Compliance on Antenatal Care advices Among Antenatal Mothers with Pregnancy induced Hypertension in selected Hospital Bangalore.

 

Ms. Prathima. P¹*, Dr. Mrs. S. Anuchitra²

¹HOD, OBG Department, Universal College of Nursing, IIMB Post, Arekere Micolayout Bennarghatta Main Road, Bangalore – 76

²Vice –Principal and HOD OBG Department, P.D Bharatesh College of Nursing, Belgaum, Karnataka -590020

 

ABSTRACT:

Title: Compliance on antenatal care advices among Antenatal Mothers with Pregnancy Induced Hypertension in selected Hospital Bangalore.

Objectives: To assess and associate compliance on antenatal care among Antenatal mothers with pregnancy Induced hypertension.

Method: A non experimental descriptive design was utilized among 50 antenatal mothers who were diagnosed as Pregnancy induced hypertension during their antenatal period selected as samples by using purposive sampling technique. Demographic data and compliance were collected by interview method by using checklist.  

Results: Data were analysed by using SPSS and MS excel. This study represents that 74% of samples were Non compliant, 26% of them were partially compliant. None of the samples were Compliant to the antenatal care advices. Regarding to area wise compliance: diet 4% were partially compliant, 66% of the samples was partially compliant with medication. 46% of the samples were compliant towards physical activity and only 2% of them were partially compliant on monitoring of maternal and fetal wellbeing. There was no Association between demographic variables and compliance

Conclusion: Health maintenance is an important aspect of prenatal care. Participation of the mother in the care ensures the prompt reporting of the possible problems. In order to reduce the increasing maternal mortality rates, women with hypertensive disorders in pregnancy should be inform of their disease, satisfactory medical information, the importance of compliant to the antenatal care advices, and  the consequences of the pregnancy  to the mother and baby  if she does not compliant, also should be provided by their health care providers.

 

INTRODUCTION:

Preeclampsia is a disease of multiple organ systems disorder that is unique to pregnancy and is often associated with significant maternal and neonatal morbidity and mortality, especially when it is severe and occurs well before term.

 

Because  the only cure for severe preeclampsia is delivery, there is universal consensus to deliver patients if  the disease develops after 34 weeks of gestation or if there is evidence of maternal complications and fetal distress before that time.¹

 

Despite the severity of disease of both preeclampsia and gestational hypertension, differences in risk factors between severe preeclampsia and gestational hypertension may increase controversies over expectant versus aggressive treatment, and there is insufficient literature on Asian women with preeclampsia and gestational hypertension regarding the issue of maternal complications. As there is a discrepancy between the definition of mild to moderate  preeclampsia and gestational hypertension in terms of proteinuria, the less than 300 mg/24 hours of slight proteinuria may not belong to the preeclampsia group.²

 

The definition of gestational hypertension was a systolic BP of at least 140 mmHg and/or a diastolic BP of at least 90 mmHg on at least two occasions at least 6 hours apart after the 20th week of gestation in women known to be normotensive before pregnancy and before 20 weeks of gestation. The BP recordings used to establish the diagnosis should be made no more than 7 days apart. Women with gestational hypertension and less than 1+ to 2+ proteinuria were included in our study cohort. Proteinuria was defined as the urinary excretion of ≥ 0.3 g of protein in a 24-hour specimen. This will usually correlate with ≥30mg/dL (≥1+ reading on dipstick).  Significant proteinuria is demonstrated when there is more than 500 mg of protein as above.³

 

Ten million women develop preeclampsia each year around the world. Worldwide about 76,000 pregnant women die each year from preeclampsia and related hypertensive disorders. And, the number of babies who die from these disorders is thought to be on the order of 500,000 per annum. In developing countries, a woman is seven times more likely to develop preeclampsia than a woman in a developed country. From 10-25% of these cases will result in maternal death.⁴

 

The primary aim of antenatal care is to achieve a healthy baby from the healthy mother at the end of the pregnancy. Ideally this care should begin soon after the conception and continue throughout pregnancy. The antenatal care includes the regular and periodic examination and advices regarding diet, hygiene, rest and sleep, bowel, clothing, shoes and belt, dental care, care of the breasts, coitus, travel, smoking and alcohol, immunization and warning signs of pregnancy. Very essential is the early identification of complications.⁵

 

The antenatal “booking appointment” should take place at 8–12 weeks gestation and may take place in either a hospital or in the community. The booking appointment is the time at which a detailed history is taken, usually by a midwife, and represents the first opportunity to check a woman’s ‘risk status’; women should be screened for risk factors for gestational diabetes and pre-eclampsia at the booking appointment so that an appropriate monitoring and care plan can be implemented in good time where these are identified.⁶

 

