Download A structured knowledge questionnaire will be prepared to assess the

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION.
1.
Name of the candidate and Mrs. SHAKUNTALA RANAPAL
address
1st year M.sc (N)
Faran College of Nursing
Bangalore- 49
Faran College of Nursing
2.
Name of the Institution
3.
Course of study and subject M.Sc Nursing
Obstetrics and Gynecology Nursing
4.
Date of Admission to course 29. June. 2012.
5.
Title of the topic
“A study to evaluate the effectiveness of self
instructional
module
on
knowledge
regarding
prevention of genital tract trauma during a vaginal
delivery among staff nurses working in Obstetric
Unit of selected maternity hospitals, of Bangalore.”
1
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Pregnancy and child births are a cherished dream for mother and bring joy to the
whole family.1 It is one of the vital events which need special care from conception to
postnatal period. Every mother wants to enjoy the nine months period with the baby
inside her.2 The onset of motherhood presents a unique set of physical, emotional and
psychological challenges. The challenges become even more when the new mother
experience genital tract trauma as a result of child birth.3 Maternal injuries following
childbirth process is quite common and contributes significantly to maternal morbidity
and even to death.
Early detection, prompt and effective management not only
minimizes the morbidity but prevent many gynecological problems developing in later
life.4 Therefore caring the women during pregnancy and delivery is tremendously
significant in health care delivery system.1
The term trauma is defined as a physical wound or injury. Genital trauma is one of the
trauma which occurs during vaginal birth. It involves trauma or injuries at vulva, vagina,
perineum, cervix, and uterus.5 Most acute injuries and lacerations of the perineum,
vagina, uterus, and their support tissue occur during childbirth. Whether they are acute or
non acute or whether they are repaired or not may lead to genitourinary and sexual
problems later life. Eg. pelvic relaxations, fistula, uterine prolapse, cystocele, rectocele,
dyspareunias and urinary or bowel dysfunction. During every birth some damage occurs
to the soft tissues of the birth canal and adjacent structures. The tendency to sustain
lacerations varies with each woman because the soft tissue in some women may be less
2
distensible. Damage more pronounced in nulliparous women because the tissues are more
firmer and more resistant than those in multipara.6
During the process of normal delivery, laceration of the perineum and vagina may be
caused by rapid and sudden expulsion of the head, excessive size of the newborn and
friable maternal tissues. In other circumstances, they may be caused by difficult forceps
deliveries, breech extractions, or contraction of the pelvic outlet in with the head is forced
posteriorly. Some tears are unavoidable, even in the most skilled hands, but control of
this extremely important.7
Nursing intervention to make labour safe, comfortable and effective are vital. It is
crucial for nurses to recognize and understand the normal birth process to detect and to
prevent complications from normal labour and birth. It will possible only when the nurse
and other members of obstetric team use their knowledge and skills in a concerted effort
to provide care. It is essential to manage the second stage of labour with a controlled
delivery that minimizes trauma. Currently the practice in many setting is to prevent
genital trauma manually support the perineum during birth. Alternative measures for
perineal management such as warm compression, massage with lubricant may lessen the
degree of birth canal laceration or trauma. Likewise, use of kegel exercise in prenatal and
postnatal period improves and restores the tone and strength of the perineal muscles.
Good health practices including good nutrition and appropriate hygienic measures help to
maintain the integrity.6
Midwife’s skill and judgment are crucial factors in minimizing maternal trauma and
ensuring an optimal birth for both mother and baby. These qualities are acquired by
3
experience but certain basic principles should be applied whatever the expertise of the
midwife. These are: observation of progress, prevention of infection, emotional and
physical comfort of the mother, anticipation of normal events, recognition of abnormal
developments. So, every nurse should be aware of preventive measure of genital trauma.8
6.1 NEED FOR THE STUDY
Perineal trauma during child birth is very common, occurring in about 40% of women
during their first birth and about 20% in subsequent births. Any laceration involving
