RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE AND

ADDRESS

Ms. OINAM ROMITA DEVI

GOLDFINCH COLLEGE OF NURSING,

NO:150/24,KODIGEHALLI MAIN ROAD,

MARUTHI NAGAR,

BANGALORE-560002.

2. NAME OF THE INSTITUTION GOLDFINCH COLLEGE OF NURSING,

MARUTHI NAGAR,

BANGALORE-560002.

3. COURSE OF STUDY AND SUBJECT MSc NURSING

OBSTETRICS AND GYNAECOLOGICAL

NURSING

4. DATE OF ADMISSION TO COURSE 30-06-2010

5. TITLE OF THE TOPIC

A STUDY TO ASSESS THE KNOWLEDGE REGARDING PRE-ECLAMPSIA AND ITS

MANAGEMENT AMONG THE STAFF NURSES WORKING IN A SELECTED HOSPITAL AT

BANGALORE.

6.0 BRIEF RESUME OF INTENDED WORK

INTRODUCTION

Derive from Greek word ‘eklampsia’ means sudden flashing. Preeclampsia which is also

called toxemia is a problem that occurs in some women during pregnancy. It manifests during the second

half of pregnancy. Affecting at least 5 percent of all pregnancies, it is a rapidly progressive condition

characterized by high blood pressure, swelling in the limbs or face, and protein in urine. The high blood

pressure can affect the brain, kidney, liver and lungs.[1]

Preeclampsia is a medical condition in which hypertension arises in pregnancy in association

with significant amounts of protein in the urine. Preeclampsia refers to a set of symptoms rather than any

causative factors, and there are many different causes for the condition. It appears likely that there are

substances from the placenta that can cause endothelial dysfunction in the maternal blood vessels of

susceptible women. While blood pressure elevation is the most visible sign of diseases, it involves

generalize damage to the maternal endothelium, kidney and liver, with the release of vasoconstrictive

factors being secondary to the original damage. Preeclampsia may develop from 20 weeks gestation. Its

progress differs among patients; most cases are diagnosed pre-term. Preeclampsia may also occur up to six

weeks post partum. Apart from caesarean section or induction of labour there is no known cure. It is the

most common of the dangerous pregnancy complication; it may affect both the mother and the unborn

child.2

Citizen of Journalist of Marinews reported that preeclampsia is the leading cause of maternal

death threatening life of both mother and child. This condition begins in early pregnancy with

underdevelopment of placenta often not revealing symptom until the second half of pregnancy. To develop

effective treatment and prevention strategies one needs to be able to start treatment in early pregnancy.

Gaining weight during pregnancy is a real struggle for many new mothers. But dropping about 4kg weight

between pregnancy may help many women diagnosed with preeclampsia during the first pregnancy to avoid

a recurrence the second time around. Preeclampsia, causes by high blood pressure, protein in the urine and

swelling, during pregnancy, kidneys and body’s blood clotting system.3

A study stated that preeclampsia was made using two cardinal feature of the disease after 20th

weeks of gestation in previously normotensive and nonproteinuric women Preeclampsia was diagnosed in

106 (5.87%) patients. Primiparity constitutes 53.77% of total patients. Hypertension and proteinuria were

observed in all patients. Hyperuricemia was observed in 93.65% of cases. The incidence of preeclampsia

was 5.87%. Nephrotic syndrome was observed in 11.32% of patients. 4

A study stated that preeclampsia is relatively common pregnancy disorder that originates in the

placenta and causes variable maternal and fetal problem. In the worst case, it may be threaten the survival

of both the mother and baby. The causes of preeclampsia reveal a new mode of maternal immune

recognition of the fetus, relevant to the condition. The circulating factors derive from placenta, which

contribute to the clinical syndrome, are now both understood.5

A study stated that preeclampsia is a multisystem disorder specific to pregnancy with a high

maternal and perinatal morbidity and mortality. The causes of this disorder is unknown, preeclampsia is

likely represents the clinical end point of multiple contributory factors and it is unlikely that any single

cause will be found. The blueprint for the development of preeclampsia is laid down early in pregnancy,

and delivery of the fetus and placenta remains the only effective treatment. Efforts to prevent preeclampsia

in women at high risk have been largely unsuccessful. Until the pathogenesis of preeclampsia is well

