RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE- KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
NASEEHA .K.
1ST YEAR MSC NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING.2010-2012.
DHANWANTARI NURSING COLLEGE,
41/3, VINAYAKANAGAR,
HESARGHATTA ROAD
CHIKABANAVAR,
BANGALORE 90.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. NAME OF THE
CANDIDATE AND
ADDRESS
Ms. Naseeha .K.
I year M.sc., (Nursing),
Dhanwantari Nursing College,
NO.41/3, VINAYAK NAGAR, NEAR CHIKBANAVAR RAILWAY STATION,
CHIKBANAVAR, BANGALORE 560 090.
2. NAME OF THE
INSTITUTION
Dhanwantari Nursing College
3. COURSE OF THE STUDY
AND SUBJECTS
M.Sc., (Nursing),
Obstetrics And Gynaecological
Nursing.
4. DATE OF ADMISSION OF
THE COURSES1/6/2010
5. TITLE OF THE STUDY “A study to assess the effectiveness of
structured teaching program on knowledge
regarding prevention o f varicella zoster
during pregnancy among pregnant women at
K C G Hospital Bangalore.”
BRIEF RESUME OF INTENDED STUDY:
6.1 INTRODUCTION
“The sweetest sound to mortals given are heard in Mother, Home and Heaven ’’
- William Goldsmith Brown
The term "varicella" dates back to at least the 1700s and is a modernized Latin
diminutive of variola (smallpox). The origin of the term "chickenpox" is less clear, but it may
derive from the French word for chick-pea (chich-pea), a small pea. "Shingles," used as early as
the 1300s, and "zoster" come from the Latin and Greek, respectively, for girdle.
Varicella-zoster virus (VZV) is one of eight herpes viruses known to cause
human infection and is found worldwide. Primary infection with varicella causes chickenpox in
susceptible hosts. While most healthy children have self-limited infection with primary varicella,
the incidence of hospitalization and even mortality in selected groups is significant. Varicella can
cause significant complications, such as soft tissue infection, pneumonia, hepatitis, and
encephalitis. Patients at increased risk of complications include adults, pregnant women, and
immuno suppressed hosts1
Varicella zoster virus (VZV) is a DNA virus and a member of
the herpes virus family. It is highly infectious and is transmitted by direct contact and through
respiratory droplets. About 90% of infections are contracted in the first decade of life, and
immunity to VZV is lifelong. Morbidity and mortality are much higher among older persons who
are newly exposed to VZV.
All women of reproductive age should be screened for immunity to VZV.
Women who did not have childhood "chickenpox" (or do not recall having had it) should be
tested for serum VZV immunoglobulin (Ig)G. Women of reproductive age who are not immune
should be offered varicella vaccine. Note, however, that this vaccine is contraindicated during
pregnancy. Therefore, pregnant women who are not immune to varicella should be educated to
avoid exposure to persons who have varicella or herpes zoster. Nonimmune pregnant women
who have been exposed to varicella should be offered varicella-zoster immune globulin (VZIG),
preferably within 72-96 hours post exposure. Prophylactic acyclovir, 800 mg orally 5 times daily
for 5-7 days, is also effective in preventing the infection.
Pregnant women who have been exposed and are not immune should be
counseled about the clinical manifestations of varicella that they may experience, especially
pneumonia and encephalitis.
Reactivation of latent VZV results in herpes zoster infection. This infection
is less serious than varicella secondary to the presence of maternal antibodies; however, it can be
very serious in immune compromised patients. The infection manifests clinically as fever,
malaise, and skin rash. The rash is painful and is usually confined to a dermatome. Serious life-
threatening complications of the infection include pneumonia (up to 20% of pregnant patients)
and encephalitis (up to 1% of pregnant patients).
