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Rajiv Gandhi University of Health Sciences, KarnatakaSYNOPSISFOR REGISTERATION OF SUBJECT FOR DISSERTATION1 Name of the Candidate THENESHA KName of the institution Diana College of Nursing 2 No.68, Chokkanahalli, Jakkur Post, Bangalore – 560064Masters of Science in Nursing 3 Course of Study and SubjectObstetrics and Gynecological Nursing4 Date of Admission to Course 08.06.2010Assess the effectiveness of video assisted teaching on knowledge Title of the Topic regarding prevention of Pregnancy 5 Induced Hypertension (PIH) among high risk antenatal mothers attending antenatal clinic in a selected hospital, Bangalore, Karnataka.INTRODUCTION1 Pregnancy is a normal process but it is unique and boon to every woman. It is one of the wonderful and noble services imposed by nature. The body undergoes enormous functional changes during pregnancy and the functioning is altered in order to nourish the mother, baby and to have normal delivery. Normal Pregnancy is dramatic and often underestimated. The timing and intensity of the changes vary between systems but all are designed to enable the women to nurture to the fetus and to prepare her body for labor and lactation. Most of the women may not have many problems during pregnancy, but the unlucky ones, face problems related to pregnancy and child birth. In developing countries, pregnancy and child birth are some of the leading causes of death for women in the reproductive age group. Yet, the fate of these women and children is too often overlooked or ignored.1The WHO slogan for 2005 “Make Every mother and child count”, reflects the reality that today, Government and the International Community needs to make the health of the women and children the top priority.2Various Complications can develop during the course of the pregnancy and can affect the health and well being of the mother and fetus, as well as the outcome of the pregnancy.With early recognition and today’s advanced technology, the incidence of maternal mortality resulting from complication is declining.3Common Health Disorders complicating pregnancy are PIH, GDM, Cardiac disease, renal disease and jaundice in pregnancy. A report “Global statistics – PIH” estimated that global prevalence of PIH among pregnant women is 13%.42 PIH is more common in a woman's first pregnancy and in women whose mothers or sisters had PIH. The risk of PIH is higher in women carrying multiple babies, in teenage mothers and in women older than age 40. Other women at risk include those who had high blood pressure or kidney disease before they became pregnant. The exact cause ofPIH isn't known.5High blood pressure in pregnancy (hypertension) is a very serious complication. It puts both the mother and the fetus at risk for a number of problems. Hypertension can exist in several different forms. One of these is the preeclampsia-eclampsia continuum (also called pregnancy-induced hypertension or PIH). In this type of hypertension, high blood pressure is first noted sometime after week 20 of pregnancy and is accompanied by protein in the urine and swelling. Chronic hypertension is another form of hypertension.It usually exists before pregnancy or may develop before week 20 of pregnancy.6Nurses have a vital role in the successful operation and ultimate outcome of antenatal high risk mothers’ care. The ultimate goal of nurse is to prevent hypertensive disorders of pregnancy or to assist in early diagnosis and appropriate treatment of these disorders to maximize outcome. Preeclampsia is a much study disease of pregnancy but the triggering factor remains unknown. This makes prevention difficult; however, because research indicates that several factors, such as early appropriate prenatal care, adequate fluid intake and optimal nutrition plays important roles, the nurse should include these in the prenatal instructions. When a mother develops preeclampsia during pregnancy, the goal becomes the prevention of eclampsia and uteroplacental insufficiency while attempting to facilitate fetal maturity.7NEED FOR THE STUDY3 PIH is a multi system syndrome characterized by vasoconstriction, metabolic changes, and endothelial dysfunction, activation of coagulation cascade and increase inflammatory response. PIH contributes to (MMR) Maternal Mortality Rate, Prenatal mortality rate and still birth with variations to geographical location and race.8Hypertensive disorders of pregnancy are frequent cause of maternal and fetal morbidity and mortality, the most common being