“A STUDY TO ASSESS KNOWLEDGE REGARDING POST PARTUM

HEMORRHAGE AND IT’S MANAGEMENT AMONG THE

FEMALE HEALTH WORKERS IN SELECTED PHC

OF PATAN DISTRICT IN GUJARAT STATE.”

INVESTIGATORS

PATEL CHAITALI K. PATEL HARSH M.

SOLANKI DHARATI B. PATEL HINAL P.

BARANDA DIVYA N. PRAJAPATI HONEY B.

PATEL DIXI N.

A RESEARCH PROJECT SUBMITTED FOR PARTIAL FULFILLMENT OF

THE DEGREE OF BACHELOR OF SCIENCE IN NURSING AT
GOVERNMENT COLLEGE OF NURSING DHARPUR,
PATAN FROM HEMCHANDRACHARYA
NORTH GUJARAT UNIVERSITY.
YEAR-2022
 “A STUDY TO ASSESS KNOWLEDGE REGARDING POST PARTUM

HEMORRHAGE AND IT’S MANAGEMENT AMONG THE

FEMALE HEALTH WORKERS IN SELECTED PHC

OF PATAN DISTRICT IN GUJARAT STATE.”

INVESTIGATORS

PATEL CHAITALI K. PATEL HARSH M.

SOLANKI DHARATI B. PATEL HINAL P.

BARANDA DIVYA N. PRAJAPATI HONEY B.

PATEL DIXI N.

A RESEARCH PROJECT SUBMITTED FOR PARTIAL FULFILLMENT OF

THE DEGREE OF BACHELOR OF SCIENCE IN NURSING AT
GOVERNMENT COLLEGE OF NURSING DHARPUR,
PATAN FROM HEMCHANDRACHARYA
NORTH GUJARAT UNIVERSITY.
YEAR-2022

I
 “A STUDY TO ASSESS KNOWLEDGE REGARDING POST PARTUM

HEMORRHAGE AND IT’S MANAGEMENT AMONG THE

FEMALE HEALTH WORKERS IN SELECTED PHC

OF PATAN DISTRICT IN GUJARAT STATE.”

RESEARCH GUIDE RESEARCH GUIDE

Mrs. HIRAL SHAH Mrs. HETAL BHATIYA

Principal Class-Ⅱ Lecturer

[Link]. Nursing [Link]. Nursing

Govt. College of Nursing Govt. college of Nursing
Dharpur, Patan Dharpur,Patan

INVESTIGATORS

Patel Chaitali K. Patel Harsh M.

Solanki Dharati B. Patel Hinal P.

Baranda Divya N. Prajapati Honey B.

Patel Dixi N.

A Research project submitted to Government college of nursing

Dharpur, Patan of the requirement for the Degree
of Bachelor of Science in Nursing 2022

II
 CERTIFICATE

This is to certified that we students of Group – B ( Patel Chaitali K.,

Solanki Dharati B. , Baranda Divya N. , Patel Dixi N. , Patel Harsh M. , Patel
Hinal P. , Prajapati Honey B.) 4th yr [Link]. Nursing have undergone the
prescribed the course of study leading to B .Sc. Nursing degree examination for
a period of four – year accordance with the regulation of HNGU Patan.

Certified that the work embodied in this research project……

“ A Study To Assess Knowledge Regarding Post Partum Hemorrhage

And It’s Management Among The Female Health Worker In
Selected PHC Of Patan District In Gujarat State.”

It original and has been carried out in Govt. College of Nursing Dharpur ,
Patan.

DATE : -

SIGNATURE

--------------------

MRS. HIRAL SHAH

Principal

Govt. college of Nursing

Dharpur, Patan.

III
 ACKNOWLEDGEMENT

“ SUCCESS OF AN INDIVIDUAL IS POSSIBLE WHEN HE OR SHE IS

SUPPORTED BY OTHERS”

It is a matter of great privilege for us to express our sincere to all those who
helped us through there expert guidance, active cooperation & good will in
completion of study even at the cost of their inconvenience. This effort in our
academic pursuit would not have been reality but for constructive and purposeful
support, guidance and encouragement rendered by a number of persons whose help
we specially recognize through this acknowledgement.

We first express our deep gratitude to god almighty, whose grace and close
presence have given us strength and courage this study.

We would like to express our special thanks of gratitude to our respected

principal and our research project guide Mrs. Hiral Shah, who gave us golden
opportunity to conduct Research project ; who also helped us in completing our
project within limited time frame. She provides us opportunity to prepare the project ;
whose valuable guidance and kind of supervision given to us throughout the project
with shaped present work as it shows; her consent guidance & willingness to share
her vast knowledge made us understand this project.

We are very much thankful to our guide Mrs. Hetal Bhatia for her guidance &
kind of supervision given to us throughout the project with shaped the present work as
it shows & encouragement & she also helped us in increasing our knowledge
regarding our project and for also helping in assessing books and other material from
library.

Worlds of acknowledgement would remain incomplete if we do not express

our sincere and deep sense of indebtedness to all over faculties, colleagues, friends
and our beloved parents for their unconditional support, encouragement and prayer
during the entire period of our study. Our heartily thanks are extended to our parents
who had been with us throughout this study.

IV
 We also thank all the person who directly or indirectly helped us for our
research work.

YOUR SINCERELY,

Patel Chaitali K.

Solanki Dharati B.

Baranda Divya N.

Patel Dixi N.

Patel Harsh M.

Patel Hinal P.

Prajapati Honey B.

V
 INDEX

CHAPTER NO. CONTENT PAGE NO.