Pregnant women with herpes zoster symptoms should be treated with oral
acyclovir, unless hospital admission is warranted. Oral antiviral agents (acyclovir, valacyclovir,
or famciclovir) have been shown to significantly reduce herpes-related symptoms as well as the
duration, intensity, and prevalence of zoster-associated pain. According to Drugs in Pregnancy
and Lactation, Sixth Edition, famciclovir, a category C drug, has not been studied enough in
pregnant women. Valacyclovir, also a category C drug, is metabolized to acyclovir. Acyclovir is
the drug of the 3 that has been most extensively studied in pregnant women and is the agent most
commonly used to treat patients with VZV during pregnancy. All HIV and immunocompromised
women who are pregnant and are manifesting VZV infection should be admitted to the hospital
for intravenous acyclovir.
A pregnant woman who has been exposed to VZV before pregnancy should be
reassured that her fetus is safe. It is well documented in the literature that IgG antibodies are
transplacentally passed to the fetus providing the necessary immunity. These antibodies persist in
the newborns for up to 6 months of life.[ A pregnant woman manifesting VZV infection should
be counseled about the risk of viral transmission to the fetus and the risks of fetal anomalies.
They should also be informed that these risks are very low. The incidence of fetal anomalies
after an early exposure (before 20 weeks) is 1.2% to 2.0%. VZV infection of the fetus occurs
primarily via hematogenous dissemination across the placenta. This infection may lead to
spontaneous abortion, fetal demise, and varicella embryopathy (eg, limb hypoplasia,
microcephaly, muscle atrophy, cataracts, and mental retardation). Prenatal ultrasound and
magnetic resonance imaging have been used to document the extent of tissue damage in fetal
varicella syndrome. Findings include oligohydramnious, intrauterine growth restriction, hydrops,
limb deformities, and microcephaly.
Neonatal infection may occur in 10% to 20% of neonates whose mothers became
acutely infected from 5 days before delivery to 2 days after the delivery. It results from
hematogenous dissemination of the virus across the placenta in the absence of maternal
antibodies. Infants become symptomatic 5-10 days postpartum. The clinical picture may vary
form skin lesions to systemic illness, pneumonia, for example.
In acutely infected mothers the delivery should be postponed 5-7 days to
prevent the spread of VZV to the neonate. If this is not possible, the neonate should be given
VZIG immediately after birth and should be isolated from the mother if the latter has skin
lesions/rash present.2
Varicella-zoster virus can cause a distinct congenital syndrome, a potentially fatal
neonatal infection and life-threatening maternal illness. Physicians can reduce morbidity from these
conditions by advising non immune pregnant women to avoid exposure to chickenpox and herpes zoster
and, when indicated, by promptly administering varicella-zoster immune globulin. When prevention fails,
acyclovir may be effective therapy. The concept of viral terato genesis was introduced in 1941 after an
Australian ophthalmologist noted congenital cataracts in the offspring of women who had rubella during
pregnancy.[1] Of the well-known viral exanthems of childhood, rubella is still considered the most
significant teratogen. Herpes viruses, particularly cytomegalovirus (CMV) and the herpes simplex
viruses, are widely recognized for their ability to cause serious fetal or neonatal infections.[2] It is less
well recognized that another herpes virus, the varicella-zoster virus (VZV), is also capable of causing a
distinct congenital syndrome and a fatal neonatal infection, as well as life-threatening maternal illness.[3]
This article reviews the important concepts about the two VZV syndromes, varicella (chickenpox) and
herpes zoster (zoster, shingles), as they relate to pregnancy3
Even though varicella is rare in pregnancy, the disease can lead occasionally
to disastrous illnesses for both the mother and her neonate. By contrast, normal zoster is not
associated with special problems during pregnancy and peri- natal period. Pregnant women, who
contract varicella, are at risk of varicella pneumonia which must be regarded as medical
emergency. At any stage during pregnancy, chickenpox may cause intrauterine infection. The
consequences for the fetus depend on the time of maternal disease. During the first two
trimesters, maternal varicella may result in congenital varicella syndrome which may occur in
nearly 2%. Typical symptoms are skin lesions in dermatomal distribution, neurological defects,
eye diseases, and skeletal anomalies. Maternal infection near term is associated with a substantial
risk of intrauterine acquired neonatal chickenpox in the neonate. If the mother develops varicella
rash between day 4 (5) ante partum and day 2 post partum, generalized neonatal varicella leading
to death in about 20% of the cases has to be expected. The present paper reviews the clinical
consequences and the currently available concepts of prevention, diagnosis, and therapy of
varicella-zoster virus infections during pregnancy.4
6.2 NEED FOR THE STUDY:
Of the 606 eligible respondents, surveys were received from 305 (response rate: 50%). Most
obstetrician/gynecologists knew that specific actions by pregnant women could reduce the risk of
infection. Seventy-nine to eighty-eight percent reported counseling pregnant women about
preventing infection from Toxoplasma gondii, hepatitis B virus, and influenza, 50%-68% about
varicella-zoster virus, Listeria monocytogenes, and Parvovirus B19, and <50% about
cytomegalovirus, Bordetella pertussis, and lymphocytic choriomeningitis virus. The majority
reported time constraints were a barrier to counseling, although most reported educational
materials would be helpful.5
Varicella zoster virus (VZV) is one of eight herpes viruses known to infect humans.