preeclampsia and eclampsia. Pregnant mothers should be screened routinely. Early recognition and prompt care form a multidisciplinary service, including obstetrics, cardiology, and hypertensive disorders of pregnancy reflect endometrial endothelial dysfunction and abnormalities and systematic endothelial dysfunction, which might predict future cardiovascular disease in these young women, prompting early preventive measures.9In a study it was stated that in most of the countries, PIH is the single largest cause of maternal mortality. WHO (2000) stated that maternal mortality is said to be an indicator of social inequity and discrimination against women. The Goal of national health policy was to reduce maternal mortality rate to 100 / 1, 00,000 like births by 2010.10In Global, Pre-eclampsia or PIH is a condition that affects up to 80% of pregnancies every year and is among the leading cause of maternal and fetal illness worldwide .The incidence of pre-eclampsia and eclampsia was higher in the developing countries with the highest rate reported for pre-eclampsia as 7.1% in Zimbabwe and for eclampsia as 0.81% deliveries in Columbia. The Maternal and fetal mortality rate was 0.4% for pre-eclampsia reported in Magpies and as 6.1% for eclampsia reported from Columbia. Hypertension disorders of the pregnancy are the common and direct cause of maternal deaths in South4 Africa. 19.1% of maternal deaths in a three year period (2002-2004) were associated with hypertensive disorders of pregnancy.11A study was conducted in US, stated that pregnancy associated hypertension is a leading cause of maternal death. The study reported Maternal death rate in 2005 was 9.8/1,00,000.12In national level, the developing countries like India, the maternal and prenatal mortality rates are still high. It is of great concern to suggest mothers to improve the health status of the Mother and the child. It is well accepted that only a healthy mother can give birth to a healthy baby. In 2003, Maternal mortality has declined to 301/1, 00,000 live births.13A study was conducted on comprehensive antenatal care and prevention of pregnancy induced hypertension. Hypertensive disorders in pregnancy are a universally common disease. How pregnancy induces and aggravates hypertension is still not understood fully.The incidence of pregnancy induced hypertension (PIH) in India ranges from 5-15%. InPrimi mothers 16% and Multi mothers 7%. It causes IUGR leading to low birth weights.It increases the maternal mortality by 10-15% and the prenatal mortality and morbidity by 15 to 25%.14PIH can be detected early during regular prenatal visits, which is one of the reasons they are so very important. PIH can be result in preterm baby, a stillborn baby and a baby who has growth retardation (IUGR). 15The pregnant woman's interview at her first visit the health care provider is conducted by the nurse, who obtains the data necessary to begin the high-risk screening. The physician5 or midwife caring for a pregnant woman should review the prenatal assessment sheet, order lab data, and obtain ultrasounds to determine if any risk factors are present. If it is determined that a woman has a high-risk pregnancy, she should be referred to a perinatologist for advanced care. This is the specialist who establishes and implements the medical regimen needed for the particular maternal/fetal complication and the inter- disciplinary team associated with the prenatal center works in its management. The prenatal team usually comprises a nutritionist, social worker, nurse educators, geneticists, ultrasonographers, and additional nursing staff who are responsible for the monitoring and supervising of ongoing team care of the patient.166 A nursing care program was conducted to reduce the role of pregnancy-induced hypertension in patients with clinical complications. The study was conducted to investigate the predictability of complications of pregnancy induced hypertension nursing program. Methods to confirm the diagnosis of 400 patients with PIH were randomly divided into the nursing care intervention group and control group of 200 patients in the control group received routine treatment and care, nursing care intervention study group in addition to conventional treatment and care, the law of development of the disease given under nursing care interventions. The study group maternal complications(eclampsia, placental abruption, postpartum hemorrhage, acute renal failure, fetal death, neonatal asphyxia, etc.) compared with the control group, the incidence