more than the perineal skin and the subcutaneous tissue must be regarded as an obstetric
complication. Severe perineal tears which involve the anal sphincters and the rectal
mucosa are identified in 0.6-0.9% of vaginal deliveries.9 Genital trauma during childbirth
can occur either spontaneously as a laceration or intentionally as an episiotomy. Rates of
trauma are estimated
between 30% and 85% of childbearing women, and can lead to
significant short term and long term morbidity, such as perineal pain, incontinence,
sexual problems and varying degrees of functional impairment.10
The morbidity associated with genital injury related to childbirth constitutes a major
health problem, affecting millions of women worldwide. In the UK alone, approximately
1000 women per day will require perineal repair following vaginal birth. Pain associated
with perineal trauma can be very distressing for the new mother and may interfere with
her ability to breast feed and cope with the daily tasks of motherhood. In UK up to 44%
of women will continue to have pain and discomfort for 10 days following birth and 10%
of will continue to have long term pain at 18 months postpartum. Furthermore, 23% of
women will experience superficial dyspareunia at 3 months post partum upto 10% will
4
report faecal incontinence and approximately 19% will have urinary problems. The rates
of complications reported by women depend on the severity of trauma and on the
effectiveness of treatment.11
The study was conducted to evaluate the effectiveness of an information booklet on
knowledge among staff nurses regarding the prevention and management of perineal tear
during normal delivery at Justice K.S. Hegde Charitable hospital, Mangalore. 40 samples
were selected using simple random sampling method. An evaluative approach with one
group Pre test Post test design was used for the study and data were analyzed using
descriptive and inferential statistics. Findings of the study reveals that 60% of the staff
nurses had average knowledge, 37.5% had poor knowledge, and only 2.5% had good
knowledge in the pretetest measure. Post test knowledge scores revealed 57.5% that had
good knowledge and 42.5% of them had very good knowledge. There was a significant
increase in the knowledge scores (t=23.09, p<0.05). The study findings showed that the
information booklet was effective in improving knowledge of staff nurses regarding
prevention and management of perineal tear during labour. There was no significant
association between the level of knowledge and demographic variables.12
A case series study was conducted to determine the frequency, types and
complications of genital tract trauma during child birth at Department of Obstetrics and
Gynaecology, from June 2006 to May 2010. The sample included all women who
sustained genital tract trauma. The result of the study has showed that out of total 9216
cases, 467 (5.06%) had sustained genital tract trauma. The most frequent obstetrical
trauma seen in primiparous referral cases were vaginal tears in 16 cases (25.39%) and
5
perineal tears in 12 cases (19.04%). Multiparous women were 196 (41.97%) and cervical
tears were the most frequent obstetrical trauma in them (26.53%). Grand multiparous
women were 208 having cervical tears (44.4%) and uterine rupture in 77 cases (37.01%)
each. Most frequent early morbidities were postpartum haemorrhage (75.37%),
hypovolemic shock (47.10%) and infection (33.83%). The mortality rate was 16.05%.
Conclusion of the study revealed that to genital tract trauma is a common complication of
vaginal birth mostly seen in grand multipara, leading to haemorrhage, shock and
infection.13
A prospective observational study was conducted to observe the type, incidence and
severity of maternal genital tract injuries during vaginal birth in Bharati Hospital, Pune
(Maharashtra) from August 2010 to July 2012.Sample included 2064 patients who
delivered during two years period. Among them 255 cases had perineal injuries. Result
of the study revealed the incidence of maternal injuries was 12.35%. All the birth injuries
were found to increase when episiotomy was not given. It was also found that
instrumental delivery is significantly more associated with maternal birth injuries as
compared to vaginal deliveries. Birth weight >3 kg is associated with more maternal birth
injuries, in the form of vulval lacerations (69.5%), vaginal lacerations (84.8%), cervical
tears (70.9%), para-urethral tears (62.5%). A higher incidence of 2nd degree perineal
tear was observed in multipara 0.77%. In primipara, there was 0.53% of the total
incidence of 2nd as well as 3rd degree perineal tears whereas in Multipara it was 1.58 %