Compliance should not be viewed as coercive obedience but as a negotiated agreement. In this sense compliance is part of the helping relationship between the health professionals and patients. It is the outcome of nurse patient communication and interaction. It may be defined as extent to which an individual chooses behaviours that coincide with the clinical prescription. Achieved through negotiations between the health professionals and patient. Increased attention to the area of compliance has been generated because of the impact of compliance or non compliance of health outcomes. Non compliance is there for costly. It wastes the medical and human resources, and may have serious consequences for the patients and their families or significant others.⁷

 

Preeclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. Eclampsia is a life threatening emergency that continues to be a major cause of serious maternal morbidity and is still the leading cause of maternal mortality worldwide. Appropriate prenatal care and early hospitalization of patients with pre-eclampsia can markedly reduce eclampsia.

 

OBJECTIVES OF THE STUDY:

1.      To assess  compliance on antenatal care practices  among  mothers with pregnancy induced hypertension

2.      To find out an association between compliance and demographic variables.

 

MATERIALS AND METHODS:

To achieve the objectives a Non experimental descriptive design was adopted. After obtaining administrative permission from the authorities of hospital Purpose of the study was explained to them and an oral consent was obtained before starting the study from each participant and they were assured that study is only for academic purpose, information obtained from them will be kept confidential. The population of the study included antenatal mothers who were diagnosed with pregnancy induced hypertension in the outpatient department who were in third trimester (above 32 weeks of gestation) in selected hospital Bangalore. Thus 50 mothers were selected using purposive sampling technique.

 

Tools developed by the researchers were validated by experts and tested for its reliability. The equivalence of this tool was checked by inter observer method by using the formula number of agreements/ number of agreements+ number of disagreements. The reliability obtained for maternal outcome checklist was r1 = 0.95 which indicating that the tools were reliable. Tools used were, Tool 1: demographic variable, Tool 2 that was aimed at to find out compliance on antenatal care practices using rating scale which includes Diet( 6 items, 2 items are negative scoring item) Medication (4 items, 1 items was negative scoring item), physical activity(4 items) and maternal and fetal wellbeing (2 items, 1 items was negative scoring item).Scoring were ranged from 1 to 3 respectively Never, Sometimes, always. Compliance of the samples was categorized as Non compliant, partially compliant and Compliant.

 

The study was carried out using interview technique. Relevant information (demographic data) from the study group was collected for which the investigator personally interviewed each woman with the help of background data sheet. The responses were recorded in the space provided in the questionnaire. And the compliance was assessed by rating checklist.

 

 

RESULTS:

Data were tabulated and analysed. Demographic variables and categories of compliance were presented as Frequency and percentage. Chi-square was used to find the association between compliance and demographic variables.

 

Table 1: Distribution of demographic variables

S.No	Demographic variables		Frequency	Percentage
			N	%
1.	Age in years	<20	5	10
		21-25	28	56
		26-30	14	28
		31-35	3	6
2	Education	Primary School	1	2
		Middle school	4	8
		Secondary education	23	46
		PUC	14	28
		Diploma	6	12
		Graduate	2	4
3.	Religion	Hindu	39	78
		Christian	2	2
		Muslim	9	18
4.	Income per month	<5000	7	14
		5001-10000	21	42
		10001-15000	15	30
		15001-20000	6	12
		>20001	1	2
5.	Occupation	Home maker	46	92
		Skilled worker	2	4
		Unskilled worker	2	4
6.	Parity	First pregnancy	24	48
		Second pregnancy	17	34
		Third pregnancy	8	16
		Fourth pregnancy	1	2

 

Fig  1:  Compliance on area wise.

 

Table 2: Categories of Compliance

	Noncompliant		Partially compliant		Compliant		Mean	Std. Deviation
Compliance on antenatal care	N	%	N	%	N	%
	37	74	13	26	-	-	13.22	4.581

DISCUSSION:

Compliance to treatment is a key link between process and outcome in medical care. Rationally prescribed medications are a principle intervention in primary care and a major element when considering the economics of health care. Poor compliance with a therapeutic regimen may have a major impact on clinical outcome.¹⁰

 

The present study indicates that samples were not compliant to the antenatal care and advices.  Table 1 shows distribution of demographic variables in frequency and percentage. 56% of the samples were belongs to the age group of 21-25 years. Majority of them 46% were educated up to secondary education. 78% of them were from Hindu religion. 42% of them were earning up to Rs. 10,000/- per month. Majority of the samples were Homemakers. And 48% of them were primi gravid mothers. Table 2: represents that 74% of samples Non compliant, 26% of them were partially compliant. None of the samples were Compliant to the antenatal care advices. Figure 1 shows that area wise percentage distribution of compliance. Regarding diet 4% were partially compliant, 66% of the samples were partially compliant with medication. 46% of the samples were compliant towards physical activity and only 2% of them were partially compliant on monitoring of maternal and fetal wellbeing. There were no association between compliance and demographic variables.

