Journal of Nurse Midwifery and Maternal Health

 “Once a cesarean always a cesarean” is a very old saying by most of the prominent obstetricians throughout the twentieth century. The studies in the last two decades of twentieth century suggested that this practice may not always be necessary. Options for a patient with previous cesarean are Elective repeat cesarean Delivery (ERCD) also called ERCS (Elective Repeat Cesarean Section) and Trial of labor after cesarean (TOLAC). This can have 2 outcomes wise successful TOLAC – Vaginal Birth after Cesarean Delivery (60 to 80%) or failed TOLAC­ Emergency cesarean Delivery. The benefits of a trial of labor after cesarean (TOLAC) resulting in a vaginal birth after cesarean (VBAC) may include lower rates of maternal morbidity due to Postpartum fever, Wound infection, Blood transfusion, Hysterectomy, Maternal discomfort, Length of stay etc. and Fewer cases of neonatal respiratory distress. The National Institute of health is planning to organize a “consensus development conference” in 2010 to minimize some confusion & to arrive at a decision & to elucidate current knowledge on VBAC even though there complications like uterine rupture.

Keywords: Vaginal Birth after Cesarean (VBAC); Trial of Labor after Cesarean (TOLAC); Elective Repeat Cesarean Delivery (ERCD); Repeat Cesarean Delivery (RCD).

 Background:Dysmenorrhea is a common gynecological condition with painful menstrual cramps of uterine origin. There are two categories of dysmenorrhea primary and secondary dysmenorrhea. Primary dysmenorrhea refers to menstrual pain without any pelvic pathology. These symptoms have underlying cause of elevated endometrial prostaglandins and their metabolites [1]. A dysmenorrhea prevalence of 33.5% among adolescent girls in India was reported by Nag [5]. George and Bhaduri found dysmenorrhea to be a common problem in India with prevalence of 87.7% [6]. Objectives: To Assess the Prevalence of dysmenorrhea among adolescent girls(12­14 years).To assess the risk factors of dysmenorrhea among adolescent girls. To Associate the prevalence and risk factors of dysmenorrhea among adolescent girls with their demographic variables. Methods:A descriptive study involving 100 adolescent girls were self administeredquestionnaire. Data were collected by using non­ probability purposive sampling technique. It included data regarding socio­demographic characteristics and questions pertaining to menstrual practices and checklist related to risk factors of dysmenorrhea. Results: Out of 100 adolescent girls, it were seen that 36 per cent adolescent girls had moderate prevalence of dysmenorrhea , 69 per cent adolescent girls had medium risk factors of dysmenorrhea. Conclusion: The present study revealed that, a majority of adolescent girls were posed to risk factors of dysmenorrhea and hence it can be concluded that, there should be need to provide awareness and education regarding risk factors of dysmenorrhea to adolescent girls.

Keywords: Assess; Prevalence; Risk Factors; Dysmenorrhea; Adolescent Girls.

 In worldwide population, 21 million pregnancies are occur every year, under these approximately 60In our country about 74% are getting minimized antenatal care and leads to maternal mortality ratio is 300 per 100000 live births. This study is done to assess the knowledge of warning signs during pregnancy. This study revealed that Majority of the subjects had moderate knowledge about warning signs who are admitted in antenatal ward, GRH, Madurai .This can be followed by an effective teaching programmes and in­service education can be conducted for the medical & health care professionals to update the goal.