which is more and statistically significant. Soft tissue injuries of genital tract as rupture
uterus was seen more with cases of previous LSCS (3.8%) while the incidence of rupture
uterus in unscarred uterus was significantly less (0.04%). The study concluded that the
6
risk factors of injuries are birth weight >3 kg, instrumental delivery, VBAC, age <20 and
>30, women with scarred uterus.14
All the above facts show that genital trauma contributes to significant short term and
long term morbidity and sometimes death of women. The investigator through her
detailed review and clinical experience found that the nurse midwives can play a
significant role in health promotion and health prevention, and there are varieties of
techniques which can be adopted by them which require an important role of nurse with
adequate knowledge regarding various aspects of genital tract trauma. Hence the
investigators felt to take up this study in order to equip the staff nurses with knowledge
on prevention and management of genital tract trauma while conducting delivery.
6.2 REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature refers to an
extensive, exhaustive and systematic examination of publications relevant to the research
project. Nursing research may be considered a continuing process in which knowledge
gained from earlier studies is an integral part of research in general.15
A descriptive study was conducted on trial participants who delivered spontaneously at
term. The purpose of the study was to describe the range and extent of childbirth trauma
and related postnatal pain using data from a large randomized clinical trial of perineal
management techniques. Study included 5471 sample. Data are reported for sites of
trauma, and the relation to episiotomy, suturing, and maternal reports of pain at 2 days,
10 days, and 3 months after birth. Result of study showed that 85% of all women
7
experienced some form of trauma, with first- or second-degree perineal lacerations
occurring in 2/3 of women and outer vaginal tears occurring in one-half. Tears to the
rectum and vaginal vault were more common with episiotomy. Pain declined over time,
and a gradient in pain was observed according to the site and complexity of trauma. The
study concluded that genital tract trauma is extremely common with spontaneous vaginal
birth. Effective measures to prevent or reduce its occurrence would benefit many new
mothers.16
A retrospective cohort study was done to assess whether women who had a perineal
trauma at the first delivery were at increased risk for spontaneous perineal tears at the
next delivery, and whether the risk increases with the severity of previous perineal
trauma. Study conducted at Saint-Sacrement Hospital, Canada. Sample included 1895
women who had their first and second deliveries at Saint-Sacrement Hospital, between
1985 and 1994. The result of the study revealed that who have a perineal trauma at the
first delivery more than tripled the risk (relative risk=3.3; 95% confidence interval, 2.64.2) of spontaneous perineal tears at the second delivery. The risk of spontaneous
perineal tears at the second delivery increased with the severity of previous perineal
trauma at birth. The study concluded that the risk of spontaneous perineal tears at
subsequent deliveries increases with the presence and the severity of perineal trauma at
the first delivery.17
A prospective cohort study was conducted at Royal Prince Alfred Hospital, Sydney
from 1 April 1998 and 31 March 2000 to determine risk factors for the occurrence of
severe perineal trauma during childbirth. The sample included all women having vaginal
8
births (n=6595) in a 2-year period. Findings of the study revealed that 2% of women
(n=134) experienced severe perineal trauma, 122 women had third-degree tears and 12
had fourth-degree tears. Primiparity, instrumental delivery, Asian ethnicity and heavier
babies were associated with an elevated risk of severe perineal trauma. The study
concluded that primiparity, instrumental birth, heavier babies and being of Asian
ethnicity are associated with increased rates of severe trauma.18
A retrospective cross-sectional community survey of postnatal women was done to
investigate the prevalence of enduring postnatal perineal morbidity and its relationship to
perineal trauma. The total sample size was 2100 women form two maternity units in
Birmingham. Findings of the study showed that perineal morbidity was reported (53.8%)
stress urinary incontinence, 36.6% urge urinary incontinence, 9.9% liquid faecal
incontinence, 54.5% with at least one index of sexual morbidity. Women with perineal
trauma reported significantly more morbidity (sexual morbidity, dyspareunia, stress and