TITLEPAGE Ⅱ

CERTIFICATION Ⅲ

ACKNOWLEDGEMENT Ⅳ

Ⅰ INTRODUCTION

1.1 Background of the study 2

1.2 Need of the study 4
1.3 Statement of the problem 6
1.4 Objectives of the study 6
1.5 Assumption 6
1.6 Operational definitions 6
1.7 Delimitation 7
1.8 Conceptual framework 7
1.9 summary 8

Ⅱ REVIEW OF LITERATURE

2.1 Introduction 11

2.2 literature review related to PPH 11

Ⅲ METHODOLOGY

3.1 Research approach 19

3.2 Research setting 20

VI
CHEPTER NO. CONTENT PAGE NO.

3.3 Target population for the study 20

3.4 Sample & sample size 20

3.5 Sample technique 20

3.6 Selection of tool for data collection 21

3.7 Development of tools for data collection 21

3.8 Description of tool for data collection 22

3.9 Validity of tool 23

3.10 Reliability of tool 23

3.11 Pilot study 23

3.12 Data collection 23

3.13 Plan for data analysis 24

3.14 Summary 24

Ⅳ ANALYSIS AND INTERPRETATION

4.1 Analysis and interpretation of the demographic 26

variables of the samples

4.2 Analysis and interpretation of data collection on 29

knowledge score of samples

4.3 Findings 31

4.4 Summary 31

Ⅴ SUMMARY MAJOR FINDINGS ,CONCLUSION,

VII
CHAPTER NO. CONTENT PAGE NO.

IMPLIMANTATION AND RECOMMANDATION

5.1 Summary 33

5.2 Major findings of study 33

5.3 Conclusion 34

5.4 Implications 34

5.5 Recommendation for further study 35

BIBLIOGRAPHY 37

APPENDICES 41

ABSTRACT 74

VIII
 LIST OF TABLES

TABLE NO. TITLE PAGE NO.

Table 1.2 Table showing MMR among Female Health Worker 5

In Gujarat state & in India.

Table 4.1 Frequency & percentage wise distribution of sample by 27

their demographic data.

Table 4.2.1 Knowledge level of FHW. 29

Table 4.2.2 Analysis and interpretation of FHW knowledge regarding

PPH and its managements. 30

IX
 LIST OF FIGURES

FIGURE NO. TITLE PAGE NO.

Figure 1.1 Types of PPH (Post Partum Hemmorrhage) 2

Figure 1.8 Conceptual framework of the study 9

Figure 4.1 Bar chart showing Data about demographic variables 28

Figure 4.2 Knowledge level of FHW 29

X
 LIST OF APPENDICES

APPENDIX TITLE PAGE NO.

A Consent Form 41

B Structured knowledge questionnaire and tool of sample 42

C Answer key 61

D Master sheet 62

E Letter granting permission for research study-1 66

F Letter granting permission for research study-2 67

G Certificate concern to validity of tool 68

XI
CHAPTER I

1
 CHAPTER Ⅰ

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

“No patient should die of PPH just for the lack of training.”
-S Egenberg
Postpartum hemorrhage is commonly as a blood loss of 500ml or more
within 24 hours after birth or a small blood loss that makes the woman
hemodynamically unstable is also termed as post partum hemorrhage. Massive/severe
PPH is defined as blood loss of 1000ml or more within the same [Link]
atonic is the most common cause of PPH but genital tract trauma ( i.e vaginal or
cervical laceration ), uterine rupture , retained placental tissue or maternal coagulation
disorders may also result in PPH. PPH is major cause of morbidity and mortality
within the first 24 hours following delivery and this is regarded as primary PPH.
Whereas any excessive bleeding from the birth canal occurring between 24 hours and
12 weeks postnatally ( after delivery ) is term as secondary PPH is devided into two
subtype. (1) Third stage hemorrhage (2) True post partum hemorrhage.

FIGURE 1.1 TYPES OF PPH ( Post Partum Hemorrhage )

PPH

Secondary
Primary PPH
PPH

Third stage
True PPH
hemorrhage

2
 PPH is the most common cause of maternal death during child birth India. which is
exacerbated by widespread anemia among pregnant women, accounts for 38% of all
maternal death. A with PPH can die within 2 hours after the onset of bleeding if she
does not receive any treatment. The speed with which death occur present major
challenge in setting with the poor communication and referral system and shortage of
necessary drug and equipment.

1. Methods to diagnose PPH are:-

i. Continual monitoring of pulse rate and blood pressure to detect problems.
ii. Blood test to measure red blood cell (hematocrit) and clotting factors.
iii. Ultrasound to get a detailed image of uterus and other organs.

Intervention to treat PPH generally proceed from less to more invasive and include
compression , techniques , medication , procedures and surgeries. PPH management
may also involve adjunctive therapies , such as blood and fluid replacement and/or an
anti shock garment , to treat the blood loss and other sequela that result from PPH.
Conservative management technique such as uterotonic medication , which cause
uterus to contract, external uterine massage and bimannual compression are generally
use as “first line” treatment. These compression techniques encourage uterine
contraction that counteract atony and assist with expulsion of retained placenta or
clots. The medication most commonly used in PPH management uterotonics agents.
Typically, oxytocin is use as initial medication for PPH management then other
uterotonics are administered if oxytocin fail to stop bleeding. In case of severe blood
loss from PPH, the hemostatic recombinant activated factor VIIa and the
antifibrinolytic tranexamic acid have been [Link] used in PPH management
include manual removal of the placenta, manual removal of clots , uterine balloon
tamponade and uterine artery embolization. Laceration repair is indicated when PPH
is a result of genital tract, surgical option when other measure fail to control bleeding
include curettage, uterine and other pelvic artery ligation, uterine compression suture
and hysterectomy.

3
 Early use of intravenous tranexamic acid ( within 3 hours of birth ) in addition to
standard care is recommended for women with clinically diagnosed postpartum
hemorrahage following vagainal delievery or cesarean section.
( WHO recommendations on PPH – 2017 )

The use of an effective uterotonic for the prevention of PPH during third stage of
labor is recommended for all birth.
In setting where multiple uterotonic options are available oxytocin ( 10 IU IM/
IV ) is the recommended for prevention of PPH.
In setting where oxytocin is unavailable, the ( or its quality cannot be guaranteed
), the use of other injectable uterotonics ( carbetocin or if appropriate ergometrine
fixed dose combination ) or oral misoprostol is recommended.