Key words: Warning Signs; Primi Gravida; Antenatal; Knowledge; Semi Structured Questionnaire

 Background: Dysfunctional uterine bleeding (DUB) is a gynecologic problem that occurs often during reproductive age and is the most frequent cause of urgent admission to the hospital. DUB occurs in the adolescent usually because of anovulation, a result of developmental immaturity of the hypothalamic­pituitary­ovarian (HPO) axis. Diagnosis can only be confirmed when there is no other pathology present, so it is important to exclude all the other possibilities. Objective: To assess the knowledge regarding dysfunctional uterine bleeding among women in Rural health center, Chandragiri,Tirupathi. Setting: Rural health center, Chandragiri, Tirupathi. Materials and Methods: In this descriptive study,100 reproductive age women’s(15­45 years) and reported to the RHC, Chandragiri,Tirupathi were included. A probability convenient sampling was adopted for to select the women. A structured knowledge questionnaire was used to assess the knowledge on Dysfunctional uterine bleeding. Results: The collected data were analyzed by descriptive and inferential statistics. out of 100 women’s majority 69(69%) had moderate knowledge, 29(29%) had poor knowledge, 2(2%) had adequate knowledge on Dysfunctional uterine bleeding. Chi­square test was computed for association of demographic variables with knowledge regarding Dysfunctional uterine bleeding. The findings showed significant association in Dysfunctional uterine bleeding knowledge among reproductive age women’s with regard to educational status(c2 =0.000**), occupation(c2 =0.019**), income(c2 =0.013**), duration of marriage(c2 =0.015**), source of information(c2 =0.026**), at p< 0.01 significance. No significant association was found with other demographic variables. Item wise analysis done for the items. Conclusion: The study revealed that knowledge of Dysfunctional uterine bleeding, risk factors, etiology and it’s management was moderate. So, there is a need to educate the rural women to increase awareness about Dysfunctional uterine bleeding.

Keywords: Dysfunctional Uterine Bleeding; Reproductive Age Women; Knowledge.

 Background: Emergency contraception is a method of contraception that can be used to prevent unprotected act of sexual intercourse. There are both hormonal and non hormonal methods of emergency contraception are available. These methods also been called “morning after pill” or post coital contraception. Aim: The present study aims to assess the effectiveness of structured teaching programme regarding emergency contraception on knowledge among married women. Methods: The community based study was conducted in selected villages at Mamandur such as Meiyur and Vadapathi. The setting was chosen on the basis of feasibility in terms of availability of adequate samples . There are around 1337 married women residing in the selected villages. The research design chosen for the study was Quasi experimental­ pre test and post test design.110 married women those who fulfilled the inclusion criteria were selected by using simple random sampling technique (lottery method). The inclusion criteria for the study includes 1) Women those who were married, 2) Women those who were between the age group of 18­40 years and 3)Women who can read and write Tamil. The exclusion criteria includes women who had any psychiatric problems and women who have any gynecological problems. Structured questionnaire was to assess the knowledge regarding emergency contraception among married women. Results:With regard to pre test and post test level of knowledge regarding emergency contraception among married women, majority 63(57.3%) of married women had moderately adequate knowledge and only 1(0.9%)of them had adequate knowledge in the pretest where as in the post test, all mothers had adequate knowledge (100.0%) on emergency contraception. There was a highly significant difference found between the pretest and post test level of knowledge regarding emergency contraception among married women at p = 0.000 level. Conclusion: The present study concludes that, structured teaching programme was effective in improving the knowledge of married women on emergency contraception. Emergency contraception is safe and effective if it use within 72 hours of unprotected sexual intercourse for preventing an unplanned pregnancy, although it is not widely used. Widespread and appropriate use of emergency contraception should be encouraged as it is a promising means to arrest the increasing abortion rate and to educate women of reproductive age about emergency contraception.

Keywords: Structured Teaching Programme; Emergency Contraception; Knowledge.