defined, it is unlikely that effective preventive strategies will be developed.6

6.1. NEED FOR THE STUDY Preeclampsia is a common pregnancy disorder associated with an increased in systemic

inflammation, is the leading cause of maternal and fetal morbidity throughout the world. It is associated

with shallow extra villous trophoblast invasion of the deciduas, leading to uteroplacental blood flow that is

inadequate for the developing fetal placental unit.7

Preeclampsia is defined as the association of pregnancy induces hypertension and proteinuria

of ions and magnesium sulfate300mg/24h or more after 20 week’s gestation. It complicates 0.5 to 7% of

pregnancies. It is a severe complication of pregnancy, which leads to persisting fetal morbidity and

mortality. Antihypertensive drugs are use to limit maternal complications and magnesium sulfate which is

probably not used enough in France need to be administered with care and strict monitoring.8

European Journal of human Genetics stated that preeclampsia and intrauterine growth

restriction are related, pregnancy-specific disorders with a substantial genetic influence, which may have a

joint genetic etiology. Fifty women with previous pregnancy complicated by intrauterine growth restriction

were recruited from a recent genetically isolated population in Netherlands. Their relationships were

estimated by means of a large genealogy database that contains information on more than 110000

individuals from the isolate over 23 generations. The proportion of related women with previous

preeclampsia (95.1%) or pregnancies complicated by intrauterine growth restriction (95.1%) was

significantly greater than expected chance. Combine analysis of both disorders did not change the

magnitude of familial aggregation.9

Janet conducted a study on risk of early or severe preeclampsia related to pre-existing

conditions. Among 70, 924 women in Danish National Birth Cohort, they used hospital discharge data to

identify 2117 cases of preeclampsia, of which 499 were early, 426 were severe and 228 were both early and

severe. Prospective interview data were supplemented with hospital registry data to identify women with

preexisting condition. The study concluded that pre-existing maternal and obstetric condition are associated

with a high proportion of severe or early cases of preeclampsia. Obesity and overweight contributed

independently to the risk of preterm preeclampsia, a finding with potentially profound health implications.10

Kristen conducted a study to determine the risk of preeclampsia associated with factors that

may be present at antenatal booking. The study showed that the risk of preeclampsia associated with factors

that may be present at antenatal booking. The study showed that the risk of preeclampsia is increased in

women with a previous history of preeclampsia and in those with atiphospholipid antibodies, pre-existing

diabetes, multiple pregnancy, nulliparity, family history, raised blood pressure at booking, raised body mass

index before pregnancy or at booking, or maternal age ≥40 years, for multiparous. These factors and

underlying evidence base can be used to assess risk at booking so that a suitable surveillance routine to

detect preeclampsia can be planned for the rest of the pregnancy.11

Carla stated that maternal deaths are too often solitary and hidden events that go uncounted.

The difficulty arises not because of lack of clarity regarding the definition of maternal death, but because of

weakness of health information system and consequent absence of the systematic identification and

recording maternal death. In recent years, innovative approaches to measuring maternal mortality have been

developed, resulting in a stronger information base WHO, UNICEF, UNFPA estimated for the year 2000

indicates total of 529,000 in just 13 countries.12

World health organization reported that two thousand years after preeclampsia was

described, still it complicates 10% of pregnancies yet their causes remain unknown. They are among the

major contributors to maternal and perinatal morbidity and mortality worldwide. Preeclampsia is also

associated with substantial health problem later in life in both women and their children.13

Deckker stated that preeclampsia is associated with increase maternal and perinatal morbidity

and mortality. Preeclampsia is more than pregnancy-induced hypertension. The hypertension is only one

manifestation of an underlying multifactorial, multisystem disorder, initiated early in pregnancy. In

established severe diseases there is volume contraction, reduce cardiac output, enhance vascular reactivity,

and increase vascular permeability and platelet consumption. Medical treatment of severe hypertension in

pregnancy is required.14

Hence, the researcher felt the need to assess the knowledge regarding preeclampsia and its

management among the nurses working in selected hospitals, Bangalore to improve their knowledge which

will ensure the effective management of the pre-eclamptic patient.

