RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
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NAME OF THE CANDIDATE AND
RAJI MATHEW PANICKER
ADDRESS
JOSCO COLLEGE OF NURSING
NELAMANGALA.
BANGALORE.
2
NAME OF THE INSTITUTION
JOSCO COLLEGE OF NURSING
NO.3590, INFANT JESUS BUILDING,
CHENNAPPA EXTN.,
NELAMANGALA,
BANGALORE-562123.
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COURSE OF THE STUDY AND
M.Sc. NURSING I YEAR
SUBJECT
OBSTETRICS AND
GYNAECOLOGICAL NURSING
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DATE OF ADMISSION
26.10.2009
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TITLE OF THE TOPIC
A COMPARATIVE STUDY TO
ASSESS THE KNOWLEDGE ON USE
OF KICK COUNT CHART BETWEEN
PRIMIGRAVIDA AND
MULTIGRAVIDA MOTHERS
ATTENDING ANTENATAL OPD AT
SELECTED HOSPITALS,
BANGALORE.
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6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR STUDY
The health of the women represents the health status of any country. Women‘s health
assumes importance during pregnancy because her health status directly effects the health of
the fetus1. Thus in order to reduce the perinatal mortality formal counting of the fetal
movements by pregnant women could identify a fetus which is at risk of compromise, thus
allowing for prompt and appropriate action. The recording of the fetal activity serves as an
indirect measure of central nervous system integrity and function indicating that fetal
movements are a reliable sign of fetal well being.2
According to the recent statistics estimated by World Health Organisation in 2009
perinatal death occurred world wide was 7.6 million and almost 98% occurring in the
developing countries. In India the perinatal death estimated was about 48.6 per 1000 live
birth3.
Maternal perception of fetal movement is a valuable tool for early detection of fetal
compromise. Fetal movement is a reliable sign of fetal well being. A study was conducted on
reduction of perinatal mortality by monitoring of fetal movement and its effect on perinatal
outcome.
A quantitative research survey design was used to obtain information from
pregnant mothers and simple random probability sampling was used ninety seven pregnant
mothers participate but only limited information on the importance of fetal movement
monitoring in relation to perinatal outcome was displayed. Content on contextual health
education for mothers on Fetal movement monitoring was proposed.4
Perinatal mortality has been linked to an iceberg. In order to reduce the perinatal
mortality, formal counting of fetal movements during pregnancy reduces the risk of fetal
demise in the utero.
A study was conducted on the reduction of still birth with the
introduction of fetal movement information and guidelines. Women experiencing decreased
fetal movements are at increased risk of adverse outcomes.
Singleton third trimester
pregnancies presenting with a perception of Daily fetal movement were registered and
outcomes were collected independently at 14 hospitals. Assessment period included from
April 2005 to October 2005, the still birth rate among womens was 10.2%. Thus improved
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management of Daily fetal movement and uniform information should be provided to
womens regarding Daily fetal movement chart5.
Another study was conducted on the evaluation of the importance of maternal fetal
movement counting as a measure of fetal well being. Findings of the study stated that fetal
movement counting emerged as a valuable non invasive methods of assessing fetal well
being. But most of the women were unaware of the daily fetal movement charting thus
suggestions were made for increasing the awareness of fetal movement charting among
pregnant mothers6.
A prospective population based cohort study was conducted to identify the maternal
characteristics in women presenting with decreased fetal movements. In 14 delivery units a
total of 2374 pregnancies were registered from June 2004 to October 2005. The result ended
by 32% presented with perceived absence of fetal movement of whom 25% waited for more
than 24 hours without any movements leading to still birth and fetal growth restriction. Thus
a perception of Decreased fetal movements is significantly associated with adverse outcome
such as still birth, fetal growth restriction Guidelines for management and information to
pregnant women are needed7
The investigator during the experience founded that most of the women does not have
adequate knowledge regarding fetal movement count during pregnancy. Assessments of fetal
movements are used as a marker of fetal viability and well being. It reduces the risk of still
birth, Fetal Growth Restriction and fetal distress and thereby there will be reduction of the
perinatal mortality. Women should be aware of the potential concerns associated with the
decrease in fetal movement and be enabled to report any concern is timely fashion. Thus the
investigator felt the need to assess the knowledge of the mothers on use of fetal kick count
chart.
6.2 REVIEW OF LITERATURE.
Review of literature is a key step in the research process. The typical purpose for
analyzing or reviewing the existing literature are to generate research questions to identify
what is known and not known about a topic. The major goal of the review of literature is to
develop a strong knowledge base to carry out research and non research scholarly activities2.