Primary infection causes varicella (chickenpox), after which virus becomes latent. Years later, VZV
reactivates and causes a wide range of neurological diseases. The aim of the present report was to
critically examine the published literature to evaluate advantages and limitations of therapy of VZV
infection in both immunocompetent and immunocompromised patients. Aciclovir (ACV) has been the
drug of choice for many years for the treatment of VZV infections. Recently, other antiviral agents have
been developed to overcome the low oral bioavailability of ACV, as well as to provide a more flattering
dosage regime. Chickenpox is a benign self-limiting disease in the majority of cases and usually no
specific treatment is required. Treatment of shingles is indicated to reduce the acute symptoms of pain
and malaise, to limit the spread and duration of the skin lesions and to prevent the development of post-
herpetic neuralgia. Different classes of drugs have been used for the treatment of post-herpetic neuralgia.
The first choice of any of these medications should be guided by the patient's medical health, the likely
adverse effects of the drug and the patient's preference.6
Infection with varicella zoster virus (VZV) is often considered a childhood 'right of
passage'; however, primary infection occurring in women of child-bearing age can have significant
adverse consequences both for the mother and for her fetus. During the first trimester, primary VZV
infection may result in stillbirth or a baby born with the stigmata of the congenital varicella syndrome,
while infection in the peripartum period can result in neonatal varicella, which carries a significant
mortality rate despite appropriate antiviral therapy. Varicella in pregnant women can progress to
pneumonitis and other severe sequelae that may also compromise the viability of the fetus. Exposure to
VZV most commonly occurs in the community or from children in the household, but occasionally,
exposure may occur in the hospital environment. Determining a woman's serostatus prior to pregnancy is
advised, as effective vaccines are now available and should be administered to non-pregnant seronegative
women of child-bearing age. Clinical practice guidelines for management of a pregnant woman exposed
to VZV are presented.7
The total number of women included in the study was 1522, corresponding to a
participation rate of 83%. The prevalence of varicella-zoster antibodies in pregnant women was 96.1%
(95% CI 95.1-97.1). The prevalence of antibodies was 94% in pregnant women aged 15-24 years, 95% in
those aged 25-29 years and >95% in those aged 30-49 years. The prevalence of antibodies was not
associated to the place of birth, place of residence (urban or rural), educational level and social class. The
study showed that 6% of pregnant women aged 15-24 years and 5% of those aged 25-29 years were
susceptible to varicella-zoster infections in Catalonia .8
Infections with varicella zoster virus (VZV) are common viral infections associated with
significant morbidity. Diagnosis and management are complex, particularly in immunocompromised
patients and during pregnancy. The present recommendations have been established by a
multidisciplinary panel of specialists and endorsed by numerous Swiss medical societies involved in the
medical care of such patients (Appendix). The aim was to improve the care of affected patients and to
reduce complications.9
In a retrospective case-control study to calculate the incidence of varicella
zoster (VZ) in pregnancy, to know why the incidence is high and to suggest a strategy to prevent
the disease. Twenty-one pregnant women with VZ were compared to two control groups. The
first control group ( n =30) had normal pregnancy and no VZ. The second control group ( n =27)
had VZ and no pregnancy. Assir region has a total population of 150 000 (Abha area). The
incidence of VZ in pregnancy in Asir region during the study period was 0.23%, which is high if
compared to other studies. In comparison to controls, cases had a significant increase in fever
episodes, hospital admission, viral pneumonia and hospital stay. P values were <0.0001,
<0.0001, <0.05 and <0.01, respectively.Also, VZ in pregnancy negatively affected the perinatal
outcome as evidenced by a significant increase in congenital malformation and neonatal
admission to NICU ( P <0.0001 and <0.002, respectively). The high incidence of VZ during
pregnancy can be explained by the social behaviour of the population under study. In a
conservative society unmarried women rarely mix and contact with viral infections is minimal.
