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...

5) Ross DS, Rasmussen SA, Cannon MJ, Anderson B, Kilker K, Tumpey A, Schulkin J, Jones

JL.Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dross3@cdc.gov

6) Mustafa MB, Arduino PG, Porter SR.Oral Medicine Section, Department of Oral and

Maxillofacial Surgery, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan.

maysonmustafa@yahoo.com

7) Daley AJ, Thorpe S, Garland SM.Infection Control Department, The Royal Women's Hospital

and The Royal Children's Hospital, Melbourne, Australia. andrew.daley@rch.org.au

8)Plans P, Costa J, Espuñes J, Plasència A, Salleras L.General Directorate of Public Health, Department

of Health, Generalitat of Catalonia, Barcelona, Spain. pedro.plans@gencat.net

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

Wkly. Swiss recommendations for the management of varicella zoster virus infections. 2007

May 5;137(17-18):239-51.

10) J Obstet Gynaecol. Varicella zoster during pregnancy: a strategy for prevention.Elamin Ali

M.Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, King

Khalid University, Saudi Arabia. 2001 Jan;21(1):17-20.

11) J Obstet Gynecol Neonatal Nurs. Varicella infection in pregnancy.McCarter-Spaulding

DE.Boston College, School of Nursing, Chestnut Hill, MA 02467-3812, USA.

mccartdw@bc.edu, 2001 Nov-Dec;30(6):667-73.

12) Am J Infect Control. 1998 Jun;26(3):369-81; quiz 382-4.Varicella-zoster virus: infection,

control, and prevention.,Stover BH, Bratcher DF.,Kosair Children's Hospital, Clinical

Information Management Department, Alliant Health System, Louisville, Ky., USA.

13) Semin Perinatol..Varicella in pregnancy. Chapman.Center for Women's Medicine, Division

of Maternal-Fetal Medicine, Greenville Hospital System, SC 29605, USA., 1998 Aug;22(4):339-

46

14) Troughton JA, Crealey G, Crawford V, Coyle PV Management of varicella contacts in

pregnancy: VZIG or vaccination?Regional Virus Laboratory, Royal Group Hospitals Trust,

Northern Ireland, United Kingdom. judith.troughton@belfasttrust.hscni.net

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

registry.Clinical Risk Management and Safety Surveillance, Merck & Co., Inc., West Point,

Pennsylvania, USA. eileen_wilson2@merck.com, 2008 Mar 1;197 Suppl 2:S178-84.

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

Klinik, Universitätsspital Zürich, CH-8091 Zürich, Switzerland. kempf@derm.unizh.ch

17}J Infect, McKendrick MW, Lau J, Alston S, Bremner JVZV infection in pregnancy: a

retrospective review over 5 years in Sheffield and discussion on the potential utilization of

varicella vaccine in prevention.Department of Infection and Tropical Medicine, Sheffield

Teaching Hospitals NHS Foundation Trust, UK. mike.mckendrick@sth.nhs.uk, 2007

Jul;55(1):64-7. Epub 2007 Apr 5.

18) Med Microbiol Immunol., Sauerbrei A, Wutzler P.Herpes simplex and varicella-zoster virus

infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 1:

herpes simplex virus infections.Institute of Virology and Antiviral Therapy, Friedrich-Schiller

University of Jena, Hans-Knoell-Strasse 2, 07745 Jena, Germany. Andreas.Sauerbrei@med.uni-

jena.de, 2007 Jun;196(2):89-94. Epub 2006 Dec13.

19) Obstet Gynecol. Bohlke K, Galil K, Jackson LA, Schmid DS, Starkovich P, Loparev VN,

Seward JF.Postpartum varicella vaccination: is the vaccine virus excreted in breast milk?,Center

for Health Studies, Group Health Cooperative, Seattle, Washington 98101-1448, USA.

bohlke.k@ghc.org, 2007 Jun;196(2):89-94. Epub 2006 Dec 13.

20) J Obstet Gynaecol., Varicella zoster during pregnancy: a strategy for prevention. Elamin Ali

M.Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, King

Khalid University, Saudi Arabia., 2001 Jan;21(1):17-20.

21) Wise RP, Braun MM, Seward JF, Mootrey GT, Shields KE, Salive ME, Krause

PR.Pharmacoepidemiologic implications of erroneous varicella vaccinations in pregnancy

through confusion with Varicella zoster immune globulin.

22) Can Fam Physician. Varicella zoster virus. Recent advances in management.Rajan P, Rivers

JK.Division of Dermatology, University of British Columbia, Vancouver Hospital and Health

Sciences Centre, 2001 Nov;47:2299-304.

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