of the differences were statistically significant (P <0.01), study group was significantly lower than the control group. It was concluded as PIH nursing intervention for patients with predictability measures can significantly reduce the incidence of maternal complications.17A study was conducted to determine the health education in enhancing the self care agency of pregnant women among 30 antenatal mothers in Turkey. The study concluded that after health education the self care agency scores of the pregnant women increased significantly.18It was felt that maternal mortality rate from high risk factors during pregnancy could not diminish until their knowledge and attitude where understood and brought more into line with the norms of modern obstetric care. The investigator during her clinical experience noted many high risk antenatal mothers who have inadequate knowledge. The investigator planned to assess their knowledge regarding prevention of Pregnancy7 Induced Hypertension and she also felt the immense need to provide video assisted teaching programme for the high risk mothers.REVIEW OF LITERATURE :Review of literature is defined as a broad, comprehensive, in-depth, systematic and critical review of scholarly publications, unpublished scholarly print materials and audio visual materials.19Literature review for the present study has been collected and presented under the following headings.1. Literature related to incidence and prevalence of PIH.2. Literature related to the management of PIH.3. Literature related to the complications of PIH.4. Literature related to prevention of PIH.5. Literature related to effectiveness of teaching program on PIH.Literature related to incidence and prevalence of PIH:Worldwide, it is estimated that 5, 29,000 women die yearly from complication of pregnancy and childbirth, about one women every minute. The incidence of the preeclampsia in hospital practice varies widely from 5-15%. The incidence in primigravidae8 is about 10% and in multigravidae 5%. Imperfect documentation and lack of uniformity in the diagnostic criteria are the responsible factors in variation of its frequency. In the developing countries, the incidence is expected to be higher. Comparative low figures in the hospital statistics is due to inclusion of only severe degree of the syndrome, the minor ones being ignored.20It was reported that the rate of PIH has risen steadily by about 30% to 40% since 1990.Now it is 38.8/1000 live births.21In India 10% to 30% of pregnancies belong to the high risk category. About 5,85,000 women die each year from pregnancy related census, 99% of them are from the developing countries, out of each 80% of the deaths are due to direct obstetrics causes(such as hemorrhage, infection, hypertension, abortion) and 20% are due to indirect causes ( such as anemia, malaria, hepatitis, AIDS). Secure maternal mortality is 6 to 10 times more frequent than maternal mortality. WHO estimates that 95% of these deaths are handicaps is avoidable.22According to Indian Council of medical researchable task for a study (2002) in India where maternal mortality rate is 582/1, 00,000 live birth and hypertensive disorders were responsible for 24% of all maternal deaths.23A retrospective study to determine the maternal outcome in pregnant women with hypertensive disorder. A retrospective analysis was undertaken on 255 consecutive cases of PIH. Of the 255 cases 11% had eclamptic convulsion, 11% of women demonstrated to have HELLP syndrome.24Literature related to the management of PIH:9 Ideally all patients of pre-eclampsia are to be admitted in the hospital for effective supervision and treatment. There is no place of domiciliary treatment in an established case of pre-eclampsia. However, in some centers cases of preeclampsia are managed in the day care unit (p 639). In the developing countries where the prevalence of preeclampsia is more and hospital facilities are meagre, there is no alternative but to put the uncomplicated mild pre-eclampsias in domiciliary treatment regime. Rest, high protein diet and mild sedative at bed time are prescribed and the patient is investigated and checked after one week or even earlier. If treatment fails, the patient is to be admitted. It is essential that she should be warned against the ominous symptoms such as headache, visual disturbances, vomiting, epigastric pain or scanty urine.25A study was conducted about the short and long term strategies for the management of hypertensive disorders of pregnancy. In this study, the main focus