Effectiveness of deep breathing exercise on Nausea, Vomiting among Primigravida antenatal with Hyperemesis gravidum admitted at Antenatal ward of Pravara Rural Hospital, Loni (Bk)

 

Ms. Pallavi Sahane*, Mrs. Bharti Weljale

Pravara Institute of Medical Sciences, College of Nursing, Loni, Bk. Dist: Ahmednagar (M.S.), India. 413736

 

ABSTRACT:

Background: Nausea and vomiting are common symptoms during early pregnancy Hyperemesis gravidum represents a severe in tractable nausea and vomiting before the 20^th week of gestation. Nausea and vomiting are commonly experienced by women in pregnancy (NVP). Symptoms are usually limited to the first trimester, but can persist until birth. Both mild and more severe symptoms can have negative effects for the mother, her unborn child, and the family. Deep breathing exercise and progressive relaxation therapy are more popular. Deep breathing exercise is also found to reduce the nausea and vomiting. This awareness made the researcher to provide the breathing techniques such as deep breathing exercise during the first trimester of pregnancy. Vomiting affects more than 50% of women in early pregnancy and nausea is present in 70-80%. Many times, it is unreported because it is considered to be the normal part of pregnancy. Objectives: To assess effectiveness of deep breathing exercise on nausea and vomiting among primi gravida with hyperemesis gravidum Antenatal mother in comparison with Experimental and control group Material and Method: A Quasi experimental research study undertaken Antenatal Wards of Pravara Rural Hospital Loni BK. A total of 60 primigravida hyperemesis gravidum Antenatal mother were selected with the help of. Non randomized purposive sampling technique was used to assess effectiveness of Deep breathing exercise to reduced nausea and vomiting among primi hyperemesis gravidum mother. Modified Rhodes Index Scale was used for assess the nausea and vomiting structured observational checklist was used to assess nausea and vomiting. the study comprises total 60 primigravida mother. they were grouped as study group and control group through Non randomized purposive sampling technique. . One group received Deep breathing exercise other are resting. the researcher then observed the group to determine the effect of Deep breathing exercise Result: The collect data was analyzed by descriptive and inferential statistic. The results revealed that a significant percentage of the present study group show that Primi gravida hyperemesis antenatal mother had lower mean score (19.33 ± 3.688) which is 64.43% of total score indicate moderate level of nausea and vomiting whereas in control group the mean score was 23.46 ± 2.62) which is 78.2% of total score indicates the severe level of nausea and vomiting. The paired ‘t’ test was calculated and the value is 5.14 which is higher than the table value, indicate the statically significant difference. Finding revealed that there was significant association found between Nausea and vomiting and Demographic variables like Age, Type of diet and Mothers weight at 0.05level as there was significant association between the variable the stated null hypothesis H02 is rejected and H2 is accepted. Conclusion: Therefore, it was concluded from the statistical tests that practicing selected Patterned deep breathing technique was effective in reduction of nausea and vomiting among primigravida hyperemesis gravidum Antenatal mother. Analysis of data showed that there was significant difference between pretest and posttest nausea and vomiting scores of nauseas and vomiting in experimental group after practicing Patterned deep breathing technique and without practicing Patterned of deep breathing technique control group.

 

 

INTRODUCTION:

World Health Organization stated that the pregnancy and childbirth are special events in woman’s lives and indeed in the lives of their families. This can be a time of great hope and joyful anticipation. It can also be a time of fear, suffering and even death. Although pregnancy is not a disease but a normal physiological process, it is associated with certain risks to health and survival both for the woman and for the infant she bears. These risks are present in every society and in every setting. In developed countries they have been largely overcome because every pregnant woman has to take special care during pregnancy and childbirth. In developing countries where each pregnancy represents an journey into the unknown from which all too man woman never return, due to lack of care provision. ¹ Gupta N mentioned that nature has best owed a woman with the capability of producing children, the process that makes her mother. But sad part is that, this normal life furthering process of procreation can lead to as grim a situation as death. At least 40% of all pregnant women will experience some type of complications during their pregnancies. For about 15% these complications will be potentially life threatening, and will require immediate obstetric care. Maternal death also compromises the health and survival of infants and children they have behind.²

 

Nausea and vomiting in pregnancy is extremely common. Hyperemesis gravidarum (HEG) is the most severe form of nausea and vomiting in pregnancy. A continuous spectrum of the severity of nausea and vomiting ranges from the nausea and vomiting that occurs in most pregnancies to the severe disorder of Hyperemesis gravidarum. Studies estimate that nausea and vomiting occur in 50-90% of pregnancies. This is supported by studies showing that women who had nausea and vomiting were less likely to have miscarriages and stillbirth.² Hyperemesis gravidarum is characterized by persistent nausea and vomiting associated with ketosis and weight loss (>5% of prepregnancy weight). Hyperemesis gravidarum may cause volume depletion, electrolytes and acid-base imbalances, nutritional deficiencies, and even death. Severe Hyperemesis requiring hospital admission occurs in 0.3-2% of pregnancies.