6.2. REVIEW OF LITERATURE

A review of the literature refers to an extensive, exhaustive and systematic examination of

publication relevant to the research project. Most often associated with academic-oriented literature, such as

thesis, a literature review usually precedes a research proposal and result section. The result of a literature

review and analysis according to the style requirements for courses, journals, thesis, dissertation and grant

proposal makes the presentation. A well structured literature review is characterized by a logical flow of

ideas; current and relevant references with consistent appropriate.15

SECTION-A STUDIES RELATED TO KNOWLEDGE ASSESSMENT OF THE STAFF NURSE

REGARDING PRE-ECLAMPSIA

Adson conducted a study to compare the assessment of endothelial function through flow-

mediated dilatation in pregnant women with pure preeclampsia and superimposed preeclampsia. The flow-

mediated dilatation of the brachial artery was carried out according to the recommendations of the

International Brachial Artery Reactivity Task Force in pregnant women with preeclampsia syndrome. The

study concluded that the flow mediated dilatation of the brachial artery of patients with preeclampsia

syndrome was not capable of differentiating between preeclampsia and superimposed preeclampsia.

However, the data suggest that superimposed preeclampsia is associated with worse endothelial functionaI

comparison to preeclampsia.16

Whitney conducted a cross-sectional study to explore the extent to which pregnant women

understand the symptoms and potential complications related to preeclampsia and to determine the factors

that are associated with better understanding. This was a cross-sectional study in which 112 pregnant

patients were interviewed to determine their preeclampsia knowledge. Knowledge was evaluated using a

25-item survey addressing the symptoms, consequences, and proper patient actions associated with

preeclampsia. Patients were also asked in an open-ended question to define preeclampsia; all responses

were rated by three obstetricians. Information about demographics, medical and obstetrical history, and

health literacy was also obtained. Health literacy was assessed using the short Test of Functional Health.

The study concluded that pregnant patient have a generally poor understanding of preeclampsia, although

improved understanding is associated with having received information about the disease. Further

investigation will be needed to determine how best to educate patients and whether this education can also

decrease adverse outcomes associated with this syndrome.17

Marie- Elise conducted a study on cardiovascular risk factor assessment after preeclampsia

in primary care. The review of medical records of 1196 women in four primary health care centers, who

were registered from January 2000 until July 2007 with an International Classification of Primary Care code

indicating pregnancy. Records were searched for indicators of preeclampsia. Of those who experienced

preeclampsia and of a random sample of 150 women who did not, the following information on

cardiovascular risk factor management after pregnancy was extracted from the records: frequency and

timing of blood pressure, cholesterol and glucose measurements and vascular diagnoses.35 women

experienced pre-eclampsia. The study concluded that despite the evidence of increased risk of future

cardiovascular disease in women with a history of preeclampsia, follow-up of these women is insufficient

and undeveloped in primary care in the Netherlands.18

Katja H. conducted a study on a relationship between insulin sensitivity and vasodilatation

in women with a history of pre-eclamptic pregnancy. Women with a history of preeclampsia are

characterized by vascular dysfunction and an increased risk of cardiovascular disease. In the present study

we investigated whether insulin sensitivity is decreased in women with previous preeclampsia and whether

it is associated with endothelium-dependent and/or -independent vasodilatation and/or features of metabolic

syndrome. Twenty-eight non obese women with previous severe preeclampsia and 20 women with a

previous normotensive pregnancy were studied 5 to 6 years after the index pregnancy. The women were

tested for lipid profile, inflammatory status and endothelial activation. The present study indicates a relation

between insulin sensitivity with vascular dilatory function in women with previous preeclampsia.

Furthermore, early onset preeclampsia correlates with impaired insulin sensitivity later in life. 19

Elene conducted a study on preeclampsia in lean normotensive normo tolerant pregnant

women can be predicted by simple insulin sensitivity indexes. The aim of the study was to evaluate 3

insulin sensitivity indexes and oral glucose early and late in pregnancy in a large number of normotensive

pregnant women with a normal glucose tolerance and to test the ability of these indexes to predict the risk of

subsequent preeclampsia. In all, 829 pregnant women were tested with a 75-g, 2-hour oral glucose load in 2

periods of pregnancy: early and late. Preeclampsia developed in 6.4% of the pregnant women and correlated

positively with the 75th percentile of insulin sensitivity with a sensitivity of 79% in the early and 83% in the

late period and a specificity of 97% in both. The study concluded that their high sensitivity and specificity,

these indexes could be useful in predicting the development of preeclampsia in early pregnancy, before the

disease become clinically evident. 20

Audrey conducted a study on work, leisure-time physical activity, and risk of

preeclampsia and gestational hypertension. The authors assessed the independent and combined effects of

work and regular leisure-time physical activity during early pregnancy on risk of de novo preeclampsia (n =