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“A literature review is a process of reading, analyzing, evaluating and summarizing
scholarly materials about a specific topic.”
The review of literature is an important study in any aspect of research because it gives
a deeper insight in to the problem area and helps to clarify a problem and justify research.
The literature reviewed has been present under the following heading.
A) Studies related to assessment and effectiveness of using fetal movement chart.
B) Studies related to reduction of perinatal mortality by fetal movement chart.
C) Studies related to daily fetal movement counts in prevention of still birth.
D) Studies related to detection of fetal distress by fetal movement chart.
A) Studies related to assessment and effectiveness of using fetal movement chart.
A study was conducted to determine fetal monitoring by daily fetal movement chart.
Pregnant women in the third trimester were included in the study and were categorized in to 4
and the fetal outcome was assessed. Categories 1,2,3,4 were monitored by daily fetal
movement chart. The study concluded that daily fetal movement chart interpretations were
reactive 79%, non reactive 21% and good 84% reduced 16% respectively. Sensitivity of daily
fetal movement chart were 81 percent and specificity were 71 percent. Thus pregnant women
monitoring daily fetal movement chart experienced a favorable outcome and demonstrated as
a valuable test for the assessment of fetal well being8.
A study was conducted to determine the degree of compliance with a fetal movement
kick chart by high risk patients versus the standard count to 10 method. This prospective trail
included 1400 high risk patients. The result indicates compliance in the CLAP group 638 of
700 was greater than in the count to 10 group 448 of 700, 91 versus 64 % ; p < 0.0001. Thus
kick chart method is an easy and inexpensive tool for fetal monitoring and should continue to
be used in obstetric practice9
A study was conducted to evaluate the patients acceptance of three commonly used
chart. The 85 enrolls were given the different charts in a random manner and questioned at
the next office visit. The outcomes were favourable with all the charting techniques. The
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result were ending as the kick count chart method was rated most preferred in 95.3% of the
cases and emerged as the most acceptable charting technique for patients to monitor fetal
movement10.
A prospective study was conducted in order to compare the results of fetal movement
count as performed by either the attending staff or by the patients using the non stress test. A
total of 283 non stress test were performed in 200 patients of at least 32 weeks of gestation.
Fetal movement counts performed by the attending staff and by the patients were recorded on
241 and 170 occasions respectively. Thus the study concluded that there was best correlation
between fetal movement count by the attending staff with non stress test was when the
criteria of three or more fetal movements within 10 minutes was used, likewise best
correlation between patients fetal movement count by patients with non stress test was found
when ten fetal movements within 2 hours was used as a cut off point and thus suggests the
usefulness of fetal movement count as a cheap and effective method of screening for good
fetal well being11
B) Studies related to reduction of perinatal mortality by fetal movement chart.
A study was conducted on the effects of perinatal mortality by the introduction of
daily fetal movement count chart in the last month of pregnancy in all low risk and high risk
pregnancies. The study was carried out on 300 booked cases after introducing daily fetal
moment Chart in the nineth month of pregnancy. Daily fetal movement chart was used to
record number of fetal movement perceived by patients for one hour after food, they were
made to lie down in the left lateral side and put the hand over her abdomen and count fetal
movements. The conclusion was no fetus was lost after introduction of Daily fetal movement
chart and suggests that introduction of Daily fetal movement helps in reduction of parental
mortality in the absence of any other adverse factors necessitating early delivery12.
A prospective study was carried out over 500 booked cases after introducing daily fetal
movement count chart in the nineth month of pregnancy. Daily fetal movement chart was
used to record number of fetal movements perceived by patient for one hour after food. The
study concluded that no fetus was lost after introduction of Daily fetal movement chart in 250
cases that were given Daily fetal movement chart and this was compared to 250 booked cases
who were not given Daily fetal movement chart. Five intrauterine death occurred is the
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control group 2% of parental mortality, 15 patients were admitted with decreased fetal
movements in the Daily fetal movement chart Group. Thus Daily fetal movement chart is the
ninth month of pregnancy helps in identifying at risk fetus in the low risk pregnancies13
C) Studies related to daily fetal movement count in prevention of still birth
A study was conducted on daily fetal movement count in the prevention of still birth
among 6597 pregnant women who were all given fetal movement chart to use in the third
trimester differ from that among 13705 pregnant women of whom only a very few selected
high risk mothers used fetal movement charts. The study concluded that maternal monitoring
of fetal movement reduces the risk of intra uterine death.14
A study was conducted on prevention of still birth with introduction of fetal movement
information and guidelines. Over 3000 women participated and were given written
information on monitoring fetal movement and were invited to practice fetal movement
monitoring for their remainder pregnancies. The result indicates that still birth occurred less
frequently among women who learned how to monitor fetal movement.15
D) Studies related to detection of fetal distress by fetal movement chart.