 Background: Stress is a common disorder occurs worldwide in everyone’s life. It affects the mind and the body. Mothers of children in the NICU experience high levels of stress and that there are interventions which can decrease the stress level of the parents and also can affect their ability to breast feed their infant. Hospitalization of a child is the break in the unity of the family. Emotional reactions of each member of the family must be considered to help them to adjust with stress due to the hospital situation and illness. Parents whose child has been admitted to the hospital feel not only separation from their children but also feeling of inadequacy as others provide care for other children. They feel anxiety, anger, fear, disappointment, self­ blame and possible guilty feeling due to lack of confidence and competence for caring the child in illness and wellness.Objectives: 1. To identify the level of stress among mothers when their neonates are admitted in NICU. 2. To identify the coping strategies used by mothers in NICU. 3. To correlate the stress with coping strategies used by mothers in NICU. 4. To determine the association of stress level and coping strategies with the selected demographic variables. Method: A descriptive research design was used to assess the level of stress and coping strategies among mothers of neonates admitted in NICU at S.V.R.R.G.G.H, Tirupati. A total of 100 NICU mothers were selected by purposive sampling technique. Tool used for conducting study was Parental Stressor Scale and Coping Health Inventory for parents to assess the level of stress and coping strategies. Data were analyzed with the help of descriptive and inferential statistics. Results: The major findings of the study revealed that among 100 mothers 27 (27%) mothers had mild stress, 49(49%) mothers had moderate stress and 24(24%) mothers had severe stress. Among 100 mothers 30(30%) mothers had poor coping, 47(47%) mothers had moderate coping and 23(23%) mothers had good coping. Conclusion: The amount of stress that the mothers of neonates experienced was the result of NICU admission. The nurses in the unit should work out a plan for educational programmes based on stress level that will help the mothers to gain knowledge on coping strategies.

Keywords: Intensive Care Unit; Mothers; Stress; Coping Strategies.

 The study was conducted to assess the effect of ambulation onfetomaternal parameters during first stage of labour among primigravida mothers. Objectives: To assess the effect of ambulation on fetomaternal parameters among primigravida mothers during 1st stage of labour. To compare the effect of ambulation on fetomaternal Parameters among primigravida mothers with demographic variables of the experimental group. To find out the association between the effect of ambulation on fetomaternal true– experimental, post­test only control group design was used to achieve the objectives of the study. Probability simple random sampling technique was adopted to select the sample. The sample size comprised of 60 primigravida mothers, 30 mothers in the experimental group and 30 mothers in the control group. Analysis of data was done by using descriptive and inferential statistics. Findings of the study: Except In The Labour Pain Perception the mean scores of fetomaternal parameters were significantly higher in the experimental group than in the control group. The ambulation was found as an effective strategy in reducing labour pain of primigravida mothers, as the ‘t’ value computed (t=13,699), in increasing cervical dilatation (t=6,975), in increasing cervical effacement (t=9,937), in increasing frequency of uterine contractions (t=17,748), in increasing duration of uterine contractions (t=14,780), in shortening duration of 1st stage of labour (t=12,325), in good facilitation of fetal head descent (t=10,543), all which were significant at p<0.01. The fetal heart rate (t=2.140) was significant at p<0.05 level. Relationship between the ambulation effect of fetomaternal parameters among primigravida mothers with respect to their demographic variables I the experimental group was analyzed by using chi­square (c2 ) test. Conclusions: The findings revealed that majority of respondents in the experimental group were having less labour pain, increased cervical dilatation and effacement, increased frequency and duration of uterine contractions, shorter duration of 1st stage of labour, rapid fetal head descent and good fetal heart rate in the 1st stage of labour. The ambulation was effective intervention for the primigravida mothers to get good maternal and fetal outcome. There was no relationship between the effect of ambulation on fetomaternal parameters with demographic variables of primigravida mothers in the experimental group except with gestational age in weeks. A similar study can be conducted on a larger population. A similar study can be undertaken on a sample with different demographic characteristic like husband’s education and occupation. A similar study can be carried out by using different fetomaternal parameters like rupture of membranes and engagement. A similar study can be conducted by increasing the length of ambulation. A comparative study can be onducted by providing ambulation to both primigravida and multigravida mothers to assess fetomaternal parameters. A similar study can be conducted by using other intervention like maternal positions and its effect on fetomaternal parameters.

Keywords: Fetomaternal; Primigravida Mothers.