urge urinary incontinence) than women with an intact perineum. Women with perineal
trauma also resumed sexual intercourse later than women with an intact perineum. Study
concluded that post natal perineal morbidity is common in women with all types and
grades of perineal trauma.19
A cross sectional study was done from April 1st and July 31st 2005 in Eskisehir to
evaluate the effect of postpartum perineal trauma to the frequencies of perineal pain of
urinary incontinence and of dyspareunia. The sample of the study was 1500 women who
delivered by vaginally with vertex presentation at term with normal birth weight. A
questionnaire was used in this study. The findings of the study was that urinary
9
incontinence, perineal pain, and dyspareunia frequencies were higher in women with
perineal trauma than women without perineal trauma in their first childbirth (for each
one p<0.05). This study concluded that the effect of postpartum perineal trauma can
increase the frequency of urinary incontinence, perineal pain and dyspareunia .20
A retrospective descriptive analysis was done at a tertiary care facility during 19961997. The sample included 510 women with a singleton pregnancy to identify factors
related to perineal trauma in childbirth. Results of the study showed that factors related to
laceration were age, insurance status, and marital status. For all women, laceration was
more likely when in lithotomy position for birth (p = .002) or when prolonged second
stage labor occurred (p = .001). Findings revealed that side-lying position for birth and
perineal support and compress use are important interventions for decreasing perineal
trauma. Study concluded that Strategies to promote perineal integrity need to be
implemented by nurses who provide prenatal education and care for the laboring
woman.21
A review on published and unpublished randomized and quasi- randomized was
conducted to assess the effect of perineal techniques during the second stage of labour on
the incidence of perineal trauma. The study included 8 trials involving 11,651 randamised
women .The result of the study revealed that there was a significant effect of warm
compresses on reduction of third and fourth degree tears (risk ratio (RR) 0.48, 95%
confidence interval (CI) 0.28 to 0.84 (two studies, 1525 women)). There was also a
significant effect towards favouring massage vs hands off to reduce third and fourth
degree tears (RR 0.52, 95% CI 0.29 to 0.94 (two studies, 2147 women)). Hands off vs
10
hand on showed no effect on third and fourth degree tears, but it observed a significant
effect of hands off on reduced rate of episiotomy (RR 0.69, 95% CI 0.50 to 0.96 (two
studies, 6547 women). The study concluded that the use of warm compresses on the
perineum is associated with a decreased occurrence of perineal trauma.22
A study was conducted to gain evidence about the effect of birth position on perineal
outcome, and to assist birth attendants in providing women with information and
opportunities for minimizing perineal trauma. Study sample included 2891 normal
vaginal births. The study results showed that the lateral position was associated with the
highest rate of intact perineum (66.6%) and the most favorable perineal outcome. The
squatting position was associated with the least favorable perineal outcomes (intact rate
42%), especially for primiparous. A statistically significant association was demonstrated
between perineal outcome and accoucheur type. The obstetrician group generated an
episiotomy rate of 26 %, which was more than five times higher than episiotomy rates for
all midwife categories. The rate for tear requiring suture of 42.1 % for the obstetric
category which was 5 to 7 % higher than midwives. Intact perineum was achieved for
31.9 % of women delivered by obstetricians compared with 56 to 61 % for three
midwifery categories. Findings of the study revealed the growing evidence that birth
position may affect perineal outcome.23
A retrospective case-control analysis was done to identify risk factors for the
development of severe perineal lacerations and to give recommendations for its
prevention. The study was conducted at University Hospital, Germany. The sample
included 2,967 deliveries. The result of the study revealed that 50 (1.7%) mothers had
11
higher-grade lacerations. Mediolateral and median episiotomy, advanced maternal age,
vaginal operative delivery; higher fetal birth weight and abnormal cephalic presentation
were associated with severe lacerations. The study concluded that advanced maternal age
plays an important role in the development of anal sphincter tears in nulliparous women.
Episiotomy and operative vaginal deliveries should be restrictively performed when
possible.24