A study was conducted in a clinical setting on a variety of techniques used for the
assessment of fetal well being in high risk pregnancy. The daily fetal movement record has
been found to be an inexpensive, non invasive, simple tool that may be used for the
continuous assessment of the fetus by the mother. Patients were instructed to count the
number of fetal movements perceived in a 30 minute period, three times per day. The result
indicates that daily fetal movement record may predict fetal distress occurring and can be
used as a screening tool that may signal the need for future fetal well being assessment16
A study was conducted to determine the feasibility of using fetal movement counting
as an assessment tool for monitoring and predicting the outcomes of a given pregnancy. Fetal
movement patterns were divided in to the first and the second halves of the pregnancy with
the associated implications of the different evaluative data in determining fetal compromise,
fetal distress and death. The study concluded that values of daily fetal movement counts are
the methods for calculating them and the indications for recording and assessing fetal
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movement patterns, thus fetal movements give an indication as to the prognosis of the
pregnancy and fetal outcome17
STATEMENT OF THE PROBLEM
A comparative study to assess the knowledge on use of kick count chart between
Primigravida and Multigravida mothers attending
antenatal OPD at selected Hospitals,
Bangalore.
6.3 OBJECTIVES OF THE STUDY
1. Assess the knowledge scores on use of kick count chart between primultigravida and
multigravida mothers.
2. Compare the knowledge scores on use of kick count chart between primigravida and
multigravida mothers.
3. Associate the knowledge scores on use of kick count chart between primigravida and
multigravida mothers with their selected demographic variables.
6.4 OPERATIONAL DEFINITIONS
1. Knowledge: Refers to the ability to feel, interpret and report the decrease, absence or
sudden increase of fetal movements of primigravida and multigravida mothers.
2 Primigravida: Refers to a woman who is married and pregnant for the first time having 58 months of gestational period attending the antenatal OPD for regular check up.
3. Multigravida: Refers to a woman who is married and has become pregnant for more than
one time having 5-8 months of gestational period attending the antenatal OPD for regular
check up.
4. Kick Count Chart: Refers to a graph or grid printed on a piece of paper with spaces to
record the daily movements of the baby after 5 months of pregnancy.
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5. Antenatal OPD: Refers to a place in the hospital where pregnant mothers come for
regular check up.
6.5 HYPOTHESIS
H1: There will be significant association with the knowledge scores on use of kick count
chart and their selected demographic variables.
6.6 DELIMITATIONS
1. The study is limited to the knowledge aspects only.
7. MATERIALS AND METHODS
7.1
The data will be collected from the
SOURCES OF DATA
primigravida
and
multigravida
mothers attending the antenatal
OPD
at
selected
Hospitals,
Bangalore.
The research approach adopted for
7.1.1 RESEARCH APPROACH
the present study is descriptive,
which will be used to compare the
knowledge of mothers and it is an
overall plan for collecting and
analyzing
comparison.
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the
data
for
the
The research design adopted for
7.1.2 RESEARCH DESIGN
the
present
study
is
non-
experimental descriptive.
The study would be conducted in
7.1.3 SETTING OF THE STUDY
the treatment room of antenatal
OPD
at
selected
Hospitals,
Bangalore.
Target Population: Comprises of
7.1.4 POPULATION
all the married primigravida and
multigravida mothers having 5 – 8
months of gestational period.
Accessible
Population:
The
population for the present study
comprises
of
primigravida
all
and
the
married
multigravida
mothers having 5 – 8 months of
gestational period attending the
antenatal OPD.
.
7.1.5
The proposed sampling technique
SAMPLING TECHNIQUE
adopted for the present study is
simple random technique which is
of probability sampling approach
considering every even samples
having 5 – 8 months of gestational
period attending the antenatal OPD.
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The proposed sampling size of this
7.1.6 SAMPLE SIZE
study consists of 50 primigravida
and 50 multigravida mothers.
7.1.7
SAMPLING CRITERIA
1. Primigravida and multigravida
A) INCLUSION
mothers attending the antenatal
CRITERIA
OPD for regular checkup having
5 – 8 months of gestational
period.