44) and gestational hypertension (n = 172) among women recruited from 13 obstetric practices in the New

Haven, Connecticut, area between 1988 and 1991. Control subjects were normotensive throughout

pregnancy (n = 2,422). Information on time at work spent sitting, standing, and walking and on leisure time

physical time activity before and during pregnancy was collected via face-to-face interviews The studies

concluded that these data suggest that regular physical activity during pregnancy may reduce preeclampsia

risk. 21

SECTION-B STUDIES RELATED TO NURSES MANAGEMENT REGARDING

PREECLAMPSIA

Stacey McCoy conducted a study on risk factors for the development of preeclampsia

includes microvascular diseases, such as diabetes mellitus; vascular and connective tissue disorders;

hypertension; antiphospholipid antibody syndrome; and nephropathy. Several pathophysiological factors

contribute to the development of the preeclamptic state, including vasospasm onset, coagulation system

activation, increased inflammatory response, and ischemia. The study concluded that magnesium sulfate

remains the drug of choice for the prevention and treatment of preeclampsia. Alternative antihypertensive

agents may provide additional benefit in the management of hypertension for preeclamptic patients.22

Bombrys conducted a study on expectant management of severe preeclampsia at 27 to 33

weeks gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of

expectant management. The aim of expectant management of severe preeclampsia between 27 and 33

weeks of gestation is to improve perinatal outcome without compromising maternal safety. Perinatal

outcome is dependent in large part on the gestational age at the time of disease onset and maternal and fetal

status at the time of presentation. This retrospective study evaluated maternal morbidity and perinatal

outcome with expectant management of severe preeclampsia between 27 (0/7) and 33 (6/7) weeks'

gestation, with data stratified by gestational age at the time of onset of expectant management. The

investigators reviewed the medical records of 336 gravid women with severe primary or superimposed

preeclampsia who delivered before 34 (0/7) weeks at an Ohio medical center, to identify a study population

of 66 patients (71 fetuses) between 27 (0/7) and 33 (6/7) weeks. All patients were treated with

corticosteroids for fetal lung maturity. Expectant management resulted in pregnancies being prolonged by a

median of 5 days (range: 3-35). Nineteen (27%) newborns had a birth weight below the 10th percentile for

gestational age, and 6 (8%) had a birth weight below the fifth percentile. Among patients in whom

expectant management was instituted at 27-27 (6/7) weeks, there was 1 neonatal death, 5 cases of

respiratory distress syndrome, 2 cases of bronchopulmonary dysplasia, and 2 cases of necrotizing

enterocolitis, but no cases of grade III or IV intraventricular hemorrhage. Among those whose expectant

management began at ≥32 weeks, neonatal morbidity was minimal. There were 2 cases of transient renal

insufficiency, 5 cases of HELLP syndrome, and 6 cases of pulmonary edema, of which 0, 1, and 3 cases,

respectively, occurred in women in whom expectant management started at ≥32 weeks. The composite

maternal morbidity was 27%; the morbidity was 40% at 32-32 (6/7) weeks and 33% at 33-33 (6/7) weeks.

Although most maternal complications did not appear to be related to the gestational age at the institution of

expectant management, placental abruption was more common among pregnancies managed expectantly at

≤28 weeks than among those >28 weeks (25% vs. 6%, P = 0.05). These data support a role for expectant

management of early severe preeclampsia from 27 to 31 (6/7) weeks'. However, on the basis of these data

and previous findings, the investigators recommend that women with severe preeclampsia at ≥32 weeks'

gestation should be delivered following corticosteroid administration.23

Melanie Chichester conducted a study on cesarean deliveries, a fact that is impacting

perianesthesia nurses across the country. Although many factors have contributed to this phenomenon, the

end result is the need for perianesthesia nurses to update their knowledge base and skill sets to include

standard care during the immediate postpartum period. In addition, the perianesthesia nurse will need to

consider the normal physiological changes of pregnancy and delivery to assess for postoperative

complications unique to obstetrical patients that can significantly affect mortality and morbidity in the