was given on recent developments in the prediction and pathogenesis of these disorders, prevention of preeclampsia and current strategies for the treatment of hypertension in pregnancy. It also explores the evidence relating adverse pregnancy outcome to an increased future risk of cardiovascular disease and potential strategies to minimize this risk.26A study was conducted about “A comparison of walking versus stretching exercise to reduce the incidence of preeclampsia: a randomized clinical trial”. Women were randomized to either the walking group (n=41) or the stretching group (n=38). The walkers exercised an average of 36 (SD, 6) minutes at 18 weeks gestation, 34 (SD, 7)10 minutes at 28 week of the intervention. Equally on average, the stretching group exercised 4 (SD, 2) times a week at 18 weeks gestation, 5 (SD, 1) times a week at 28 weeks gestation. The incidence of preeclampsia was 14.6% (95% CI, 0.07 to 13.8) among the stretchers. The mean transferring level, an antioxidant marker, was significantly higher in the stretching group mean (412 mg/dL, 95%CI, 389 to 435) than the walkers at the time of labor (mean=368 g/dL, 95%CI, 346 to 391) (P=0.05). Regular stretching exercise may promote endogenous antioxidants among women at risk for preeclampsia.27Literature related to the complications of PIH:Pregnancy induced hypertension may develop into eclampsia, the occurrence of seizures.Fetal complications may occur because of prematurity at time of delivery.28A study was conducted on supplementation of Vitamins C and E to prevent complications of pregnancy – associated hypertension. A total of 10,154 women underwent randomization. Two groups were similar with respective baseline characteristics and adherence to the study drug. Outcome data were available for 9969 women. There was no significant difference between the vitamin and placebo groups in the rates of the primary outcome (6.1% & 5.67% respectively); relative risk 1.07; 95%CI, 0.93 to 1.24). Vitamins C and E supplementation initiated in the 9 to 16th week of pregnancy in an unselected cohort of low risk, nulliparous women did not reduce the rate of adverse maternal or prenatal outcomes related pregnancy associated hypertension.2911 A study was conducted on pregnancy induced hypertension complicated acute disseminated intravascular coagulation with the clinical analysis of 26 cases. In 26 patients with PIH complicated acute DIC, 7 cases died (26.92%), while 17 neonates died(58.62%) in 29 neonates (3 cases were twin pregnancy). Caesarean section and hysterectomy were performed on 7 cases respectively; including 4 cases underwent both of them. The causative factors of PIH complicated acute DIC included placental abruption (7 cases), amniotic fluid embolism (4 cases), eclamptic seizure (4 cases), surgical injury (7 cases) and bleeding (4 cases). The conclusion was there are close relationship between PIH and DIC, PIH complicated acute DIC is the major cause of maternal and prenatal mortality, special attention should be paid on preventing DIC forPIH.30A study was conducted on investigating the risk of hypertension shortly after pregnancies complicated by preeclampsia. Women with preeclampsia were significantly more likely than controls to have hypertension (adjusted odds ratio, 13.92; 95% CI, 5.04-66.46;P<.001) preeclampsia, may provide opportunities to identify women at risk for cardiovascular morbidity years before the onset of disease, allowing a window for prevention and intervention.31A study was conducted in Ohio, to compare the frequency of the adverse fetal outcome in women who developed PIH with or without Protienuria. The study was compared with598 pre-eclamptic mothers and normotensive mothers. The findings revealed that in12 women who have pre-eclampsia has increased the rate of preterm delivery (25%) and delivery of small for gestational age (20.8%) infant.32A study was conducted on incidence of pregnancy induced hypertension and the effects of mother and fetus in Shangai. There were 158,790 deliveries in ten years. The total numbers of PIH were 8,852 cases. The incidence of PIH was 5.57%. The rate of mild, moderate and severe PIH was 55.83%, 29.39%, and 14.78% respectively. There were 114 cases (1.29%) complicated with preeclampsia. The rate if caesarean section of placenta0.52%, heart failure 0.34%, renal failure 0.20%, DIC 0.03%, maternal death one cases.The prenatal death 66 occurred in cases (7.18@1000) in which fetal death 48 cases, still birth 12 and neonatal death. The incidence of PIH and the