- Routes of oxytocin administration for the prevention of PPH after vagainal birth.
- Advance misoprostol distribution to pregnant women for prevention of PPH.
- Umbilical vein injection of oxytocin for the treatment of retained placenta.
- UBT for the treatment of refractory PPH .
( WHO recommendation on PPH -2020 )

1.2 NEED OF STUDY

Incidence of PPH reported as 2-4% after vaginal delivery and 6% after cesarean
section with the uterine atony being the cause in about 50% [Link] year about 14
million women around the world suffer from PPH. In india sample registration
scheme during survey of causes of death 1998, reported that PPH was a major cause
of maternal mortality and responsible for 30% of maternal death according to SRS
2001-2003 PPH accounts 38% of maternal death. Estimate of maternal mortality ratio
in india done by Indian council of medical research (ICMR) in 2003 also show PPH
as leading cause of maternal mortality in study population.

PPH is leading cause of maternal morbidity and mortality in developing

countries. Bleeding is main cause of maternal death in Africa ( 33.9 % ) and Asia
( 30.8 %) and second cause in Latin America and in the Caribbean ( 20.8% ). Globally
, 35 % of maternal deaths are associated with PPH . The estimated mortality rate from
bleeding in developed countries was below 13.4%. However, studies have shown the

4
trend of increase incidence of PPH as cause of severe maternal morbidity in
developed countries, such as Australia, Canada, United Kingdom and United State.
Similarly, 3179 maternal deaths ( 14.26 % of the total ) where related to hemorrhage
from 1997 to 2009 according to mortality information system of the ministry of health
in Brazil of these 1296 ( 40.8% ) deaths occurred after childbirth .Two regions , sub
Saharan Africa and south asia account for 86% of maternal deaths worldwide.
Postpartum hemorrhage is significant factor for maternal mortality. Prevalence of
PPH is 6.0% worldwide and highest prevalence was noted in Africa which is almost
10.1%. Sub-Saharan Africans suffer from the highest maternal mortality ratio-533
maternal death per 100,000 live birth, or 200,000 maternal deaths a year. South Asia
follows, with maternal mortality ratio of 163 or 57,000 maternal deaths a year,
accounting for 19% of global total.
The maternal mortality ratio in developing countries in 2015 is 239 per 100,000
live birth versus 12 per 100,000 live birth in developed countries. Thus 99 % of all
maternal deaths occur in developing countries. In India sample registration scheme
(SRS), during survey of causes of death 1998, reported that PPH was major cause of
maternal mortality and responsible for 30% of maternal deaths and according to SRS
2001-2003, PPH accounts 38 % of maternal death. Estimate of maternal mortality
ratio in India done by Indian council of medical research (ICMR) in 2003 also showed
PPH as leading cause of maternal mortality in study population.
([Link])
Maternal mortaliy ratio has come down significantly in the state to 28 in 2019–2022,
from 38.4 in 2010–2011. Total maternal death recorded at the start of the decade
stood at 186, which come down 133 last year of the total 1076 maternal deaths in the
past decades 17. 5 % were due to PPH.

Table 1.2 Table showing MMR among female in Gujarat state & in India.

INDICATOR GUJARAT INDIA

MMR 75 113

MMR DUE TO
23.3 33.9
BLEEDING

5
 During, our community posting we find that there is inadequate knowledge
about post partum hemorrhage and its management in female health worker. Hence,
the investigator felt the strong need to assess the knowledge in female health worker
about post partum hemorrhage.

1.3 STATEMENT OF PROBLEM

“A STUDY TO ASSESS KNOWLEDGE REGARDING POST PARTUM

HEMORRHAGE AND IT’S MANAGEMENT AMONG THE
FEMALE HEALTH WORKERS IN SELECTED PHC
OF PATAN DISTRICT IN GUJARAT STATE.”

1.4 OBJECTIVE OF THE STUDY

1. To assess the existing knowledge of female health workers regarding post partum
hemorrhage and its management.

1.5 ASSUMPTION
The study assumption as followed :

1) Female health workers will have enough knowledge about PPH and its Management.

1.6 OPERATIONAL DEFINITION

1. ASSESS : It refers to evaluate the value, importance or quality.
In this study assess refers to evaluate knowledge of female health
workers regarding PPH and its management.

2. KNOWLEDGE : It is theoretically or practical understanding of subject.

In this study knowledge obtains from the female health workers to the
questionnaires regarding PPH and its management. It is measured by structured
knowledge questionnaires.

6
3. PPH : Any amount of bleeding from or into genital tract following birth of the baby
up to the end of puerperium , which adversely affect general condition of the patient
evidenced by rise in pulse rate and falling BP, is called postpartum hemorrhage.

4. MANAGEMENT: In this study initial management include identified PPH,

determining the cause and implimanting appropriate intervention based on etiology.

5. FEMALE HEALTH WORKER : Auxilliary nurse midwife (ANM ) is a village

level female health worker in india who is known as first contact person between
community and the health services.

6. PRIMARY HEALTH CENTRE : The primary health centre is the basic structural
and functional unit of the public health services in developing country, to provide
accessible, affordable and available family health care to people.

1.7 DELIMITATION OF THE STUDY

The study is delimited to :

1) Female health workers In selected PHC of patan district in Gujarat state.

2) Study sample delimited to 40 samples.

1.8 CONCEPTUAL FRAMEWORK

Conceptualization refers to the process of refining general or abstract idea D.
Polite (1987). The conceptual model is general amalgam of all the related concepts in
the study problem and provides certain frame of reference for the researcher.