Bottom of A study was conducted to examine risk factors for third and fourth degree
perineal lacerations and periurethral, vaginal, and labial lacerations. Sample included
1009 primiparous women with singleton pregnancies and vaginal deliveries. Finding of
the study expressed that Large fetal size (> or = 3500 g) substantially increased the risk
of perineal (odd ratio [OR], 3.8; 95% confidence interval [CI], 1.8 to 7.9) and periurethral
(OR, 2.3; 95% CI, 1.0 to 5.0) lacerations but not other types of lacerations. Episiotomy
had no impact on perineal lacerations (OR 0.9) but had very strong protective effects for
other lacerations (OR 0.1). Prolonged second stage of labor (> 120 minutes) increased the
risk of perineal and vaginal lacerations but reduced the risk for periurethral lacerations.
Instrumental
deliveries
were
significant
risk
factors
for
third-
and
fourth-
degree perineal lacerations, with by far the strongest effect for low forceps (OR 25.0
versus < 3 for outlet forceps, outlet vacuum, and low vacuum). Study concluded that
separating different birth canal lacerations is critical in identifying risk factors and
potential preventive strategies.25
12
6.3 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of self instructional module on knowledge
regarding prevention of genital tract trauma during a vaginal delivery among staff
nurses working in Obstetric units of selected maternity hospitals, Bangalore.”
6.4 OBJECTIVES OF THE STUDY
The objectives of the study are to:
1. assess the Knowledge regarding prevention of genital tract trauma during vaginal
delivery among staff nurses prior to the administration of self instructional
module.
2. prepare a self instructional module on prevention of genital tract trauma during a
vaginal delivery for staff nurse.
3. evaluate the effectiveness of self instructional module on knowledge regarding
prevention of genital tract trauma during vaginal delivery among staff nurses.
4. find out the association between knowledge regarding prevention of genital tract
trauma during a vaginal delivery among staff nurses with their selected socio
demographic variables.
6.5 HYPOTHESIS
H1: There is a significant change in the knowledge regarding the prevention of genital
tract trauma during vaginal delivery among staff nurses before and after the
13
administration of self instructional module as measured by the scores obtained
according to their responses to items in the questionnaire.
H2: There is a significant association between knowledge regarding prevention of genital
tract trauma during vaginal delivery of staff nurses with selected socio demographic
variables.
6.6 OPERATINAL DEFINITIONS
Evaluation:
In this study evaluation refers to the systematic determination of worth and
significance of a self instructional module to know it’s effectiveness in hike of the
knowledge of staff nurses regarding prevention of genital tract
trauma during vaginal
delivery.
Effectiveness:
In this study effectiveness is capability of self instructional module to produce an
expected increase in knowledge of staff nurses regarding prevention of genital tract
trauma as measured in the terms of responses given to the items in tool before and after
administration of the self instructional module.
Knowledge:
In this study knowledge refers to information gained through education, experience,
and practice of staff nurses regarding prevention of genital tract trauma during vaginal
14
delivery as measured by the score obtained according to their responses in a structured
questionnaire which will be graded as through their knowledge scores which is measured
as adequate knowledge, moderately adequate, inadequate knowledge.
Self instructional module:
In this study it refers to the systematically organized learning booklet in English
prepared by the investigator and validated by experts, which contains information
regarding various aspects of prevention of genital tract trauma during child birth.
Genital tract trauma:
In this study genital tract trauma is one of the trauma which occurs during vaginal
birth. It involves trauma or injuries to vulva, vagina, perineum, cervix, and uterus.
Vaginal delivery:
In this study vaginal delivery is the process of giving birth to a child through birth
canal either cephalic or breech presentation or instrumental delivery.
Staff nurses:
In this study registered staff nurses working in the branch of obstetrics who deals with
care of women during child birth in selected maternity hospitals.
Selected socio demographical variables:
In this study it refers to age, educational status, years of experience and area of work
15
of obstetric staff nurses.
6.7 ASSUMPTIONS:
The study is based on the following assumptions:

Staff nurses in selected hospital will have interest to participate in this study.

Self instructional module will enhance the knowledge regarding the prevention of
genital tract trauma during vaginal delivery among staff nurses.

Obstetric staff nurses will co-operate and participate in this study.
6.8. DELIMITATIONS
The study is delimited to:

The study is delimited to nursing staffs working only in Obstetric wards of
selected maternity hospitals at Bangalore.

Assessment of knowledge only as correct the responses made to the items in the
knowledge questionnaire.
7 MATERIALS & METHODS
7.1 SOURCES OF DATA
Staff nurses those who are working in the obstetric wards of selected maternity hospitals
at Bangalore.
16
7.2 METHODS OF DATA COLLECTION
Research Method
: pre-experimental study
Research design
: One group pretest post test design
Sampling technique
: purposive sampling
Sample size
: 60 Obstetric Staff nurses
Setting of the study
: study will be conducted at maternity setting of Santosh
Hospital, Ghoshia Hospital,Vanivilas Hospital, Yelahanka
Government Hospital, Bangalore.
7.2.1 CRITERIA FOR SAMPLING
INCLUSION CRITERIA
This study includes “staff nurses’’ who are:

available at the time of data collection.

willing to participate in the study.

working in Obstetric units of selected maternity hospitals of Bangalore.

able to communicate in English.
EXCLUSION CRITERIA
The study excludes obstetrics staff nurses who:

are not willing to participate to this study.
17

attended workshops or seminars on prevention of genital tract trauma.
7.2.2 DATA COLLECTION TOOL
A structured knowledge questionnaire will be prepared to assess the knowledge of
staff nurses regarding prevention of genital tract trauma vaginal delivery. A self
instructional module also will be prepared regarding prevention of genital tract trauma.
The content validity of the tool will be established in consultation with guide experts
from the field of obstetrics medicine and obstetrics and gynaecology nursing. The self
instructional module also will be given to experts to establish content validity.
Reliability of the tool will be established by split half method. Prior to the study, formal
administrative permission will be obtained from concerned authority. Further, an
informed consent will be taken from the staff nurses regarding their willingness to
participate in the study. The proposed period of data collection will be in august 2013.
7.2.3 DATA ANALYSIS METHOD
Data analysis will be done by using both descriptive and inferential statistics.
Sociodemographic variables will be analyzed descriptively by frequency and percentage
distribution with the help of column, bar and pie diagrams. Mean and standard deviation
will be used to assess the knowledge regarding the prevention genital tract trauma. A
paired “t” test will be done to compare the mean pre- test and post test scores of obstetric
staff nurses regarding the assessment of prevention genital tract trauma during vaginal
delivery. A chi square [χ2] test will be used to determine association between the mean
18
pre test knowledge score of obstetric staff nurses with their selected socio demographic
variables.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR
OTHER HUMAN OR ANIMAL?
YES.
The self instructional module and structured knowledge questionnaire will be used on
subjects. No other interventions which cause any physical harm will not be used in the
study.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED?
YES.

Confidentiality and anonymity of the subjects will be maintained.

A written formal administrative permission from institutional authority will be
obtained prior to the study.