rate of prenatal infant death can be reduced by strengthen antenatal monitoring, prevention, early diagnosis and treatment of PIH.33Literature related to prevention of PIH:Although there is no known way to prevent preeclampsia, it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as preeclampsia early. Proper prenatal care is essential. At each pregnancy checkup, the health care provider will check the weight, blood pressure, and urine (through a urine dipstick test) to screen for preeclampsia.3413 As with any pregnancy, a good prenatal diet full of vitamins, antioxidants, minerals, and the basic food groups is important. Cutting back on processed foods, refined sugars, and cutting out caffeine, alcohol, and any medication not prescribed by a doctor is essential.Talk to your health care provider before taking any supplements, including herbal preparations.35A study was conducted on calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. In this study preeclampsia and eclampsia are common causes of seriously morbidity and death. Calcium supplementation may reduce the risk of preeclampsia through a number of mechanisms, and may help to prevent preterm birth. Calcium supplementation appears to approximately halve the risk of preeclampsia, to reduce the high risk of preterm birth and to reduce the rate of occurrence the composite outcome ‘death or seriously morbidity’. There were no other clear benefits, or harms.36A study was conducted regarding regional differences in prevention of pregnancy induced hypertension. In this review, it is found that the underlying cause of preeclampsia and the result of clinical trials performed to prevent this disease, that the causes and strategies to prevent preeclampsia are different in developed and developing countries. It also suggests that establishment of an adequate prenatal care is the only effective way to reduce the incidence of preeclampsia in population from developing countries, especially in women at high risk of pregnancy induced hypertension.3714 A study was conducted about low dose acetylsalicylic acid in prevention of pregnancy induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches. Forty three women on acetylsalicylic acid and 43 on placebo were successfully followed up. The use of acetylsalicylic acid was associated with statistically significant reduction in the incidence of pregnancy induced hypertension (11.6% vs.37.2%, RR=0.31, 95% CI0.13 – 0.78) and preeclampsia (4.7% vs. 23.3%, RR=0.2, 95%CI 0.05-0.86). Acetylsalicylic acid was not associated with excess risk of maternal or fetal bleeding. In women rated in Doppler velocimetry waveform analysis to be at high risk of preeclampsia, low dose acetylsalicylic acid reduces the incidence of pregnancy induced hypertension and especially proteinuric preeclampsia.38Literature related to effectiveness of teaching program on PIH:A study was conducted to assess the efficacy and acceptability of a patient held pictorial card aimed at raising awareness and appropriate health seeking behavior in response to prodormal symptoms of imminent eclampsia. Pictorial cards were issued to antenatal clinics and used to give instruction and advice to the women. Mothers were surveyed before and after the introduction of the cards. The study concluded that mothers’ awareness and response to symptoms improved significantly and there was a marked drop in eclampsia incidence.39A descriptive exploratory study was conducted with aimed at identifying the factors that are associated with preeclampsia and assessing the quality of midwifery care during labor in women with preeclampsia in South Africa. The study revealed that women affected15 with preeclampsia delayed in attending the antenatal clinic resulting in the control of the disease being difficult. Based on the findings of the study, it is recommended that health education on prevention of preeclampsia should be done on an ongoing process, while carriers for mothers should be given in service education program.40A study was conducted on Evaluation of a structured teaching program on pregnancy induced hypertension treatment and teaching program in general practice. 