The present study aim testing the knowledge regarding management of post
partum hemorrhage among female health workers in selected phc of patan district in
Gujarat state.

7
 The conceptual framework is based on “System Theory Model” coined for the
study provides a basis of reference for the development of learning materials for
people.
This model consists of 3 phases :
1. Input
2. Process
3. Output

1. INPUT
Input is formal of energy information, material of human that enters into a
system through its boundries in this study. The input refers to female heath workers
with their background factor like age, sex, education, experience, attendance any in
service education programme on PPH.

2. PROCESS
It is the process that occurs in between the input and output process which
enables the input to be transfer as output in such a way that it can be reality used by
questionnaires to assess the knowledge regarding PPH and its management among
female health workers in selected PHC of Patan district in Gujarat state.

3. OUTPUT
In this study output refers to the level of knowledge in female health workers in
selected PHC of Patan district such as adequate, moderately adequate and inadequate
after process.

1.9 SUMMARY
This chapter deals with introduction, background of the study, need of the study,
statement of the problem, objective, assumption, operational definition, delimitation
of the study, conceptual framework of the research.

8
 -

INPUT PROCESS OUTPUT

Demography Of Preparation And Expected Outcome
Sample Development of Tool Regarding PPH and
its management
- Age - Knowledge among Female
- Education Questionnaire Health Worker.
- Experience Validity
- Previous Reliability
.
Knowledge Pilot Study
Final Study

FEEDBACK

Figure 1.8 Conceptual framework of the study

9
CHAPTER Ⅱ

10
 CHAPTER Ⅱ

REVIEW OF LITERATURE

2.1 INTRODUCTION

Literature review may be defined as a selection of available documents, both

published and unpublished on the topic of research interest, which contain
information, ideas, data and evidence written form a particular standpoint to fulfill
certain aims or express certain views on the nature of the topic and how it is to be
investigated and the effective evaluation of these documents in relation to the research
being proposed.

A literature review is and evaluative report of information found in the literature

related to selected area of study. The review describes, summarized, evaluates and
clarifies this literature. It gives a theoretical base the research and helps to determine
the nature of research.( Queensland university, 1999 )

A literature review a body of text that aims the review the critical points of
knowledge on a particular topic of research. ( ANA, 2000 )

2.2 LITERATURE REVIEW RELATED TO POST PARTUM

HEMORRHAGE :-

AH SHAH, DN PANCHAL ( 2021 ) Conducted study of maternal Reproduction,

Contraception, Obstretric and Gynecology and perinatal out come in patients of
post partum hemorrhage in tertiary care hospital, Gujarat. This prospective study was
done among 50 cases of post partum hemorrhage out of 13,628 deliveries at civil
hospital, Asarwa, Ahmedabad during November 2008 to October 2010 and analysis
was done regarding patient’s socio demographic characteristics, various risk factors
,causes and maternal and perinatal out come. Incidence of PPH was 0.36% . Almost
> 85% cases were belonged to 20-34 years age group. Highest cases (38% ) seen in
primigravida and 72% cases have normal vaginal delivery. Anemia noted in highest
cases ( 22% ) and 68 % cases have most common etiology was atonicity. Birth weight
11
<2.5 kg found in 36 % cases. Most common maternal out come was fever ( 16 % )
and 72% cases delivered healthy and alive birth. The patients were mostly
primiparous. The commonest associated medical condition was anemia. The
commonest underlying cause of PPH was atonicity of the uterus.

PARIDHI JAIN , NISHA THAKUR , ASHU JAIN , SUNITA AGARWAL,

SANGITA KAMRA, SHYLA JOCOB ( 2020 ) [ International Journal of
Reproduction, Contraception, Obsretrics and Gynaecology8(5)[Link]]
Conducted factors associated with increase blood loss during delivery. We studied
100 pregnant women were either in spontaneous labor or admitted for induction of
labor, underwent vaginal delivery or ceasarean section in our institute. Active
management of 3rd stage of labor in all 100 cases included 10 IU intramuscular
oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all
cases was noted. Of the included cases, 27 had to be given extra uterotonics for
atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of
PPH in 11 of the 12 cases , while one case was of atonic uterus plus trauma. Half of
all PPH cases responded to medical management alone, five cases had to undergo
tamponade / step wise devascularization and one case had to undergo obstertric
hysterectomy. Blood loss was significantly higher in women aged more than 35 years,
primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred
uterus in and had more than 1 high factor. Among various high-risk condition,
significantly higher blood loss was observed in patient with chronic hypertension,
gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH,
placenta previa , pre- eclampsia and sickle cell trait. Fifteen women avoided PPH by
using reliable method of blood loss measurement and initiating interventions early.
Organized PPH management protocol morbidity and mortality of the mother and
neonate can be prevented.

SN AGARWAL, TM SHETH, 2012 ([Link]) conducted a study to

compare the efficacy and side effects of misoprostal and methylergometrine for the
prevention of post partum hemorrhage in active management of third stage of labor. A
prospective study was carried out at SSG Hospital Vadodara from January 2011 to

12
may 2012. 200 women with singleton uncomplicated pregnancies between 37-42
weeks were enrolled for the study. Immediately after delivery of baby, all women
received three capsules orally and the contents of an ampoule by intravenous
injection. The capsules contain either a total of 600 µg misoprostol or placebo or the
ampoule 200 µg of methaylergometrine or placebo. Main outcomes were duration of
third stage of labor, amount of blood loss, need for further uterotonic drugs and the
presence of side effects. Duration of third stage of labor was 8.06 minutes with
methylergometrine and 11.46 minutes with misoprostol (P< 0.001). post partum
hemorrhage occurred in 1% and 5% women with methylergometrine and misoprostol
respectively (P=0.2137). the need for further uterotonic drugs was 1% and 5% after
methylergometrine and misoprostol respectively (P=0.2137). 11% women developed
fever (>38 C)after misoprostol and none after methylergometrine. Shivering occurred
in 11% women after misoprostol and in 1% women after methylergometrine. Diarrhea
occurred in 6% women in misoprostol group and in none in the methylergometrine
group. Nausea occurred in 9% and 1% with methylergometrine and misoprostol
respectively. This study suggests that although protection from post partum
hemorrhage using parenteral methylergometrine and oral misoprostol is nearly equal,
misoprostol is associated with more side effects.