Below cited studies were stating the importance of appropriate dietary pattern and compliance to treatment will reduce the complications. 

 

In a randomized controlled trial 201 healthy nulliparous women were randomly allocated by means of a computer generated randomization list. From 20 weeks of gestation until delivery they received either 2 g of oral elemental calcium (n = 103) per day or an identical placebo (n = 98) The incidence of gestational hypertension was 6.18% in the calcium group and 17.20% in the placebo group (RR = 0.28; 95% CI 0.08-0.80), and the incidence of preeclampsia was 2.06% in the calcium group and 11.82% in the placebo group (RR = 0.13; 95% CI 0.01-0.64). In conclusion calcium supplementation given in pregnancy to nulliparous women reduces the incidence of pregnancy induced hypertension.⁸

 

Another study was to estimate the association between dietary patterns during pregnancy and the risk of preeclampsia in 23,423 nulliparous pregnant women at gestational week 15. The pregnancy outcomes were obtained from the Medical Birth Registry of Norway. Principal component factor analysis identified 4 primary dietary patterns that were labeled: vegetable, processed food, potato and fish, and cakes and sweets. Women with high scores on a pattern characterized by processed meat, salty snacks, and sweet drinks were at increased risk [OR for tertile 3 vs. tertile 1: 1.21; 95% CI: 1.03, 1.42]. These findings suggest that a dietary pattern characterized by high intake of vegetables, plant foods, and vegetable oils decreases the risk of preeclampsia, whereas a dietary pattern characterized by high consumption of processed meat, sweet drinks, and salty snacks increases the risk. ⁹

 

CONCLUSION:

Health maintenance is an important aspect of prenatal care. Participation of the mother in the care ensures the prompt reporting of the possible problems. Prenatal care is one of the models of primary and secondary prevention of disease. In order to reduce the increasing maternal mortality rates, women with hypertensive disorders in pregnancy should be inform of their disease and satisfactory medical information should be provided by their health care providers.

 

Most of the complications, related to pregnancy induced hypertension are occurring due to maternal negligence or unawareness on the disease and its management. Nurses have more responsibility on creating awareness among antenatal mothers  regarding  importance of consuming calcium rich diet, adding more vegetables and fruits, avoiding salty, add needed salt in the food, and educating about monitoring maternal and fetal wellbeing by facilitating distribution of booklets, handouts, charts, regularly to all out patient department of hospitals health clinics in rural and urban and they can conduct workshops and camps regarding pregnancy induced hypertension in hospital setup in order to create awareness.

 

REFERENCES:

1.       Jenkins SM, Head BB, Hauth JC. Severe preeclampsia at < 25 weeks of gestation: maternal and neonatal outcomes. American Journal of Obstetrics and Gynaecology 2002; 186:790–5.

2.       North RA, Brown MA. Gestational hypertension: how much should we worry? In: Belfort MA, Thornton S, Saade GR, eds. Hypertension in Pregnancy, 1st edition. New York: Marcel Dekker, 2003:189–92.

3.       Report of the National High Blood Pressure Education Program. Working group report on high blood pressure in pregnancy. American Journal of Obstetrics and Gynaecology 2000;183:S1–22.

4.       Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNIFPA and the World Bank, Geneva, World Health Organization, 2007.

5.       Park K. Preventive and social Medicine. 18^thed. Jabalpur: Banarsidas Bhanot; 2007. p. 417,438.

6.       National Institute for Clinical Excellence, Antenatal care: NICE Clinical Guideline 62. 2010. http://guidance.nice.org.uk/CG62/NICEGuidance/pdf/English

7.       Donna R.Falvo. Effective patient education – a guide to increase compliance. Jones and Bartlett publishers interaction, 2004 7-8,219-223.

8.       Purwar M, Kulkarni H, Motghare V, Dhole S. Calcium supplementation and prevention of pregnancy induced hypertension. Journal of Obstetrics and Gynaecology Res. 1996 Oct;22(5):425-30.

9.       Brantsaeter AL, Et.al A dietary pattern characterized by high intake of vegetables fruits, and vegetable oils is associated with reduced risk of preeclampsia in nulliparous pregnant Norwegian women. Journal of Nutrition. 2009 Jun; 139(6):1162-8. Epub 2009 Apr 15.

10.     Vermeire E, H. Et al. Patient adherence to treatment: three decades of research. A comprehensive review. Journal of Clinical Pharmacy and Therapeutics (2001) 26, 331 – 42.

 

 

Received on 30.07.2014           Modified on 14.08.2014

Accepted on 22.09.2014           © A&V Publication all right reserved