10 primary health care practices. From each practice 20 women (30 to 60 years old, mean of the last two blood pressure measurements at or above 160 and/or 95 mmHg) were randomly selected; in 5 practices these women were to participate in the treatment and teaching program me; in the remaining 5 practices hypertension care was continued without the availability of such a program me (controls). Of the 100 control women 26 and of the100 intervention women 14 were lost to observation; 46 women had agreed to participate in the programme. The mean number of prescribed antihypertensive agents per women decreased in the intervention group (1.8 +/- 1.3 at baseline, vs 1.2 +/- 1.2 at follow-up) compared to the control group (1.6 +/- 1.3 vs 1.8 +/- 1.6); difference 0.8 (95% CI 0.4 to1.1), p < 0.0001. In the control group 9% and in the intervention group 33% of women had documented reductions of body weight (p < 0.0001). Blood pressure decreased in the intervention group (162 +/- 14/100 +/- 7 mmHg at baseline, vs 154 +/- 16/95 +/- 9 mmHg at follow-up) compared to the control group (161 +/- 13/98 +/- 7 mmHg vs 158 +/- 18/96+/- 11 mmHg); differences for systolic blood pressure 5 (95% CI 0 to 10) mmHg, p =0.071; for diastolic blood pressure 4 (1 to 7) mmHg, p = 0.018.it was concluded that the introduction of a structured pregnancy hypertension treatment and teaching program me16 in general practice may lead to significant improvements of pregnancy induced hypertension care.41Statement of the ProblemAssess the effectiveness of video assisted teaching on knowledge regarding prevention ofPregnancy Induced Hypertension (PIH) among high risk antenatal mothers attending antenatal clinic in a selected hospital, Bangalore, Karnataka.Objectives To assess the knowledge on Prevention of Pregnancy Induced Hypertension among high risk antenatal mothers before intervention. To assess the effectiveness of video assisted teaching module on prevention ofPregnancy Induced Hypertension among high risk antenatal mothers. To find the association between post-test knowledge scores on prevention ofPregnancy Induced Hypertension among high risk antenatal mothers and their selected demographic variables.Operational definitionEffectiveness17 Effectiveness refers to significant gain in the knowledge as determined by the statistical difference in pre-test and post-test scores on prevention of pregnancy induced hypertension among high risk antenatal mothers attending antenatal clinic in a selected hospital, Bangalore, Karnataka.Pregnancy Induced Hypertension (PIH)PIH is a multi system disorder of unknown etiology characterized by development of HT to the extent of 140/90 mmHg or more with proteinuria, induced by pregnancy after the20th weeks in a previously normotensive and non- proteinuric women.Video Assisting TeachingIt refers to the planned video teaching provided on prevention of PIH to high risk antenatal mothers attending antenatal clinic. It consists of video clippings related to introduction, meaning, signs and symptoms, and preventive measures such as regular antenatal check up, diet, calcium supplementation, exercises, activity, relaxation techniques, rest and sleep.Prevention of Pregnancy Induced HypertensionIt refers to measures taken by the antenatal mothers to prevent pregnancy induced hypertension. These measures include regular antenatal check up, diet, calcium supplementation, exercises, activity, relaxation techniques, rest and sleep.High Risk MothersHigh risk antenatal refers to antenatal mothers associated with certain conditions or risk factors that predispose the mother to develop Pregnancy Induced Hypertension. The risk18 factors associated with Pregnancy Induced Hypertension are young and elderly primigravida, family history of hypertension, placental abnormalities, genetic disorders and pre-existing vascular or renal disease.Assumptions: High risk antenatal mothers may not have adequate knowledge regarding the prevention of Pregnancy Induced Hypertension. Video assisted teaching module may enhance the knowledge of the high risk mothers on prevention of Pregnancy Induced Hypertension.Hypothesis :H1: There will be a significant difference between pre-test and post-test knowledge scores on prevention of Pregnancy Induced Hypertension among high risk antenatal mothers. H2: There will be a significant association between post-test knowledge scores on prevention of Pregnancy Induced Hypertension among high risk antenatal mothers and their selected demographic variables.7. Materials and methods19 7.1. Source of Data Data will be collected from the high risk antenatal mothers’ attending antenatal clinic, Bangalore, Karnataka. 