SIDDESH SITARAM SHETTY, KUSUM VENKOBRAO MORAY,

HIMANSHU CHAURASIA, BEENA NITIN JOSHI 2021
([Link]) conducted a study to cost of managing atonic post
partum hemorrhage with uterine balloon tamponade devices in public health settings
of Maharashtra, India. Health system cost was estimated using primary economic
microcosting, data from Health Management Information System and published
literature for event probabilities. Four public health facilties from the state of
Maharashtra, India representing primary, secondary and tertiary level care were
choosen for primary costing. Unit, package annual cost of atonic PPH management
with three UBT devices were measured. This included cost of medical treatment,
UBT intervention and PPH related surgeries under taken in public health system of
Maharashtra for year 2017-2018. Medical management of atonic PPH cost the health
system US$37 (95% CI 29 to 45) per case, increasing to US$44 (95% CI 36 to 53)
with condom-UBT and surgical interventions for uncontrolled cases. Similar cost was
estimated for ESM-UBT. Bakri-UBT reported a higher cost of US$59 (95% CI 46 to
13
73) per case. Overall annual cost of managing 27,915 atonic PPH cases with condom-
UBT intervention in Maharashtra was US$12,26,610 (95% CI 870 250 to 1 581 596).
Atonic PPH management in public health facilities of Maharashtra with condom-
UBT, ESM-UBT or Bakri-UBT accounts to 3.8%, 3.8% or 5.2% of the states annual
spending on reproductive and child health services.

NGUYEGTOAN,TRAN,SARAHBAR-ZEEV,CATRINSCHULTE-
HILLEN,WILLIBALDZECK2022([Link])condected
Tranexamic Acid for Postpartum Hemorrhage Treatment in Low-Resources Settings:
A Rapid Scoping Review. Tranexamic acid effectively reduces bleeding in women
with postpartum hemorrhage in hospital settings. To guide policies and practices, this
rapid scoping review undertaken by two reviewers aimed to examine how TXA is
utilized in lower-level maternity care settings in low-resource settings. Articles were
searched in EMBASE, MEDLINE, Emcare, the Maternity and Infant Care Database,
the Joanna Briggs Institute Evidence Based Practice Database, and the Cochrane
Library from January 2011 to September 2021. We included non-randomized and
randomized research looking at the feasibility, acceptability, and health system
implications in low and lower-middle-income countries. Relevant information was
retrieved using pre-tested forms. Findings were descriptively synthesized. Out of 129
identified citations, 23 records were eligible for inclusion, including 20 TXA
effectiveness studies, two economic evaluations, one mortality modeling. Except for
the latter, all the studies were conducted in lower-middle-income countries and most
occurred in tertiary referral hospitals. When compared to placebo or other
medications, TXA was found effective in both treating and preventing PPH during
vaginal and cesarean delivery. If made available in home and clinic settings, it can
reduce PPH-related mortality. TXA could be cost-effective when used with non-
surgical interventions to treat refractory PPH. Capacity building of service providers
appears to need time-intensive training and supporting monitoring. No studies were
exploring TXA acceptability from the standpoint of providers, as well as the
implications for health governance and information systems. There is a scarcity of
information on how to prepare the health system and services to incorporate TXA in
lower-level maternity care facilities in low-resource settings. Implementation research

14
is critically needed to assist practitioners and decision-makers in establishing a TXA-
inclusive PPH treatment package to reduce PPH- related death and disability.

SHRIKANTWARADE,NIMISHASHARMA,2020([Link].
[Link]) conducted A prospective study of B-Lynch suture in the management of
atonic PPH at tertiary care centre. It was a single centre, hospital based cross-
sectional study conducted in the department of obstetrics and gynecology in a tertiary
care hospital in Maharashtra. About 50 cases during the study period (Nov 2017 to
June 2019) who failed the medical management of control of PPH were included in
the study. Demographic details like age, gestational age, religion, socio-economic
status and gravid were noted in the case record form. Amount of blood loss, success
rates, immediate complications and follow up fertility were assessed. Among the 50
study subjects, 24% had blood loss of < 1000ml, 54% had loss between 1000 to
1500ml, 16% had loss of 1501 to 2000ml and 6% had loss more than 2000ml in the
present study. About 80% of the cases were successful and 20% failed in the present
study. About 6% of the cases had wound gaping, 12% each had fever and had
hospital stay more than 5 days and 14% of the cases had wound infection in the
present study. About 90% of the cases had return of regular menstruation in the
present study. The success rate of B-Lynch immediate complications in our study.
Follow up data also suggested that majority of them recovered with normal routine.
In our experience, the B-Lynch technique is a safe, effective and easily implemented
method of arresting bleeding in cases of major primary PPH due to uterine atony.

GEETIKA THAKUR, PARAMITA KARMAKAR,PARIKSHAA GUPTA,SC

SAHA 2021 ([Link] conducted Uterine Scar Dehiscence: A Rare
Cause Of Life-Threatening Delayed Secondary Postpartum Hemorrhage. Delayed
postpartum hemorrhage is not a well studied condition as the incidence is very less.
Amongst the patient who developed delayed PPH, the proportion of cases being
reported is further less as most of the cases are managed on an outpatient basis. Even
the ones who reach emergency pose a diagnostic dilemma as there is no specific
definition to quantify delayed PPH into mild, moderate or severe. Severe secondary
PPH due to scar dehiscence is very rare and the bleeding occurs commonly due to the
shearing of vessels on the margins of the uterine scar. The risk factors reported for
scar dehiscence are multiparity, diabetes, emergency surgery, infection and incision
15
placed too low in the uterine segment. Two out of these, ie, multiparity and diabetes
were present in our patient. Uterine scar dehiscence with infection requires a high
index of suspicion as a rare cause for postpartum localized /generalized peritonitis
with sepsis. Severe abdominal wound infection after cesarean section may be
associated with uterine wound dehiscence, which poses a grave risk to the mother in
her future pregnancy.