 

PROBLEM STATEMENT:

Effectiveness of deep breathing exercise on nausea, vomiting among primigravida antenatal with hyperemesis gravidum admitted at antenatal ward of Pravara Rural Hospital, Loni (Bk)

 

OBJECTIVES:

To assess effectiveness of deep breathing exercise on nausea and vomiting among primi gravida with hyperemesis gravidum Aantenatal mother in comparison with experimental and control group

 

MATERIALS AND METHODS:

Research design and approach: quantitative evaluatory approach.

 

Research design: Pretest Post Control group design

 

Research variables:

Independent variable: deep breathing exercise

 

Dependent variable: nausea, vomiting among primigravida antenatal with hyperemesis gravidum

 

Extraneous variables: Age, educational status, occupation, religion, type of family, family income

 

Setting of the study: PIMS Loni (BK), Ahmednagar.

 

Population: primi gravida mothers attending Antenatal clinics

 

Sample Size: n60

 

Sampling Technique: Purposive sampling

 

Inclusion criteria:

Primi gravida mother who were:

·       Become pregnant first time/(primi)

·       Attending antenatal clinics

·       Willing to participate in study.

·       Able to read and write Marathi.

 

Exclusion criteria

Primi gravida mother who were:

·       Not willing to participate in study

·       Not available during data collection

 

Methods of data collection: Structured observational checklist

 

Reliability: The tool was found to be reliable with the r value for the anxiety (r = 0.80)

 

ANALYSIS AND INTERPRETION OF RESULTS:

This chapter deals with the analysis and interpretation of the data collection in order to determine the Effectiveness of deep breathing exercise on nausea, vomiting among primigravida antenatal with hyperemesis gravidum admitted at antenatal ward of Pravara Rural Hospital, Loni (Bk)

 

SECTION A:

Table No 1:

Sociodemographic Data	Experimental group (n= 30)		Control group (n=30)
	Frequency	Percentage	Frequency	Percentage
Age
18-21 years	6	20	12	40
22-25 years	22	73	16	53
26-29 years	2	2	2	6
30 or above	0	0	0	0
Education
No formal Education	0	0	4	13
Primary	4	13	6	20
Secondary	14	46	10	33
Higher Secondary	9	30	9	30
Graduation and above	3	10	1	3
Any other	0	0	0	0
Occupation
Home Maker	19	63	18	60
Daily Workers	2	6	6	20
Farmer	0	0	0	0
Business	0	0	1	3
Government/Private	9	30	5	16
Employee
Family Income
≤3000 Rs	0	0	3	10
3001-6000 Rs	5	16	14	46
6001-9000 Rs	13	43	6	20
≥9001 Rs	12	40	7	23
Type of Family
Nuclear	18	60	15	50
Joint	12	40	15	50
Religious
Hindu	21	70	14	46
Muslim	7	23	9	30
Any other	2	6	7	23
Type of Diet
Vegetarian	10	33	9	30
Non vegetarian	0	0	3	10
Mixed	20	66	18	60

 

Table No 2: Maternal characteristics hyperemesis primigravida Antenatal mother

Sociodemographic Data	Experimental group (n=30)		Control group (n=30)
	Frequency	Percentage	Frequency	Percentage
Period of gestation
1-3 months	12	40	13	43
3-6 months	11	36	14	46
6-9 months	7	23	3	10
Height
≤ 145cm	1	3	0	0
146-155cm	16	53	16	53
156-165cm	12	40	13	43
166-175 cm	0	0	1	3
≥ 176 cm	1	3	0	0
Weight
≤ 50kg	9	30	9	30
51-55 kg	21	70	21	70
56-60 kg	0	0	0	0
61-65 kg	0	0	0	0
66-70kg	0	0	0	0
≥ 71 kg	0	0	0	0

 

Clinical Parameter:

In study group significant percent (47%) of them had hemoglobuline level 8-10gm/dl and 11-13gm/dl respectively, whereas in control group (40%) and 30% of them had the same level. in both group most (83%and 80%) of them had presence of acetone on the urine sample. this data highlights the fact that the hyperemesis gravidum do have the presence of the acetone in the urine. In both group higher percent (40% and 50%) of them had B+ve blood group, followed by significant percent (27% and 20%) had AB+ve and the remaining had 0- and A +ve blood group. In both group most (90% and 83%) had Rh positive factor and the remaining had Rh-negative factors.