2. Primigravida and multigravida
mothers who are willing to
participate.
3. Primigravida and multigravida
mothers
who
are
available
during data collection.
4. Mothers who know how to read
Kannada and English.
1. Mothers who are not willing to
B) EXCLUSION
participate..
CRITERIA
2. Mothers having complications of
polyhydramnios
and
anterior
placenta
3. Mothers who are having less than
4 months of gestational period.
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7.2 DATA COLLECTION METHOD
The tool for the proposed study is
7.2.1 TOOL FOR DATA
structured knowledge questionnaire
COLLECTION
which would be developed by the
investigator with the help of
extensive literature and expert
opinions.
7.2.2 PROCEDURE
OF
DATA The plan of data collection for the
proposed study is as follows:
COLLECTION
Permission will be obtained
from the hospital authorities and
respondents using simple random
technique,
samples
are
drawn.
Subsequently structured knowledge
questionnaire will be given to the
participants.
Proposed data collection period
will be of 30 days.
Data analysis will be done through
7.2.3 DATA ANALYSIS METHOD
descriptive and inferential statistics
Descriptive Statistics
Frequency,
mean,
Percentage
standard deviation of described
demographic variables.
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Inferential Statistics
Paired “t” test would be used to
compare
Primigravida
knowledge
and
among
multigravida
mothers. The Chi-square test would
be used to find the association of
knowledge
with
the
selected
demographic variables.
7.3 DOES THE STUDY REQUIRES INVESTIGATIONS TO BE CONDUCTED ON
PATIENTS OR ANY OTHER HUMAN OR ANIMALS?
No, only educational intervention is carried out by comparison of Primigravida and
Multigravida mothers knowledge regading the use of kick count chart.
7.4 ETHICAL CLEARANCE
- The main study will be conducted after the approval of research committee.
- Permission will be obtained from the concerned head of the institution.
- The purpose and after details of the study will be explained to the study
respondents and as informed consent will be obtained from them .
- Assurance will be given to the study respondents on the confidentiality of the data
collected from them.
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8 . LIST OF REFERENCES
1. B T Basavanthappa . Text book of Nursing Research, 2nd edition Jaypee Publication.
2007; 92-93,264
2. Varney’s Text Book Of Midwifery, fourth edition , Medical Book Publishers 2005;
632
3. Kiran Wassan, Shazia Rani, Journal of Pakistan, Medical Association, Rawalpindi,
2009, Dec; 32(1):15-17.
4. Maputle, M.S. Mothiba.M.T. Mothers Knowledge of fetal movements monitoring
during pregnancy 2006, June;12(3) ;23-25
5. Julie Vicoria, Eli Saastad et al. Reduction of fetal movement with introduction of fetal
movement 2009, July; 22(4): 430-432.
6. Saastgad E, Ahlborg T, Froen Jf , Low maternal awareness of fetal movements is
associated with small for gestational age infants. J. Midwifery womens
7. Stray Pedersen et al. Maternal characteristics and pregnancy outcome in women
presenting with decreased fetal movements counts in late pregnancy. 2009; 88(12):
1345-51.
8. V.Soundaram, A. B. Chattopadhyay, Fetal monitoring by daily fetal movement chart
2004 ;10(4) : 2 - 4.
9. Luis M. Gomel et al, Compliance with a fetal movement chart by high risk Obstetric
Patients 2007; 24(2); 89 - 93.
10. Smith C.V, Davis S et al. Patients acceptance of monitoring fetal movements.
2002Feb ; 37(2) :144 - 146.
11. K. Chaturachindra et al. Assessment of fetal well being 2004 April; 39(1):
23 – 27.
12. Gantes M et al. Use of daily fetal movement record 2004 Sept; 15(5):
390 - 393.
13. Charlyn A. Coleman .Fetal movement count and assessment tool 2002 Feb
26(1): 15 - 23.
14. Singh Guneesh, Dasgupta. Daily fetal movement chart an inexpensive way of
assessing fetal well being 2009 June ; 59 (3): 1217 - 219.
15. Lt Col G Singh, Maj K Sidhu. Daily fetal movement count chart 2008 Dec; 64: .
212 - 213.
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16. N.G Haddad et al. Daily fetal movement count in the prevention of still birth
2005 Oct ;8: 87 - 91.
17. Katherine Brind Amour et al. Monitoring fetal movement to prevent still births.
2008 Aug ;12(3) :15 - 17.
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