surgical postpartum patient.24

Shakila Thangaratinam conducted a study on tests for predicting complications of

preeclampsia; a protocol for systemic reviews. It was included manual searches of bibliographies of primary

and review articles. An initial search has revealed 19500 citations. Two reviewers independently selected

studies and extracted data on study characteristics, quality and accuracy. Accuracy data are used to

construct 2 × 2 tables. Data synthesis will involve assessment for heterogeneity and appropriately pooling

of results to produce summary Receiver Operating Characteristics (ROC) curve and summary likelihood

ratios. This review generated predictive information and integrates that with therapeutic effectiveness to

determine the absolute benefit and harm of available therapy in reducing complications in women with pre-

eclampsia.25

Von Dadelszen Pet conducted a study on recommendations for the comprehensive

evaluation and management of organ dysfunction associated with preeclampsia are included. The main

points in the review are: Preeclampsia is a systemic disorder that may affect many organ systems; For

preeclampsia remote from term (<34 weeks), expectant management improves perinatal outcomes, but

requires obsessive surveillance to mitigate maternal risks and is a "package"; Initial assessment and

ongoing surveillance of women with preeclampsia should include assessment of all vulnerable maternal

organs as well as of the fetus; Initiate antihypertensive drug treatment immediately if BP >160 mmHg or

BP more than 110 mmHg, or if BP 140-159 mmHg and/or BP 85-109 mmHg (prepregnancy renal disease

or diabetes); The treatment of nonsevere pregnancy hypertension should include a treatment goal of BP

80-105 mmHg (depending on practitioner preference), with one of the following agents, Methyldopa,

Labetalol, Nifedipine, or, with special indications (renal or cardiac diseases), diuretics; Drugs to avoid:

angiotensin-converting enzyme inhibitors; angiotensin II receptor antagonists; and atenolol; For the acute

management of severe hypertension, initially reduce BP by 10 mmHg and maintain the blood pressure at

or below that level with either Nifedipine or Labetalol; For both prophylaxis against and treatment of

eclampsia, MgSO4 (4 g IV stat, then 1 g/hr); For recurrent seizures, MgSO4 (2g IV stat, then increase to

1.5 g/hr); Total fluid intake should not exceed 80 ml/hr; tolerate urine outputs as low as 10 ml/hr; Early-

onset and/or severe preeclampsia predict later cardiovascular morbidity and mortality; it would seem

prudent to offer such women screening and lipid lowering interventions.26

American Family Physician conducted a study on diagnosis and management of

preeclampsia that this disorder affects approximately 5 to 7 percent of pregnancies and is a significant cause

of maternal and fetal morbidity and mortality. Preeclampsia is defined by the new onset of elevated blood

pressure and proteinuria after 20 weeks of gestation. It is considered severe if blood pressure and

proteinuria are increased substantially or symptoms of end-organ damage (including fetal growth

restriction) occur. There is no single reliable, cost-effective screening test for preeclampsia, and there are no

well-established measures for primary prevention. The study concluded that management before the onset

of labor includes close monitoring of maternal and fetal status. Management during delivery includes

seizure prophylaxis with magnesium sulfate and, if necessary, medical management of hypertension.

Delivery remains the ultimate treatment. Access to prenatal care, early detection of the disorder, careful

monitoring and appropriate management are crucial elements in the prevention of preeclampsia related

deaths.27

6.3. STATEMENT OF THE PROBLEM

“A study to assess the knowledge regarding pre-eclampsia and its management among

the staff nurses in selected hospital at Bangalore.”

6.4. OBJECTIVES

To assess the existing knowledge of staff nurses regarding pre-eclampsia.

To identify staff nurses knowledge gap regarding pre-eclampsia and its management.

To associate the staff nurses level of knowledge regarding preeclampsia and its management with

the selected demographic variables.

6.5. RESEARCH HYPOTHESES

H1: There will be significant association between the level of knowledge of staff nurses regarding

preeclampsia and its management with the selected demographic variables.

6.5. OPERATIONAL DEFINITIONS

1. Assess: Refers to the method of evaluating knowledge of the nurses working in selected hospitals

regarding preeclampsia and its management with the help of structure questionnaire.

2. Knowledge: It is the nurses understanding and ability to answer questions regarding preeclampsia and its

management as elicited by structured questionnaire which is designed by the investigator.