 

Table No 3: Assessment of nausea and vomiting among of primi hyperemesis gravida Antenatal mother before the implementation of deep breathing exercise.

Area	Study group			Control group
	Mean	SD	Mean %	Mean	SD	Mean %
Nausea and vomiting	22.13	5.42	73.76	26.6	3.37	88.6

 

The finding of present study shows that the above-mentioned table depict that both study and control group Primi gravida hyperemesis Antenatal mother had mean score (22.13±5.42) and (26.6±3.37) which is more than 73% of the total score.

 

Table No 4: Assessment of effectiveness of deep breathing exercise on after the implementation among primi hyperemesis gravida Antenatal mother.

Area	Study group			Control group
	Mean	SD	Mean %	Mean	SD	Mean %
Nausea and vomiting	19.33	3.68	64.43	26.83	3.30	78.2

 

The finding of the present study group show that Primi gravida hyperemesis antenatal mother had lower mean score (19.33 ± 3.688) which is 64.43% of total score indicate moderate level of nausea and vomiting whereas in control group the mean score was 23.46 ± 2.62) which is 78.2% of total score indicates the severe level of nausea and vomiting.

 

Table No 3: Comparison of effectiveness of deep breathing exercise on nausea vomiting among Primi gravida Hyperemesis antenatal mother with their selected demographic data. Comparison of Mean score of Primi Hyperemesis Gravidum mothers with their age.

Sr. No.	Age in year	Study group		Control group
		Post Test		Post Test
		Mean	SD	Mean	SD
1.	18-21yrs	19.66	4.08	25	4.39
2.	22-25yrs	19.54	3.69	25.12	4.32
3.	26-29yrs	16	00	23	1.41

 

The above-mentioned table depicts that It interpret that irrespective of age group primi mothers who had breathing exercise lower the severity of nausea and vomiting than the counterpart.

 

Table No 4: Comparison of Mean score of Maternal Characteristics of Primi Hyperemesis Gravidum Antenatal mothers with their Period of Gestation

Sr. No.	Period of gestation	Study group		Control group
		Post Test		Post Test
		Mean	SD	Mean	SD
1.	1-3 months	18.83	3.56	23.23	2.86
2.	4-6 months	19.27	3.82	23.4	2.76
3.	7-9 months	20.28	4.36	22.6	1.12

The above-mentioned table depicts that. It interprets that irrespective group period of gestation among primi Hyperemesis gravidum Antenatal mothers who had breathing exercise lower the severity of nausea and vomiting than the counter part.

 

Table No 5: Comparison of mean score of Primi Hyperemesis Gravidum Antenatal mothers with their Hemoglobin level

Sr. No.	Hemoglobin	Study group		Control group
		Post Test		Post Test
		Mean	SD	Mean	SD
1.	6-7gm/dl	20	5.65	23.2	1.09
2.	8-10gm/dl	19.57	3.77	24.3	3.73
3.	11-13gm/dl	19	3.65	22.6	1.34
4.	14-16gm/dl	00	00	23.3	1.15

 

The above mentioned table despite that. It interpret that irrespective group maternal hemoglobuline level among primi Hyperemesis gravidum Antenatal mothers who had breathing exercise lower the severity of nausea and vomiting than the counterpart

 

Table No 6: Association of effectiveness of deep breathing exercise Paired t’ test with socio demographic variable among primi hyperemesis gravida Antenatal mother.

Sr. No.	Variable	t test	level of significance
1.	Nausea amd vomiting	5.14	significance

 

The paired ‘t’ test was calculated and the value is 5.14 which is higher than the table value, indicate the statically significant difference.

 

Table No. 7: Association effectiveness of deep breathing exercise Chi Square test with socio demographic variable among primi hyperemesis gravida Antenatal mother.

Sr. No.	Variable	Chi square	level of significance
1.	Age	10.41	Significance
2.	Type of diet	7.5	Significance
3.	Period of Gestation	1.5	Not Significance
4.	Weight	11.2	Significance
5.	Hemoglobuline	1.5	Not Significance

 

Finding revealed that there was significant association found between Nausea and vomiting and Demographic variables like Age, Type of diet and Mothers weight at 0.05level as there was significant association between the variable the stated null hypothesis H02 is rejected and H2 is accepted.

