Assessment of Nurses Knowledge Regarding Cause and Management of Abortion at Rajshahi Medical College Hospital

Posted on 23rd Sep 2024 09:33:16 PM Medicine


1.1 Introduction

Termination of pregnancy is one of the most common gynecological procedures. This procedure is annually performed on approximately 11,000 women An abortion is a pregnancy that ends before the baby can survive outside the womb because it has not yet reached viability. An abortion may be early - during the first 14 weeks of pregnancy, or late. The vast majorities are early - only about 1% of abortions are late.

Each year, some 205 million women throughout the world become pregnant and nearly one in five (20%) chooses to terminate the pregnancy. Of these 42 million induced abortions, approximately 19 to 20 million are estimated to be unsafe. To increase choice and access to safe abortion services and to reduce morbidity and mortality from unsafe abortions, non-surgical methods of abortion, known as medical abortion, have been developed which use safe and effective drug-based methods to terminate an unwanted pregnancy. Much progress has been made in developing effective and acceptable regimens and in the registration and affordability of drugs, all of which contribute to making medical abortion a safe, viable alternative to surgical abortion procedures such as vacuum aspiration, sharp curettage, and intra-uterine injections. Despite these significant advances, medical abortion remains under-utilized and inaccessible for many women, particularly in developing countries. Gaps remain in understanding and overcoming the social, behavioral, financial, legal, policy and programmatic obstacles that would make medical abortion available to those women who desire to use it.

Recognizing these gaps in knowledge, the Special Programme of Research, Development and Research Training in Human Reproduction at the World Health Organization (WHO) is launching a research initiative specifically focusing on medical abortion. The Special Programme is inviting social science and operations research proposals or concept papers which seek to provide an in-depth understanding of issues related to improving access to medical abortion in low-income settings. Investigators are encouraged to identify and develop a research topic that is of high priority in their local context and that will have a significant impact on programme and policy development. Suggested research topics are elaborated below and include, but are not limited to, the following areas: perspectives of women seeking abortion and of providers; strategies for training and retaining new providers and expanding the pool of trained providers in public-sector facilities; identifying barriers to access; testing interventions to improve pre- and post-abortion care provided to women who use medical abortion; and introducing medical abortion into public and private sector abortion and reproductive health services.

1.2 Definition of abortion

Interruption of pregnancy before 28 weeks with or without expulsion products of conception is called abortion. 

OR

Abortion is a process of partial or complete separation of the products of conception from the uterine wall with or without partial or complete expulsion from the uterine cavity before the age of viability.                     

1.3 Causes of abortion

The causes of abortion are given bellow:

Maternal: General: Endrocrine imbalance (eg: diabetes mallitus) 

- Chronic nephritis

- Hypertension

- Syphilis     

Local: Irritation or damage of uterus (any abdominal operation) eg: Fibroid 

- Congenital abnormalitis of uterus

- Cervical incopetence

b) Ovular: Genetic abnormality

- Hydatidiform mole

c) Traumatic: Mental- eg; worried, anxity , shock 

- Physical – eg: kick , boul        

1.4  Risk factors of abortion

The risk factors of abortion are following given bellow:

a) First trimester traveling

b) Heavy work

c) History of previous abortion

d) Anaemia

e) First trimester and last trimester coitus                

f) Trauma

1.5  Sign and symptoms of abortion

The sign and symptoms of abortion are following given bellow:

a) bleeding per vagina

b) continuation lower abdominal pain

c) history of expultion of fleshy mass per vagina

d) subsidence of abdominal pain 

e) vaginal discharge with fouel smelling

f) temperature may be raise

g) cervix feels firm

1.6 Investigation of abortion

The investigation of abortion are:

a) Blood-for haemoglobin, haematocrit, ABO and RH grouping, culture and sensitivity.

b)  Urine for immunological test, culture

c) Ultrasonography  

d) Plain X- ray for abdomen

e) Cervical or high vaginal swab for culture and sensitivity 

1.7 Management of abortion

The management of abortion are following given bellow:

a) Hospitalization of the patient.

b) Bed rest of the patient.

c) Open I/V channel and give intravenous fluid.

d) Give antibiotics and analgesic.

e) Give blood transfusion if needed.

f) Maintain intake output chart.

g) Evacuation of the uterus by dilatation and curettage.