3. Pre-eclampsia: It is a multi system disorder of unknown etiology characterized by development of

hypertension to the extent of 140/90 mm Hg or more with proteinuria after the 20th week in a previously

normotensive and non- proteinuric patient.

4. Management: It is the act of managing preeclampsia with efficiently and effectively by the nurse.

6.7ASSUMPTIONS

The study subject will have some knowledge regarding preeclampsia and its management.

Their knowledge of preeclampsia and its management depend on their experience in selected

hospitals.

Their knowledge of preeclampsia and its management depend on their educational qualification.

6.8. DELIMITATIONS

The study is delimited to 100 samples.

The study delimit to nurses working in selected hospitals of Bangalore city.

6.9. PROJECTED OUTCOME

The study will be conducted to assess the knowledge regarding preeclampsia and its management among

nurses working in selected hospitals which will help to improve their skill to manage pre-eclamptic cases.

7.0. MATERIALS AND METHODS

7.1 SOURCE OF DATA

7.1.1 RESEARCH DESIGN: Descriptive non-experimental research design.

7 .1.2 SETTING FOR THE STUDY: The study will be conducted in a selected maternity hospital

at Bangalore.

7.1.3 POPULATION: Data will be collected from nurses working in selected hospitals at Bangalore.

7.2 METHOD OF COLLECTION OF DATA:

7.2.1 SAMPLING TECHNIQUE: Non -probability convenient sampling technique.

7.2.2 VARIABLES UNDER THE STUDY:

Attribute variables: Age, Experience, Educational Qualification etc.

7.2.3 SAMPLE SIZE: 100 nurses working in selected hospitals.

7.2.4 DURATION OF STUDY: 4 weeks.

7.2.5 INCLUSIVE CRITERIA FOR SAMPLING:

Nurses working in selected hospitals.

Those who are willing to participate in the study.

7.2.6 EXCLUSIVE CRITERIA FOR SAMPLING:

Nurses who are available during the study period.

7.2.7 INSTRUMENT INTENDED TO BE USED:

Part I: Demographic data consist of professional educational status, number of year of

experience in nursing service, area of exposure in selected hospitals.

Part II: Structured questionnaire.

7.2.8 METHOD OF DATA COLLECTION:

The investigator will administer the structured knowledge questionnaire to assess the knowledge to

collect the data from the subject.

7.2.9 LIMITATIONS:

The study is limited only to those nurses who are working in selected hospitals at Bangalore and is

limited only for 4 weeks duration.

7.2.10 PILOT STUDY PLAN: Only 10% of the sample will be taken for the pilot study.

7.2.11 7.2.11 METHOD OF DATA ANALYSIS AND INTERPRETATION

The investigator will analyze the data obtained by using descriptive and inferential statistics, the

plan of data analysis will be as follows:

Organize the data in a master sheet/computer

Mean frequency, standard deviation and percentage.

Chi-square and correlation co-efficient.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE

CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO, PLEASE DESCRIBE

BRIEFLY

YES

7.4 HAS ETHICAL CLEARENCE BEEN ABTAINED FROM YOUR INSTITUTION IN CASE OF

7.3?

Yes, the ethical clearance will be obtained from concern authorities and consent will be taken

from the subject. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the study

will be maintained with honesty and impartiality.

7.5. ETHICAL COMMITTEE:

Title of the topic

A study to assess the knowledge regarding pre-eclampsia and

its management among the staff nurses working in a selected

hospital at Bangalore.

Name of the candidate Ms. OINAM ROMITA DEVI

Course and the subject MSc Nursing in Obstetrics & Gynaecology

Name of the guide Mrs. Julie Justin. A

Ethical committee Approved

8.0 LIST OF REFERENCES

1. www.medindia.net.

2. www. wikepedia.com.

3.www.merinews.com.

4. Jai Prakash et al. Spectrum of kidney diseases in patient with preeclampsia.2009; Vol-58:Page 245-247.

5. Christopher W. Redmam et al. Latest Advances in Understanding Preeclampsia: American Journal of

Therapeutics. 2009; Vol-16(4): Page284-288.

6. Errol R. Norwitz et al. Preeclampsia Prevention and Management. Reproductive Sciences ; 2000: Vol-

7 (1) : Page 21 -36.

