favorable.20
A retrospective study was conducted on pregnancies after redical vaginal
trachelectomy for early-stage cervical cancer in Quebec City Canada. The study
retrospectively reviewed
first
30
patients
treated
by laparoscopic
pelvic
lymphadenectomy, followed by radical vaginal trachelectomy. The median age of the
patients was 32 years (range 22-42 years) in that 15 were nulligravid, and 19 were
nulliparous. The study result shows that only 06 patients attempted pregnancy so far
has they succeeded, 04 have had healthy babies delivered by cesarean section at 39,
38, 34, and 25 weeks of gestation, 02 are currently 33 and 08 weeks pregnant. The
study concluded that radical vaginal trachelectomy appears to be a valuable procedure
in well selected patients with early stage cervical cancer.21
An observational study was conducted to analyze the fertility rates,
complication and recurrences in a group of women who have undergone radical
vaginal trachelectomy and pelvic lymphadenectomy for early stage cervical cancer.
The sample was 123 consecutive women who undergone radical vaginal
trachelectomy pelvic lymphadenectomy for early stage cervical cancer. Data were
9
collected prospectively. A total of 123 women were followed up for an average of 45
months. The study findings shown that out of 123, 66 women attempted pregnancy,
there were 55 pregnancies, out of 55 pregnancies 26 were preterm and 28 were
fullterm pregnancy. The 05 year cumulative pregnancy rate among women trying to
conceive was 52.8%. The study concluded that for selected women with early-stage
cervical cancer, radical vaginal trachelectomy and pelvic lymphadenectomy are
fertility-sparing options.22
A retrospective study was conducted regarding treatment in patients with earlystage cervical cancer, radical vaginal trachelectomy (RVT) as a fertility-preserving
surgery can be put on a par with radical hysterectomy as to oncologic safety.
Prospective collection of fertility data of patients treated with RVT. Descriptive
statistical analysis was performed, 212 patients were followed up after RVT. The
study results shown that only 76 patients (35.9%) were seeking parenthood currently.
60 pregnancies occurred in 50 women. Five patients (8.3%) had first-trimester
miscarriage, 3 had second-trimester miscarriage (5.0%), 2 patients decided for
pregnancy termination (3.3%), and 1 patient (1.7%) had an ectopic pregnancy. Three
women (5.0%) delivered prematurely before 28th weeks of gestation, 15 (25.0%)
delivered between 28 and 36 weeks, and 27 women (45.0%) reached full term, four
women had pregnancy. The study concluded that Preservation of childbearing
function is a great advantage for patients with early-stage cervical cancer. Many
patients do not seek parenthood immediately.23
A case study was conducted on Radical abdominal trachelectomy is a safe
and fertility preserving option for women with early stage cervical cancer. The study
obtained data of 08 patients who undergone RAT, from medical and pathological
10
records. The study results shows that the 03 (37.5%) patients had a tumor size
smaller than 02 cm, and 05 (62.5%) patients had a tumor size larger than 02 cm, 07
(87.5%) patients had stage IB1 and 01 (12.5%) patient had stage IIA tumor. There
were no recurrences. 03 patients became pregnant which resulted in 02 live births and
01 aborts. The spontaneous pregnancy rate was 50%. The study concluded that RAT
is a reliable surgical option for a patient with early stage cervical cancer who wants to
preserve fertility.24
A cohort study was conducted to prove the surgical and oncological safety of
radical vaginal trachelectomy (RVT) and laparoscopic lymphadenectomy for patients
with early-stage cervical cancer who are seeking parenthood. A database of 225
patients with early-stage cervical cancer and intention to treat by RVT after
laparoscopic lymphadenectomy was prospectively maintained. A total of 212 patients
were treated according to the protocol. The study results shows that in the cohort of
patients treated according to protocol, 8 recurrences occurred and 4 patients died from
recurrence, no severe long-term complications occurred. The study concluded that
Radical vaginal trachelectomy combined with laparoscopic lymphadenectomy is a
safe method for treatment of patients with early-stage cervical cancer who are seeking
parenthood.25
An observational study was conducted to determine whether medical
trechelectomy, combined with pelvic lymphadenectomy, can be a feasible method for
the treatment of early-state cervical carcinoma in women who want to preserve their
fertility. The sample was 12 women with stage 1 carcinoma of the cervix were
undergone radical trachelectomy and pelvic lymphadenectomy of the intact uterus as
treatment. The study result shows that four pregnancies have occured, with 2 third-
11
trimester deliveries and 2 preterm deliveries, respectively. The study concluded that
radical trachelectomy, combined with pelvic lymphadenectomy, can be a feasible
method of treatment for early-stage cervical carcinoma in women who want to
preserve their fertility.26
6.4 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme on
knowledge regarding radical vaginal trachelectomy as a fertility preservation in
cervical cancer among final year Bsc nursing students in selected nursing colleges in
Tumkur.”
6.5 OBJECTIVES OF THE STUDY

To assess the knowledge regarding radical vaginal trachelectomy as a
fertility preservation in cervical cancer among final year Bsc nursing
students.