YOGESH THAWAL, DIPAK K KOLATE,MINAL M PATVEKAR, SHIKHA

JINDAL, HEMANT DESHPANDE (2019) [Internation Journal of
Reproduction,Contraception,obstetrics and Gynecology 8(5)
[Link]] conducted study of management of postpartum hemorrhage
and its complications. This prospective observational study was conducted in
department of obstetrics and gynecology, [Link] Patil Medical college, pimpri, Pune,
Maharashtra, India. A total number of 80 cases of postpartum hemorrhage that fulfill
the selection criteria were included. Data collected and analyzed in PPH patient with
medical and surgical management. In present study, most of cases were multigravida
(60%) and more than 50% of patients required blood and blood products. In present
study, most of the post partum bleeding or post partum hemorrhage cases manage by
medical methods. Uterotonic drugs this was possible due to early identification and
timely intervention. Active management of third stage of labor is recommended in all
cases. Seventy percent cases were manage by medical methods while rest of cases
required surgical management. Among the medical management uterotonic drugs
and bimanual uterine compression was used while among surgical methods repair of
vaginal and cervical laceration was mostly required.

MOUMITA GHOSH , GUPA ROY ( 2022 )[[Link]] -

Conducted Descriptive survey on impact of skill training on knowledge and practice
regarding Active Management of the Third stage of Labor among staff nurses in
selected hospitals, west [Link] objectives of the study were assess the
knowledge level on AMTSL among staff nurses, to identify the practices on AMTSL,
to determine relationship between knowledge and practices on AMTSL, to find out
the association between knowledge and selected demographic variables and to find
out association between practices and selected demographic variables .The variables

16
were knowledge and practice of AMTSL. Conceptual framework was based on [Link]
Bertalanffy‘s General system’s model ( input , process and output). Descriptive
survey design was adopted to collect data from 50 staff nurses by purposive sampling
technique with help of structured questionnaires and observation checklist .The
findings indicates that 68 % staff nurses had fair knowledge regarding AMTSL , 14%
had good knowledge, 72 % of staff nurses had fair practice score , 18% had good
practice score. Practices after delivery of placenta was the best area during delivery.
The correlation analysis suggest that knowledge was csignificant association between
practice and age of staff nurses [ x2 df (1) = 4.1 ; p < 0.05 ] .based on the present
study findings it was found that the knowledge and practices of staff nurses regarding
AMTSL were fair.

Sonia Mlata PhD (Nursing) Scholar, Desh Bhagat University off to

NHI , Mandi Gobindgarh District, Fategarhsahib, panjab -
2021[[Link]]Conducted study to evaluate the effectiveness of structured
teaching programme on knowledge regarding PPH and its management . To find out
association between knowledge score and selected demographic variables. To prepare
an information booklet regarding prevention and management of PPH . The aim of
study was to improve postpartum hemorrhage women’s conditions and also provide
knowledge to staff nurses. Quantitative approach with one group pre test – post test
design was adapted. Total sample were 45 staff nurses of selected hospital.
Convenient and consecutive sampling techniques were use . Data was collected by
demographic performa and questionnaire . The data was analyzed by using descriptive
and inferentian statistics . The staff nurses had maximum knowledge (74%) in the
area of physiology of third stage of labor , while minimum knowledge ( 42.1 % ) in
the area of component of PPH . It indicating that increase in knowledge score was
done by chance but because of the intervention. Hence , it was interpreted that STP
was significantly effective in increasing the knowledge of staff nurses.

17
CHAPTER Ⅲ

18
 CHAPTER Ⅲ
METHODOLOGY

For any research work the methodology of investigation is of vital

importance. Research methodology is a way to solve the problems . It is a systematic
procedure in which the researcher starts from a initial identification of the problems to
final conclusion. The methodology of research indicates the general pattern of
organizing the procedure of gathering valid and reliable data for the problem under
investigation . ( C . R . Kothari – 1996 )

The chapter deals with the brief description of methodology adopted for
the study . The content included in this chapter is research approach , research setting,
the sample and sampling technique development and description of tool, validity and
reliability of the tool, data collection procedure and the plan of data analysis for the
present study. A structured knowledge questionnaires is used in this study. In the
study collected data without making changes or introducing treatments. Data obtained
are analyzed and result may lead to the formation of assumption that can than be
tested experimentally. Within a quantitative framework, the observation are
represented by numbers that can be statistically analyzed. Data in non experimental
research are generally collected through the use of questionnaires, interviews,
observation , literature reviews and critical – incident technique. In this study data
collected with the use of written structured tool such as questionnaires . The present
study is carried out to assess the knowledge regarding post partum hemorrhage and its
management among female health workers of selected PHC of Patan district in
Gujarat state. ( Suresh K . Sharma )
3.1 RESEARCH APPROACH
Research approach is the most significant part of any research. The
appropriate choice of research approach depends upon the purpose of research study
which has been under taken . It is an important step in research process. It is broad
basic procedure for collecting data in a particular research situation.
Research approach involves the description of plan to investigate the phenomena
under the study in a structured (quantitative), unstructured (qualitative) or a
combination of the tool two methods (qualitative -quantitative integrated approach) .