After marriage and during pregnancy the social exposure of the non-immune to cases becomes
more frequent. Also, contact with cases was greatly enhanced by the social mixing in modern
facilities such as schools, shopping centres and health facilities. Recently an effective VZ
vaccine has been introduced successfully. It will be prudent to include the vaccine in the
expanded program of immunisation already adopted by our health authorities. This will be cost-
effective and many cases can be averted.10
Varicella (chickenpox) is a common childhood illness. Most adults are immune to
the virus because of previous exposure. Pregnant women who contract varicella risk complications such
as pneumonia. Varicella may be transmitted from mother to fetus and could cause congenital varicella
syndrome or perinatal infection. Susceptibility to varicella should be determined before pregnancy.
Varicella zoster immune globulin may be considered for the mother or newborn if exposure occurs.
Acyclovir may decrease the risk of maternal complications from infection.11
Varicella-zoster virus is a herpes virus that produces a primary infection, chickenpox,
manifested by a vesicular eruption and is considered one of the common childhood infectious diseases.
After the initial infection the virus becomes latent, then when activated it is manifested as herpes zoster,
commonly known as shingles. This highly communicable human disease is associated with serious
morbidity and significant mortality, particularly among the immunocompromised. When introduced in the
hospital, significant disruptions occur and serious sequelae may results. Recently, a live virus varicella
vaccine was approved by the Food and Drug Administration in the United States. Studies have shown the
vaccine to be safe and effective. Widespread use of this vaccine may be beneficial in reducing the
opportunities for varicella-zoster virus introductions in health care settings.12
Varicella-zoster virus may cause serious infection, particularly pneumonia, in adult
women. Women of child-bearing age should be questioned about immunity to varicella preconceptually,
and offered serological testing, and VARIVAX vaccine if indicated. All pregnant patients should be
questioned about immunity to varicella during their first prenatal appointment. Susceptible patients
should be counseled to avoid contact with individuals who have chickenpox. If exposure occurs, VZIG
should be administered within 96 hours in an attempt to prevent maternal infection. Varicella
embryopathy may occur as a result of maternal infection particularly in the first half of pregnancy with an
incidence of 1% to 2%. Varicella of the newborn is a life-threatening illness that may occur when a
newborn is delivered within 5 days of the onset of maternal illness or after postdelivery exposure to
varicella. Susceptible neonates should receive VZIG. Acyclovir is active against the varicella-zoster virus,
and treatment is indicated in seriously ill adults and neonates.13
6.3 REVIEW OF LITERATURE:
A study is conducted by Troughton JA, Crealey G, Crawford V, Coyle PV suggests
that in NI either of the proposed antenatal screening strategies would be less costly than current
practice. This finding supports the suggestion that varicella immunity testing should be included
in the Antenatal Infectious Diseases Screening Programme, either as part of the universal
vaccination programme or solely as an antenatal programme.The cost of VZIG issued to
pregnant women in 2006 was pound100,800; 43% of births were to primigravidas therefore the
estimated cost of VZIG issued to multigravidas was pound58,100. The cost of verbal screening
with post-partum vaccination is estimated at pound23,750 p.a., saving pound34,350 over current
policy. The estimated cost of screening all primigravidas with post-partum vaccination is
pound43,000, saving pound15,100.14
A study conducted by Wilson E, Goss MA, Marin M, Shields KE, Seward
JF, Rasmussen SA, Sharrar RG revealed that from 17 March 1995 through 16 March 2005, 981
women were enrolled. Pregnancy outcomes were available for 629 prospectively enrolled
women. Among the 131 live births to varicella-zoster virus-seronegative women, there was no
evidence of congenital varicella syndrome (rate, 0% [95% confidence interval [CI], 0%-6.7%]),