7. American Society for investigation Pathology. 2008; Vol- 172: Page 1571 – 1579.

8. Winer N Lastest developments: management and treatment of preeclampsia. J Gynecol obstct Biol

Report (Paris). 2008; Vol-37(1): Page 5-15.

9. Anne L Berends etc; Familial aggregation of preeclampsia and intrauterine growth restriction in a

genetically isolated population in the Netherlands. European Journal of Human Genetics. 2008; Vol-16:

Page1437-1442.

10 .Janet M Cotvov et al. Risk of early or sever preeclampsia related to pre-existing condition. Department

of Epidemiology, University of Pittsburgh, PA, USA. November 7; 2006.

11. Kirsten Duckitt et al. Risk factor for preeclampsia at Antenatal Booking: Systematic receives of

Controlled Studies. Department of Obstetrics and Gynaecology, John Radcliff Hospital, Oxford. 2005; Vol-

330: page 565.

12.Carla Abouzahr. Global burden of maternal death and Disability. World Health Organization, Geneva,

Switzerland. 2003; Vol- 67(1) : page 1-11.

13. The Cost of Preeclampsia in the USA. Global Programme to Conquer Preeclampsia/ Eclampsia.2002;

World Health Organization.

14. Dekker GA. Management and Monitoring of Severe Preeclampsia. European Journal of Obstetrics,

Gynecology, and Reproductive Biology.2001; Vol- 96(1): Page-8-20.

15. Basavanthappa BT.Nursing Research. Edition second; Jaypee Brothers Medical Publishers (P)

LTD ,New Delhi: Page 92 103.

16. Edsor Vieira da Cunha Filho et al ;Flow-Mediated dilation in the differential diagnosis of preeclampsia

Syndrome. Arquivos Brasileiros Decardiologia. 2010; Vol-94(2):Page 66-78.

17. Whitney B. You MD et al. Factors associated with Patient Understanding Preeclampsia September 22,

2010;Vol-23:Page 507-512.

18. Marie – Elise Nijdam et al. Cardiovascular risk factor Assessment after preeclampsia in primary

care .2009;Vol-10(77):Page 147-149.

19. Katja H. Lampinen et al. A relationship Between Insulin Sensitive and vasodilatation in women with a

History of preeclampsia pregnancy.Hypertension. 2008; Vol- 52: Page 394-401.

20. Elena Parretti et al. Preeclampsia team Normotensive Normotolerant pregnancy women can be

predicted by Simple insulin sensitive indexes. American Heart Association; 2006; Vol-47,Page-449.

21. Andrew F. Seftlas et al. Work, Leisure-time Physical Activity, and Risk of preeclampsia and

Gestational Hypertension. Oxford Journal Medicine.2003; Vol- 160(8): Page 758-765.

22. Stacey Mc Coy et al. Pharmacotherapeutic options for the treatment of preeclampsia. American

Journals of Health system pharmacy. 2009; Vol 66(4): Page 337-344.

23. Bombay et al. Expected management of serve Preeclampsia at 27 (0/7) to 33 weeks Gestation: maternal

and prenatal outcome according to gestational age by weeks at onset of expectant management. Obstetric

complication. 2009; Vol- 64(9): Page 579-581.

24. Melanic chichester. Caesarean Delivery is rising implication for theparianesthesia Nurse. Department of

obstetrics and Gynecology, University of Connecticut Health centre, Farmington, 2008; Vol-23(5): Page

321- 334.

25. Shakila Thangaratinam. (BMC) Bio Medical Central Pregnancy Childbirth. 2008; Vol-8: Page 38.

26. Von Dadelszen P et al. A journal and virtual Library. 2007; Vol-12 : Page 2876-2889.

27. Diagnosis and Management of preeclampsia. American Family Physician; December 2004; Vol-70(12).

9 Signature of the candidate

10 Remarks of the guide

Studies like this will help the nurses to update

their knowledge regarding pre-eclampsia and its

management and influence the mothers in turn to

have a safe delivery.

11

Name and designation of

11.1 Guide Prof. Julie Justin. A, M.Sc Nursing in

Obstetrics & Gynaecology

11.2 Signature

11.3 Co-Guide(if any) -

11.4 Signature

11.5 Head of Department Prof. Julie Justin. A

11.6 Signature

12

12.1 Remarks of the

Principal

This study will provide adequate information to

the staff nurses regarding pre-eclampsia and its

management

12.2 Signature