To assess the effectiveness of structured teaching programme on
knowledge regarding radical
vaginal
trachelectomy as
fertility
preservation in cervical cancer among final year Bsc nursing students.

To find out the association between pre-test level of knowledge with
selected socio-demographic variables.
6.6 OPERATIONAL DEFINITIONS

Effectiveness: In this study it refers to the extent to which the structured
teaching
programme
on
knowledge
regarding
radical
vaginal
trachelectomy as a fertility preservation in cervical cancer achieved its
objectives in improving knowledge in final year Bsc nursing students.

Structured teaching programme: In this study it refers to the
information provided through systematically organized teaching regarding
radical vaginal trachelectomy as a fertility preservation in cervical cancer
12
for duration of 45 minutes with the help of audio visual aids such as charts
and overhead projector.

Knowledge: In this study it refers to correct response given by final year
nursing students regarding radical vaginal trachelectomy as a fertility
preservation in cervical cancer as it is elicited through self administered
knowledge questionnaire.

Radical vaginal trachelectomy: In this study Radical vaginal
trachelectomy technique involves a laparoscopic pelvic lymphadenectomy
followed by vaginal resection of a portion of the cervix

Fertility preservation: In this study fertility preservation offers couples
or individuals the opportunity to preserve their ability to have children’s in
the future.

Cervical cancer-In this study cervical cancer is a malignant neoplasm of
the cervical area.

Final year Bsc nursing students: In this study it refers to the students
those who are studying in IV Bsc (N) class and having knowledge about
the obstetrical and gynaecological related health problems.
6.7 ASSUMPTIONS

Final year Bsc nursing students may have limited knowledge regarding
radical vaginal trachelectomy as a fertility preservation in cervical cancer.

Structured teaching programme is one of the best teaching strategies in
imparting knowledge regarding radical vaginal trachelectomy as a fertility
preservation in cervical cancer among final year Bsc nursing students.
6.8 HYPOTHESIS
H1: There will be a significant difference between pre test and post test
knowledge scores regarding radical vaginal trachelectomy as a fertility
preservation in cervical cancer among final year Bsc nursing students.
13
H2: There will be a significant association between the pre test level of
knowledge with selected socio demographic variables.
6.9 VARIABLES
Independent variable - structured teaching programme.
Dependent variable
- knowledge score.
7 MATERIALS AND METHODS
7.1 Source of data
Information will be collected by means of self administered knowledge
questionnaire regarding radical vaginal trachelectomy as a fertility preservation in
cervical cancer among final year Bsc nursing students.
7.2 METHOD OF DATA COLLECTION
7.2.1 Research design
Pre experimental one group pre test- post test research design.
7.2.2 Settings of the study
Selected nursing colleges in Tumkur
7.2.3 Population
Final year Bsc nursing students in selected nursing colleges in Tumkur.
7.2.4 Sample
Final year B.Sc Nursing students in selected nursing colleges in Tumkur.
7.2.5 Sampling technique
Simple random sampling technique.
14
7.2.6 Sample size
60 final year B.Sc Nursing students.
7.2.7 Sampling criteria
Inclusive criteria:
1. Final year BSc nursing students who are willing to participate in the study.
2. Final year BSc nursing students who are Eligible to write forthcoming
annual examination.
Exclusive criteria:
1. Final year B.Sc nursing students those who are not available at the time of
data collection.
7.2.8 Tool for data collection
The tool for the present study is self administered knowledge questionnaire.
It consists of two sections:
Section A - Socio- demographic variable.
Section B- Self administered Knowledge questionnaire regarding radical
vaginal trachelectomy as a fertility preservation in cervical cancer.
7.2.9 Method of data collection
The data will be collected from IV year B.Sc Nursing students by using self
administered questionnaire after obtaining permission from the college authority to
conduct the main study. On the day first, pre test will be given to the students on the
same day structured teaching programme will be given. On the day eight the post test
will be given to same students to evaluate the effectiveness of structured teaching
programme.
15
7.3 DATA ANALYSIS AND INTERPRETATION
Descriptive statistics
Descriptive statistical techniques such as Mean, Median, Mean
deviation, Standard deviation, percentage and frequency.
Inferential statistics
Chi-square test and Paired ‘t’test
7.4 ETHICAL CLEARANCE:
7.4.1.Does the study require any investigation or interventions to be conducted
on patients or other human or animals?
NO.
7.4.2. Has ethical clearance been obtained from your institution in case of 7.4?
Yes. Ethical clearance will be obtained from the institution.
16
8. BIBLIOGRAPHY:
1. WHO-Reproductive health (cited on nov15), Available from
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2. Wikipedia, the free encyclopedia, International conference on population and
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17
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18
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19
Education and Research Hospital, Istanbul, Turkey. Eur J Gynaecol Oncol.
2012;33(2):200-3.
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a
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