and major birth defects were observed in 3 infants (rate, 3.7% [95% CI, 0.8%-10.7%]). Although
the numbers of exposures are not sufficient to rule out a very low risk, data collected in the
pregnancy registry to date do not support a relationship between the occurrence of congenital
varicella syndrome or other birth defects and varicella vaccine exposure during pregnancy.15
A study condected by Kempf W, Meylan P, Gerber S, Aebi C, Agosti R,
Büchner S, Coradi B, Garweg J, Hirsch H, Kind C, Lauper U, Lautenschlager S, Reusser P, Ruef
C, Wunderli W, Nadal D.revealed that infections with varicella zoster virus (VZV) are common
viral infections associated with significant morbidity. Diagnosis and management are complex,
particularly in immunocompromised patients and during pregnancy. The present
recommendations have been established by a multidisciplinary panel of specialists and endorsed
by numerous Swiss medical societies involved in the medical care of such patients (Appendix).
The aim was to improve the care of affected patients and to reduce complications.16
A study conducted by McKendrick MW, Lau J, Alston S, Bremner
J.revealed that the incidence of varicella infection in pregnancy was at least 6 per 10,000
deliveries. Nineteen pregnant women with varicella were admitted to hospital. Three had
pneumonia. Infection occurred in the first pregnancy in a quarter of cases. The minimum cost for
all cases admitted to hospital during this period (basic costs per day) was 20,520 pounds sterling.
The cost of VZIG use for chickenpox during the same period adjusted for the population size
was 10,881 pounds sterling. This was not a comprehensive health economic study and did not
attempt to assess additional GP, midwifery, obstetric or social costs nor costs associated with
those who did not attend hospital. Two hundred and thirty-three women underwent VZV
antibody test during 2004 usually after contact with chickenpox. Sixty percent of women in
contact with chickenpox did not present to their GP or hospital immediately.Varicella in
pregnancy may be associated with significant morbidity and health care cost and prevention by
immunisation is desirable. Though targeted vaccination is attractive, screening in pregnancy
followed by a post-partum varicella immunisation programme would fail to protect 25% and
would be associated with logistical challenges not occurring with rubella immunisation.
Varicella is now a preventable disease by immunisation. Exposure in pregnancy with or without
infection has financial costs related to antibody testing and prophylaxis. Infection in pregnancy
may be associated with additional costs and potential morbidity to mother and baby. Potential
immunisation strategies are considered.17
A study conducted by Sauerbrei A, Wutzler P.revealed that primary herpes
simplex virus (HSV) infection may lead to severe illness in pregnancy and may be associated
with transplacental virus transmission and fetal infection. The consequences may be abortion,
stillbirth and congenital malformations. In neonates, the clinical findings after intrauterine HSV
infection are characterized by skin lesions, diseases of the eye and neurologic damage. Herpes
genitalis of pregnant women at the time of labor may result in life-threatening neonatal herpes.
Currently, neither active nor passive immunization is available to prevent HSV infections during
pregnancy and in the newborn infant. Therefore, antiviral treatment using aciclovir and/or
valaciclovir must be considered in all primary episodes of genital herpes as well as in neonates
who show signs of either infection. Clinical herpes lesions of the genitalia and/or positive test for
virus detection at the time of delivery are an indication for cesarean section. However, this
surgical intervention may be reduced by suppressive treatment of recurrent genital herpes with
aciclovir or valaciclovir.18
A study conducted by Bohlke K, Galil K, Jackson LA, Schmid DS,
Starkovich P, Loparev VN, Seward JF. they enrolled women identified as varicella seronegative
during routine prenatal screening at Group Health Cooperative. Participants received the first
dose of varicella vaccine at least 6 weeks postpartum and the second dose at least 4 weeks later.