19
Therefore, the approach helps to decide about the presence of absence of
randomization, as well as manipulation and controlled over variables. In present
study quantitative research approach is used which aimed to assess the knowledge
regarding post partum hemorrhage and its management among female health wokers
of selected PHC of Patan district in Gujarat state.
3.2 RESEARCH SETTING
“ Setting is the physical location and condition in which data collection take
place in a study.” ( BT Basvanthappa – 2007 )

The study setting is the location in which research is conducted . The research was
done in seleted PHC of Patan district which include ; Balisana, Ranuj, Manud,
Palasar, Der, Ganget, Borsan, Aghar, Anawada, Siddhpur cross road.

3.3 TAREGET POPULATION FOR THE STUDY

According to Polit and Hungler (1995) “population refers to

entire aggregation and case that meets a design net set criterion’’.
The target population refers to the population that the researcher intends to
study the population about which the researcher to make a generalization.
In this study target population consisted of all FHW Working in Selected of
PHC in Patan distric in Gujarat state.
3.4 SAMPLE AND SAMPLE SIZE
Sample :
Sample may be define as representative segment of the population under
study which is to be worked upon by researchers during that study. FHW of selected
PHC of Patan district were the sample of the present study”.

Sample Size :
The samples in the study are 40 from selected PHC of Patan district.
3.6 SAMPLE TECHNIQUE

A Sample consist of sub set of the units that compose the population. The sample of
study comprised FHW who were working in selected PHC of Patan district in Gujarat
state. The sampling is process of selecting portion of population to represent the entire
population. The sampling is necessary because it is more economical and efficient to

20
work with small groups of elements. The investigation adopted simple convenient
sampling technique for the selection of area and sample. The sample who met the
criteria were selected by investigator for the study. Investigator selected Female
Health Workers of selected PHC in Patan district in Gujarat state, Investigator
selected FHW for Pilot study and FHW for Final study. Investigator collected data
from 40 sample from selected PHC of Patan district. Investigator selected following
areas for data collection through Structured Knowledge Questionnaire.
3.6.1 CRITERIA FOR SAMPLE SELECTION
 Female Health Worker from selected PHC of Patan district in Gujarat
state.

3.7 SELECTION OF TOOL FOR DATA COLLECTION

Treece and Treece(1986) state “ The instrument selected in research should as far as
possible be the vehicle that would best for obtaining data for drawing conclusion,
pertinent to study and add to the body of knowledge in decipline.”
To collected the data for present study following tools were selected
constructed.
[Link] Knowledge Questionnaire.
According to Cheung A . K . L. ( 2014 ) Structured questionnaires is a document
that consists of a set of standardized questions with a fixed scheme , which specifies
the exact a wording and order of the questions , for gathering information from
respondents .
 Rationale for knowledge questionnaire : -
[Link] questionnaires helps to elicit information .
2. Relatively simple method for collection of data.
3. It offers the possibility of anonymity & group administered.
4. Knowledge tests are list time consuming .
5. The close ended questions are efficient and easy to administer .
6. It covers a large group within a short period.

3.8 DEVELOPMENT OF TOOLS FOR DATA COLLECTION

The development of tool is a step by step procedure. In Order to make the tool,
investigator can across some studies that includes Questionnaire to assess the
knowledge regarding PPH and its management. A Review of research and non

21
research literature, expert’s opinion and investigator’s experience is the basis for
construction of the tools for data collection.
The investigator prepared a structured questionnaire to assess knowledge
about PPH and its management. A Questionnaire is simply a tool for collecting and
recording information about a particular issue of interest. It is mainly made up of a list
of questions but should also include clear instructions and space for answers.
Investigator prepared a tool containing questions related to PPH and its management.

3.8.1 DEVELOPMENT OF STRUCTURED QUESTIONNAIRE

The structured questionnaire on knowledge about PPH and its management consist of
30 items. It focuses mainly on knowledge on introduction, causes, diagnosis &
prevention, management of PPH.

3.9 DESCRIPTION OF TOOLS FOR DATA COLLECTION

The Investigator was preparing tool in two sections to assess the
knowledge PPH and its management is as follow:

SECTION Ⅰ: Consist of the personal data of age, education, experience ,attendance

in any in service education programme regarding PPH.

SECTION Ⅱ: Comprised items on knowledge regarding PPH and its management. In

this structured knowledge questionnaires there are total 30 questions, among this 6
questions are about introduction of PPH, 4 questions are about causes of PPH, 7
questions are about diagnosis and prevention of PPH and 13 questions are about
management of PPH. Maximum score of questionnaire is 30, investigator cut 1 mark
for wrong answer. Investigator divided the knowledge score as following and
considered knowledge according.

CLASSIFICATION OF KNOWLEDGE OF FOLLOWING CRITERIA :-

Good knowledge level:- knowledge score between 25 to 30,
Average knowledge level:- knowledge score between 15 to 25,

22
Poor knowledge level:- knowledge score between 0 to 15.

3.10 VALIDITY OF THE TOOLS

In order to measure the validity , the tools structured knowledge test was given
to five experts. Experts including Head of the Gynec Department , Assistant Professor
of Gynec Department, Assistant Professor of the P. & S.M. Department , [Link]
nursing faculty in Dharpur , Patan , Medical Officer of PHC . They were requested to
give their opinion and suggestion for the items of the tool . Out of the items, most of
them are accepted. All necessary modification was done according to the opinion to
expert.

3.11 RELIABILITY OF THE TOOL :-

The reliability is criterion for measuring adequacy, consistency and accuracy
of tool. Tool was administered to 5 samples selected as per the set criteria’s. The
reliability was calculated by karl Person’s correlation, coefficient formula. This was
0.7.