An informed consent will be obtained from the subjects prior to the study.
19
8. LIST OF REFERENCES
1. Devi SK. Assessing the TBA’s knowledge of safe delivery. Nightingale Nursing
Times. 2010 Dec; 6 (9): p 33.
2. Sreelekha C. A study to assess the effectiveness of structure teaching programme
on minor disorders of pregnancy and its management among antenatal mothers in
selected area of Raichur. Nightigale Nursing Times. 2007 Jun; 2 (10): 24.
3. Herrera I, Schneiderman R, Perez Z. Therapy for Management of Childbirth
Perineal Tears and Post Partum Pain. 2012 Jan.1-5.
4. Dutta DC. Test Book of Obstetrics. 6th ed. Calcutta: New Central Book Agency
(p) Ltd; 2004. 423.
5. Available from: URLhttp://en.wikipedia.org/wiki/Trauma_(medicine).
6. Perry ES, Hocken MJ, Lowdermilk DL, Wilson D. Maternal Child Nursing Care.
4th ed. John Wiley and Sons publication; 2010. 486.
7. Reeder, Martin, Konaik G. Maternity nursing, Family Newborn and Women’s
Health Care. 18th ed. Philadelphia: Lippincot Publication; 1997. 566-7.
8. Fraser M, Cooper MA. Myles Textbook for midwives. 14th ed. New Delhi:
Churchill Livingstone; 2003. 502-3.
9. Leonard J, Gerhard B T. Risk factors for third and fourth degree perineal tears
during vaginal delivery. 2011 Jun 30.
10. Bontrager C. Preventing Spontaneous Perineal Trauma during Childbirth
Quantitative Research Proposal. Available from: URL: http://www. Instituteo
fmidwifery.org.
20
11. Kettle C, Fenner DE. Repair of Episiotomy, First and Second Degree
Tears.2006.196.
12. Fernandes P, Paul S, Savitha B. Effectiveness of an Information Booklet On
Knowledge among Staff Nurses regarding prevention and management of
Perineal Tear during normal delivery. Nitte University Journal of Health Science.
2012 Mar; 3(1).
13. Khaskheli M, Baloch S, Baloch AS. Obstetrical trauma to the genital tract
following vaginal delivery.2012 Feb; 22(2):95-7.
14. Kaur L, Dabhadkar S. An Observational Prospective Study of Maternal Genital
Tract Injuries during child birth. Indian Journal of Applied Research. 2012 Dec: 2
(3).
15. Basavanthappa BT. Nursing Research. 2nd ed. New Delhi: Jaypee Brothers
Medical publishers (p) LTP; 2003.p. 49.
16. Albers L, Garcia J, Renfrew M, McCandlish R, Elbourne D. Distribution of
Genital Tract Trauma in Childbirth and Related Postnatal Pain. 2001 Dec 24;
26(1), 11–17.
17. Martin S, Labrecqua M, Marcoux S, Bérubé S, Pinault J J, The Association
Between Perineal Trauma and Spontaneous Perineal Tears. 2001 Apr; 50 (4).
18. Dahlen HD, Ryan M, Homer SC, Cooke M. An Australian prospective cohort
study of risk factors for severe perineal trauma during childbirth. Midwifery 2007
Jun; 23(2).196-03.
21
19. Williams A, Herron-Marx S, Carolyn H. The prevalence of enduring postnatal
perineal morbidity and its relationship to perineal trauma. US National Library of
Medicine. 2007 Dec; 23(4): 392-03.
20. Sayiner FD, Ozerdoğan N, Tozun M, Giray S, Kosgeroglu N, Unsal A. The effect
of postpartum perineal trauma on the frequencies perineal pain, urinary
incontinence and dyspareunia. The Internet Journal of Epidemiology. 2010; 8(1).
21. Hastings-Tolsma M, Vincent D, Emeis C, Francisco T. Getting through birth in
one piece: protecting the perineum. 2001 Jan-Mar;7 (1-2):106-14.
22. Aasheim V, Nilsen AB, Lukasse M. Perineal techniques during the second stage
of labour for reducing perineal trauma. Reinar LMUS National Library of
Medical National Institute of Health. 2011 Dec 7;(12)
23. Shorten A, Donsante J, Shorten B. Birth position, accoucheur, and perineal
outcomes: informing women about choices for vaginal. 2002 Mar;29(1)
24. Hornemann A, Kamischke A, Luedders DW, Beyer DA, Diedrich K, Bohlmann
MK. Advanced age is a risk factor for higher grade perineal lacerations during
delivery in nulliparouswomen. 2010 Jan; 281(1):59-64.
25. Mikolajczyk RT, Zhang J, Troendle J, Chan L. Perinatol A J. Risk factors
for birth canal lacerations in primiparous women.2008 May.
22
9
SIGNATURE OF CANDIDATE
10
REMARSK OF THE GUIDE
It is a feasible study
11
NAME AND DESIGNATION
11.1 GUIDE
Mrs. BIJI JOSEPH
Associate Professor in Obstetric
and Gyneacological Nursing
11.2 SIGNATURE
Mrs. BIJI JOSEPH
11.3 HEAD OF THE
DEPARTMENT
Associate Professor in Obstetric
and Gyneacological Nursing
11.4 SIGNATURE
12
12.1 REMARKS OF THE
This study will help to obtain the
CHAIRMAN OR PRINCIPAL
knowledge base for staff nurses on
prevention of Genital Tract Trauma
during vaginal delivery.
Mrs. ASHA ANDREWS
12.2 SIGNATURE
PRINCIPAL
23