They collected ten breast milk samples after each vaccine dose. Breast milk samples were tested
for varicella zoster virus by polymerase chain reaction (PCR). Serum specimens were collected
from the mothers 1 month after each vaccine dose, and peripheral blood from their infants was
collected onto filter spots 1 month after the mother's second dose. These samples were tested for
varicella immunoglobulin (Ig) G by whole-virus enzyme-linked immunosorbent assay (ELISA),
or by the more sensitive glycoprotein ELISA. When possible, filter spots from the infants were
also tested by PCR for the presence of varicella zoster virus deoxyribonucleic acid (DNA).that
revealed that the twelve women were enrolled; all seroconverted after the first vaccine dose.
Varicella DNA was not detected by PCR in any of the 217 postvaccination breast milk
specimens. None of the infants was seropositive. Samples from six infants were tested for
varicella zoster virus DNA by PCR, and all were negative.They found no evidence of varicella
vaccine virus excretion in breast milk. These findings suggest that postpartum vaccination of
varicella-susceptible women need not be delayed because of breast-feeding.19
A study conducted by Elamin Ali M., this is a retrospective case-control study to
calculate the incidence of varicella zoster (VZ) in pregnancy, to know why the incidence is high
and to suggest a strategy to prevent the disease. Twenty-one pregnant women with VZ were
compared to two control groups. The first control group ( n =30) had normal pregnancy and no
VZ. The second control group ( n =27) had VZ and no pregnancy. Assir region has a total
population of 150 000 (Abha area). The incidence of VZ in pregnancy in Asir region during the
study period was 0.23%, which is high if compared to other studies. In comparison to controls,
cases had a significant increase in fever episodes, hospital admission, viral pneumonia and
hospital stay. P values were <0.0001, <0.0001, <0.05 and <0.01, respectively.Also, VZ in
pregnancy negatively affected the perinatal outcome as evidenced by a significant increase in
congenital malformation and neonatal admission to NICU ( P <0.0001 and <0.002, respectively).
The high incidence of VZ during pregnancy can be explained by the social behaviour of the
population under study. In a conservative society unmarried women rarely mix and contact with
viral infections is minimal. After marriage and during pregnancy the social exposure of the non-
immune to cases becomes more frequent. Also, contact with cases was greatly enhanced by the
social mixing in modern facilities such as schools, shopping centres and health facilities.
Recently an effective VZ vaccine has been introduced successfully. It will be prudent to include
the vaccine in the expanded program of immunisation already adopted by our health authorities.
This will be cost-effective and many cases can be averted.20
A study conducted by Wise RP, Braun MM, Seward JF, Mootrey GT, Shields KE,
Salive ME, Krause PR.revealed that a series of case reports to the varicella vaccine Pregnancy
Registry described inadvertent administrations during pregnancy of this live virus product
instead of the intended Varicella zoster immune globulin. Cases continued to accrue despite an
early publication about the pattern. The persistent problem warrants specific educational efforts
to prevent further repetitions. It also has more general implications for medical product safety
surveillance. First, this problem's original detection depended on the Pregnancy Registry's open-
ended collection of information about pregnancy exposures. It could have escaped recognition
through surveillance limited to pre specified potential risks. This need for unrestricted reporting
and human vigilance to sift through case stories has particular relevance for efforts to re-think
methods to monitor gestational drug exposures. In addition, the problem's persistence despite
initial publicity suggests that diligent surveillance may require continued follow-up of identified
safety issues. Periodic reassessments of selected preventable problems might strengthen efforts
to minimize product risks.21
A study conducted by Rajan P, Rivers JK revealed that Varicella and herpes zoster
caused by VZV can give rise to serious morbidity and mortality and should be treated. For
preventing chickenpox, safe and effective immunization is widely recommended. Treating
varicella-exposed seronegative pregnant women requires special attention because the virus can
harm expectant mothers, fetuses, and newborns. The antiviral drugs, acyclovir, valacyclovir, and
famciclovir, have been approved for treating herpes zoster and have a role in reducing the
duration of PHN. Established PHN can be managed with analgesics, tricyclic antidepressants,
and other agents. Vaccination and antiviral and other systemic agents can substantially reduce
the morbidity associated with VZV infection.22
6.4 STATEMENT OF THE PROBLEM
“A study to asses the effectiveness of structured teaching program on knowledge
regarding prevention o f varicella zoster during pregnancy among pregnant women at
K C G Hospital Bangalore. ”
6.5 OBJECTIVES OF THE STUDY
6.4.1 To asses the knowledge of pregnant women regarding prevention of varicella zoster during
pregnancy in terms of pre-test scores
6.4.2 To prepare and administer STP on knowledge regarding prevention of varicella zoster
during pregnancy
6.4.3 To asses the knowledge of pregnant women regarding prevention of varicella zoster during
pregnancy in terms of post-test scores.