 

DISCUSSION:

The biggest danger with hyperemesis gravidarum is that the women will become dehydration and no longer be able to provide the fetus with essential nutrients for growth. Prolonged hospitalization or home care with this disorder may result in social isolation. Hyperemesis gravidarum is a high-risk problem because it increases chances for pregnancy loss, intra uterine growth retardation, maternal activity restriction, fatigue and depression. In both study and control group Primi gravida hyperemesis Antenatal mother had mean score (22.13±5.42) and (26.6±3.37) is more than 73% of the total score indicate moderate type of nausea and vomiting According to that Stice. E., Pail. R that mean score (18.4±4.3) is more than 61.3% in both group of nausea and vomiting.⁸³ Primi gravida hyperemesis antenatal mother had lower mean score (19.33±3.6) which is 64.43% of total score indicate moderate level of nausea and vomiting whereas in control group the mean score was 23.46±2.62) which is 78.2% of total score indicates the severe level of nausea and vomiting. This finding is similar with the study by Werntoft D. that the average mean score is significantly decrease from (12.32±1.25 and 12.85±1.60) in both group whereas the mean percentage (38.5% and 40.15%) respectively.⁸⁴ The paired’ test was calculated and the value is 5.14 which is higher. The finding was consistent with study done by Pacika. G The result that the pretest mean was 16.4 and the posttest mean was 9.4 The calculated value t’ test. It was tabulated value (2.02). Therefore, the breathing technique and relaxation therapy treatment was effective.⁸⁵ Finding revealed that there was significant association found between Nausea and vomiting and Demographic variables like Age, Type of diet and Mothers weight at 0.05 level. The study is carried by Hosseini F., Deepa M. An also found a significant level of (p= <0.05) the mean vomiting and nausea is relation with family history, occupation, weight.⁸⁶

 

In additional to number of systematic reviews have recommended that these interventions are simple and applicable in all health care center and even homes of Antenatal mother who suffer from nausea and vomiting. As a service provider, nurses assess needs and problem of nausea and vomiting Antenatal mother and help to resolve the problems or to satisfy their need with nursing interventions.

 

CONCLUSION:

From the present study the finding demonstrated that hyperemesis primi gravida antenatal mother based on the result it was concluded that deep breathing exercise is more effective in reducing nausea and vomiting. It was significant relationship between deep breathing exercise on reducing nausea and vomiting among hyperemesis gravidum mother. It recommended that the deep breathing exercise can be routinely implemented as nursing treatment Strategies for care of the Primi hyperemesis gravida antenatal mother.

 

RECOMMENDATIONS:

The study recommends the following for further research:

The study can be conducted for larger sample size to generalize the findings.

1.     A similar study can be conducted in different settings.

2.     A comparative study can be conducted between primi gravida and multi gravida mothers.

3.     A comparative study can be done to assess the effectiveness of natural remedy and pharmacological measures on relief of nausea and vomiting.

 

ACKNOWLEDGEMENT:

The authors are grateful to the authorities of Pravara Medical Trust’s, College of Nursing Loni, Bk. District: Ahmednagar (MH) India .413736

 

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

 

REFERENCES:

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3.      Eliakin, R., Abulafia, O., and Sherer, D.M. “Hyperemesis gravidarum: Current review”. American journal of perinatology, 2000; 17 (4): 207 – 218.

4.      Author: Dotun A Ogunyemi, MD, Associate Professor of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA; Cedars Sinai Medical Center.

5.      Hershman JM, “Physiological and pathological aspects of the effect of human chorinic gonadotropin on the thyroid.” Best pract. Res. Clin. Endocrinal. Metab. 2004; 18 (2): 249 – 65.

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7.      Munch S. A qualitative analysis of physician humanism: women’s experiences with hyperemesis gravidarum. School of social work, Rutgers, the State University of New Jersey, 536 George Street, New Brunswick, NJ 08901-1167, USA.

8.      Dotun A Ogunyemi, Hyperemesis gravidarum (HG) was once major cause of maternal mortality. Associate Professor of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA; residency program director, Clerkship Director, Department of Obstetrics and Gynecology, Cedars Sinai Medical Center.

9.      Bailit JL. Epidemiologic findings from a large cohort. Division of maternal fetal medicine, department of obstetrics and gynecology, Cleveland, OH, USA.

10.   Safari HR, Alsulyman OM, Ghermam RB Goodwin TM. Experience with oral methylprednisolone in the treatment of refractory hyperemesis gravidarum department of obstetrics and gynecology, university of southern California school of medicine, los Angeles, USA.

 

 

 

Received on 15.04.2020         Modified on 06.06.2020

Accepted on 16.07.2020       ©A&V Publications All right reserved