1.8 Complication of abortion

The  complication of abortion are following given bellow:

a) Profuse bleeding

b) Perforation of the uterus

c) Sepsis

d) Placental polyp

e) Blood coagulation disorder

f) General peritonitis

g) Dyspareunia

h) Intrauterine fetal death in next pregnancy

i) Emotional depression          

1.9 Prevention of abortion

The  prevention of abortion are following given bellow:

a) Avoid first trimester traveling

b) Avoid heavy work

c) Avoid first trimester and last trimester coitus

d) Correction of anaemia

e) Avoid trauma

1.10  Justification

Abortion should be considered as a serious problem in Bangladesh, because of its adverse effects on patients, their families and the economy of the country. It increases the cost of both hospital & family expenditure. One of the main principles of nursing care is that it should not make any harm to any patient .  The role of nurses in gynae ward has become important in health care due to their ability to promote health. Education thus improves patient’s outcome in terms of quality of life. Nurses play an important role in preventing the abortion by understanding how and why abortion occurs. When abortion occurs, the patient suffers physically, mentally and financially as well. Here the patients have quite often stay longer in the hospital. Consequently it requires excess medicine, diet and beds being occupied among others excesses. Ultimately, the factors are not only wasting of Government resources but also causing suffering for the patients physically, mentally and of course financially as well.

Application of knowledge of nurses can help in preventing the abortion that would help to reduce the hospital expenditure directly. I have selected this problem for the research purposes because there is a common problem in Bangladesh. If it is possible to address, concerned families will not require paying extra cost for treatment purpose and hospital will provide more service to others who need surgical treatment. In order to reduce risk of abortion nurses should apply their knowledge and skills appropriately in providing better nursing care which might help them to prevent abortion.

1.11 Objectives of the study

General objectives:

The general objectives of this research were improving Nurses Knowledge Regarding Cause and Management of Abortion for proper management of abortion patients by education.

Specific Objectives:

The objectives of this research were to-

- assess the knowledge  of nurses about  abortion in RMCH

- assess the knowledge of nurses about causes of  abortion

- identify knowledge of nurses about risk factors of  abortion

- find out the sign and symptoms of  abortion

- asses the knowledge of nurses about prevention of abortion

- identify the knowledge of nurses about the proper management of  abortion.

1.12 Research question

What is the knowledge of nurses regarding cause and management of abortion?

1.13 Variables of the study

Independent variables includes:

- Age

- Sex

- Marital status

- Religion

- Professional qualification

- Length of service

- Specialization course

- Length of specialization course

- Monthly income

Dependent variable includes: assessment of  Nurses knowledge regarding cause and management of abortion.

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CONTENTS

Abstract

CHAPTER – 1: INTRODUCTION

1.1 Introduction

1.2 Definition

1.3 Cause of abortion

1.4 Risk factor of abortion

1.5 Sign and symptoms of abortion

1.6 Investigation of abortion

1.7 Management of abortion

1.8 Complication of abortion

1.9 Prevention of abortion

1.10 Justification 

1.11 Objective

1.12 Research question

1.3 Variables

CHAPTER – 2: REVIEW OF LITERATURE

2.1 Review of Literature 

CHAPTER – 3: MATERIALS AND METHODS

3.1 Design of study

3.2 Study place

3.3 Study duration

3.4 Study population

3.5 Sample size

3.6 Inclusion criteria

3.7 Sampling technique

3.8 Data collection instrument

3.9 Data collection procedure

3.10 Data analysis and interpretation

3.11 Validity and Reliability

3.12 Translation of the instrument

CHAPTER – 4: RESULTS

4.1 Demographic information on nurses

4.2 Knowledge related question to the nurse

CHAPTER – 5: DISCUSSION

5.1 Discussion

CHAPTER – 6: CONCLUSION

6.1 Conclusion

CHAPTER – 7: REFERENCES

7.1 Reference

CHAPTER – 8: APPENDIX

8.1 Appendix

List of Tables

Table 1: Demographic information of the participated nurses

Table 2: Knowledge related question to the nurses

List of Figures

Figure 1: Distribution of the Nurses age

Figure 2: Gender Distribution of the participated nurses.

Figure 3: Distribution of the Nurses knowledge about abortion



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