6.4.4 To find out the association between the knowledge of the pregnant women with there
selected demographic variables.
6.6 HYPOTHESIS
There is significant difference in pregnant women after administration of STP score
higher than the pretest knowledge.
6.7 OPERATIONAL DEFINITION
1. Assess:
The critical analysis and evaluation or judgment of the status or quality of a particular condition,
Situation or other subject of appraisal
2. Effectiveness:
In this study Effectiveness means the capability of producing a positive impact of structured teaching prigramme effect.
3. Structured teaching program (STP):
It is a lecture given by the investigator for 45 to 60 minutes with the help of AV aids
(charts and posters) . It involves the general concept of varicella zoster , itiolagy statistics, risk
factors ,incidence signs and symptoms, diagnosis, management and prevention of varicella zoster
in pregnancy
4. Knowledge:
Expertise, and skills acquired by a person through experience or education; the
theoretical or practical understanding of a subject;
5. Prevention:
Prevention is any activity which reduces the burden of mortality or morbidity from disease
6. Varicella zoster in pregnancy:
In this study it refers to is an infection caused by the varicella zoster virus a member of
group of DNA virus and is one of the alignments in pregnancy.
7. Pregnant women:
The condition from conception to the expulsion of the fetus.
6.7. ASSUMPTION
1. The pregnant women will have less than adequate knowledge regarding varicella Zoster in
pregnancy
2. The pregnant women will be expressing their willingness to participate and preventive
measures
3. The pregnant women will follow the preventive measures in subsequent pregnancy
6.8 DELIMITATION
1. Prescribed data collection period is 4-6 week
2. Sample size is limited to 60 pregnant women
3. Study design is limited to pre-experimental design
7 METERIALS AND METHODS
7.1 RESEARCH APPROACH
7.1.1 SOURCE OF DATA COLLECTION
Data will be collected from the pregnant women at K C G Hospital Bangalore
7.1.2 RESEARCH DESIGN: Pre-experimental single group pretest posttest design.
Group Pretest Investigation Posttest
Pregnant Women O1 X O2
Key words:
O1 = Pre test knowledge scores of pregnant women regarding Prevention of varicella
zoster during pregnancy.
X = STP on Prevention of varicella zoster during pregnancy.
O1 = Post-test knowledge scores of pregnant women regarding prevention of varicella
zoster during pregnancy
7.1.3 SETTING OF THE STUDY:
The study will be contacted in K C G Hospital Bangalore
7.1.4 POPULATION
Pregnant women selected hospital of Bangalore
7.1.5. SAMPLE
Pregnant women of selected hospital at Bangalore who full fill the inclusion criteria
7.1.6. SAMPLE SIZE
The sample consists of 60 pregnant women
7.1.7 SAMPLING TECHINIQUE:
None probability convenience sampling technique will be used
7.1.8 PILOT STUDY
Pilot study will be conducted on 10% of population which will conducted in the selected hospital
of Bangalore and that will be excluded in the main study.