7.2. Method of data collection Pre-experimental design with one group pre-test post- Research Design test approach to assess the effectiveness of video assisted teaching on knowledge on prevention of Pregnancy Induced Hypertension (PIH) among high risk antenatal mothers.Setting of the Study Antenatal clinic in a selected hospital, Bangalore, Karnataka.Population The population will be high risk antenatal mothers.Antenatal mothers who are at high risk for PIH attending Sample antenatal clinic in a selected hospital, Bangalore, Karnataka.Sample Size The sample size will be 30 high risk antenatal mothers.Sampling Technique Purposive sampling technique will be used to select the high risk antenatal mothers attending antenatal clinic, Bangalore, Karnataka.The study will include mothers: Inclusion Criteria o who are willing to participate in the study. o who are able to understand Kannada or English.20 o who will be available at the time of data collection period. Exclusion Criteria The study will exclude mothers: o Who were professionals of medical and nursing field. o mothers with associated complications.Tools Tools will be divided in following sections: Section A: Inventory to screen high risk antenatal mothers. Section B: Structured questionnaire to assess the socio demographic variables. Section C: Structured knowledge interview questionnaire to assess the knowledge on prevention of PIH among the high risk antenatal mothers.Prior to the data collection the investigator will obtain Data Collection permission from the concern authorities of the antenatal clinic, Bangalore, Karnataka. The investigator herself will collect further data collection before and after intervention.Descriptive and inferential statistics will be used for data analysis. The collected data will be organized, tabulated Data Analysis & Data Presentation and analyzed by using descriptive statistic such as percentage, mean and standard deviation. The inferential21 statistics such as chi-square test and paired‘t’ test will be used. The findings will be presented in the form of bar diagram, pie / sector and tables.7.3. Does the study require any investigations or interventions to be conducted on patients or other humans or animals?Yes, Pre-test and post-test will be conducted among the antenatal mothers who are at high risk of PIH before and after intervention.7.4. Has ethical clearance been obtained?Yes, informed consent will be obtained from concerned authority of institution and prior to study. Privacy, confidentially and anonymity will be guarded. Scientific objectivity of the study will be maintained with honesty and impartiality.22 Ethical CommitteeAssess the effectiveness of video assisted teaching on knowledge regarding prevention of Title of the topic Pregnancy Induced Hypertension (PIH) among high risk antenatal mothers attending antenatal clinic in a selected hospital, Bangalore, Karnataka.Name of the candidate Miss. THENESHA KMasters of Science in Nursing Course and the subject Obstetrics and Gynecological Nursing Prof. Kalaivani Name of the Guide Head of the Department Obstetrics and Gynecological nursing Diana College of Nursing Bangalore – 64Ethical Committee Approved23 Members of Ethical Committee1. Prof. Veda Vivek,Principal and Head of Department,Department of Community Health Nursing,Diana College of Nursing, Bangalore – 64.2. Prof. Elizabeth Dora,Head of the Department,Department of Child Health Nursing,Diana College of Nursing, Bangalore – 64.3. Prof. Kalaivani,Head of the Department,Department of Obstetrics and Gynecological Nursing,Diana College of Nursing, Bangalore – 64.4. Prof. Vasantha Chitra,Head of the Department,Department of Medical Surgical Nursing,Diana College of Nursing, Bangalore – 64.24 5. Prof. Surendra,Biostatistician, GKVK, Jakkur, Bangalore-64.6 Signature of the candidate7 Remarks of the Guide The research topic selected for the candidate is suitable as it is selected for the antenatal mothers who are at high risk for PIH. There is a need to assess the knowledge and to provide adequate information regarding prevention of PIH among high risk antenatal mothers.8 Name and Designation of Guide (In block letters) Prof. Kalaivani, Head of the Department, Obstetrics and Gynecological Nursing, Diana college of Nursing, Bangalore – 64.25 Signature9 Head of the Department Prof. Kalaivani, Head of the Department, Obstetrics and Gynecological Nursing, Diana college of Nursing, Bangalore – 64.Signature Remarks of the Chairman & The topic selected for the candidate is 10 Principal researchable and feasible and forwarded for needful action.Signature26 BIBILIOGRAPHY/REFERENCES1. Dr. Satish Goel, Pregnancy & Child Care, Ist edition, Diamond Pocket Books (P) Ltd, pp 69 to72.2. 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