7.2. METHODS OF DATA COLLECTION:
The data collection is planned through the structured questionnaire on knowledge
regarding prevention of varicella zoster during pregnancy and the questionnaire consistent of two
sections
Part A – Socio demographic variables includes age, gravid education, income type of family,
area of residence religion, prance education , influence of mass media , previace knowledge
Part B - knowledge questionnaire on prevention of varicella zoster during pregnancy
7.3 SAMPLING CRITERIA:
7.3.1 Inclusion criteria
1. Pregnant women who are attending OPD and admitted in selected hospital
2 Those who are read and write English or Kannada
3. Who are walling to participate in the study?
4 Who are available at the time of data collection?
7.3.2 Exclusion criteria
1 Who are willing to participate in the study?
2 Those who are not abele to read and write English or kannada
7.4. TOOLS FOR DATA COLLECTION
A structured questionnaire is used to collected the data from the mothers in the selected
hospital.
7.5 DATA COLLECTION PROCEDURE
Data will be collected by using structured questionnaire 15 to 20minut will be spending
with each subject to collect the data
7.6. DOES THE STUDY REQUIRES ANY INVESTIGATION OR BE
CONTECTED ON PATIENTS OR OTHER ANIMALS?
Yes the structured teaching program is used as an intervention on pregnant women on
selected hospitals at Bangalore.
7.7 HAS ETHICAL CLEARENCE BEEEN OBTAINED FROM YOUR
INSTITUTION?
The main study will be conducted after the approval of research committee of the college.
Permission will be obtained from the head of the institution. Permission from the concern
authority of selected hospital will be taken.
8. LIST OF REFERENCES
8. LIST OF REFERENCES
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Chickenpox www.uptodate.com/home/content/topic.do?topicKey=viral_in/...
2) Lev D. Kandinov, MD. Authors and Disclosures Obstetrics and Maternal-Fetal Medicine -
SimilarVaricella Zoster Virus Infection During Pregnancy. www.medscape.com › ... ›
3) Cached, Varicella Zoster: Varicella-zoster virus infections in pregnancy ...the- medical-
dictionary.com/varicella_zoster_article_8.htm -
4) Cached ,Abstract: Review of varicella-zoster virus infections in
pregnant ...byASauerbreiRelatedarticleswww.scirp.org/journal/Abstract.aspx?
paperID=1260&JournalID...
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of Health, Generalitat of Catalonia, Barcelona, Spain. [email protected]
9) Kempf W, Meylan P, Gerber S, Aebi C, Agosti R, Büchner S, Coradi B, Garweg J, Hirsch H,
Kind C, Lauper U, Lautenschlager S, Reusser P, Ruef C, Wunderli W, Nadal D.Swiss Med
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15) J Infect Dis. , Wilson E, Goss MA, Marin M, Shields KE, Seward JF, Rasmussen SA,
Sharrar RG.Varicella vaccine exposure during pregnancy: data from 10 Years of the pregnancy
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16) Kempf W, Meylan P, Gerber S, Aebi C, Agosti R, Büchner S, Coradi B, Garweg J, Hirsch H,
Kind C, Lauper U, Lautenschlager S, Reusser P, Ruef C, Wunderli W, Nadal D.Swiss
recommendations for the management of varicella zoster virus infections.,Dermatologische
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20) J Obstet Gynaecol., Varicella zoster during pregnancy: a strategy for prevention. Elamin Ali
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21) Wise RP, Braun MM, Seward JF, Mootrey GT, Shields KE, Salive ME, Krause
PR.Pharmacoepidemiologic implications of erroneous varicella vaccinations in pregnancy
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8. Signature of the candidate
9. Remarks of the guide GOOD
10. Name and designation of (in block letters)
10.1 Guide Ms, Muthukannu
10.2 Signature
10.3 Co-guide (if any)
10.4 Signature
11. 11.1 Head of the department Ms, Muthukannu
H.O.D, Obstetrics And
Gynaecological Nursing
DHANWANTARI NURSING COLLEGE
BANGALORE
11.2 Signature
12. 12.1 Remarks of the Principal : GOOD
12.2 Signature