3.12 PILOT STUDY :-

A pilot study is a small- scale version or trial run of the major study. The
function of the study is to obtain information and assess feasibility of the study
improving and to decide the plan for data analysis.
The pilot study was conducted on 29 october 2022 in Balisana PHC of Patan
district in Gujarat state and with five samples selected for study to assess feasibility of
the study and to decide the plan for data analysis. Administrative permission proceeds
formality from the authority. The investigators approached the sample individually,
discussed the objectives of the study and obtain consults for participation in the study.
The data collected through structure knowledge questionnaire with five samples from
Balisana PHC, Patan. In the results mean score is 21, mean percentage is 70%,
standard deviation is 4.30. During this time investigator has not found any difficulty.
So, that pilot study is completed without any problem.

3.13 DATA COLLECTION :-

23
 Before starting data collection formal permission was obtained from
concerned authority. Investigator collected data from PHC-Balisana, PHC-Ranuj,
PHC-Manud, PHC-Palasar, PHC-Der, PHC-Ganget, PHC-Borsan, PHC-Aghar, UHC-
Anawada, UHC-Siddhpur cross road. Co-operation for data collection was
recommended by concerned authority. Investigator was formally requested to the
authority for providing required number of samples. Formal addressing letter was
given to each respondent for their participation in the study. Data was collected on 5th
November ,2022. The investigator approach the sample individually, discuss the
objectives of study and obtained consent for participation in study. All samples gave
good co-operation during data collection procedure and no any problem faced during
data collection.

3.14 PLAN FOR DATA ANALYSIS :-

. Investigator had prepared the master data sheet for each tool and calculates
the percentage and frequency of the items. Then, made the analyses according to
objectives of the study. Descriptive and inferential statistic were used to analyses the
data. The master data sheet was prepared by the help of the computer and then mean,
mean percentage and standard deviation was calculated by computer. From all data,
various tables and graphs were prepared. Interpretation was made in descriptive
manner in term of the objectives of study

3.15 SUMMARY:-
This chapter deals with methodology adopted for the present study. It
included the research approach, research setting, target population, sample & sample
size, sample technique, selection of tool for data collection, development of data
collection tool, description of data collection tool, validity of the tools, reliability of
the tools, pilot study, data collection& plan for data analysis. A research study was
conducted in selected PHC of Patan district in Gujarat state. Conducted pilot study
before going to final study. In pilot study, 5 samples are collected by investigator for
pilot study, tool used for data collection were structured knowledge questionnaire
content validation of the tool was done by the five experts then actual tool is
implemented of the study. Actual data analysis and interpretation were made in
Chapter-Ⅳ.

24
CHAPTER Ⅳ

25
 CHAPTER Ⅳ

ANALYSIS & INTERPRETATION

The main purpose of this chapter is to organize and summarize the data for
easy interpretation. The chapter deals with analysis and interpretation of data
collected during the study from 40 samples working in selected PHC of Patan district
in Gujarat state. For collecting the data the investigator has used the structured
knowledge questionnaires. Descriptive and inferential statistics were used for
analysis. The data collected was analyzed on the basis of objectives and assumption of
the study.
(Polit and Hungler,2008), described analysis as, “A process of organizing
and synthesizing data in such a way that research questions can be answered a
hypothesis tested”. Interpretation refers to process of making sense of results of
examining the implication of the findings within a broadest context.
Analysis and interpretation of the data based on the objectives and
assumptions of the study.

The objectives of the study were:-

1. To assess the existing knowledge of female health workers regarding PPH
(postpartum hemorrhage) and its management.

Analysis and interpretation of the data:-

Major findings of the study are presented under the following sections and
headings.
The obtained data are organized and presented in the following sections.
4.1 Analysis and interpretation of the demographic variables of the samples.
4.2 Analysis and interpretation of data collected on knowledge scores of samples.

26
4.1 ANALYSIS AND INTERPRETATION OF THE
DEMOGRAPHIC VARIABLES OF THE SAMPLES
This data deals with characteristics of samples in term of their age , educational
status , experience, if attend any in-service education, ( Table :- 4.1 )
TABLE 4.1 Frequency and percentage wise distribution of samples by their
demographic data. ( N = 40 )

[Link] Variables Frequency Percentage

1. Age
a) 21-30 year 26 65%
b) 31-40 year 14 35%
c) 41-50 year 00 00.00%
d)51 & above year 00 00.00%

2. Education
a) G.N.M Nursing 00 00.00%
b) A.N.M Nursing 40 100%

3. Clinical Experience
a) 0-5 years 23 57.05%
b) 6-10 years 16 40.00%
c) 11-15 years 01 02.05%
d) 16-20 years 00 00.00%
e) 21-25 years 00 00.00%
Above 26 years 00 00.00%
4. If attend any in service
education?
a) Yes
25 62.05%
b) No
15 37.05%

5. Total 40 100%

27
 TABLE 4.1 reveals that out of total 40 sample under this study majority of
sample (65%) are in the age group of 21 – 30 years , 14 (35%) are in the age group of
31 -40 year , 00.00% are in the age group of 41 – 50 years and 00.00% are in the age
group of above 51 years. As regard to education found that majority of samples 40 (
100 % ) were in A.N.M Nursing , 00 ( 00% ) in G.N.M Nursing . Distribution of
samples according clinical experiences found that majority of samples were 23(
57.05% ) in 0-5 years of experience, 16 ( 40% ) were in 6-10 years of experience and
1 ( 2.5 % ) were in 11-15 years of experience and 00.00% experiences in above 16
years. As regard to attended in service education programme on PPH 25 ( 62.5% )
FHW were attended it and 15 ( 37.5 % ) FHW did not attended any in service
education programme.

100%
21-30 YEAR

90%
80%
0-5 YEAR

70%
6-10 YEAR
31-40 YEAR

60%
50%
40%
30%
11-15 YEAR

20%
10%
0%
AGE EXPERIENCE

Figure 4.1 Bar chart showing data about demographic variables

28
4.2 ANALYSIS AND INTERPRETATION OF DATA
COLLECTED ON KNOWLEDGE SCORE OF SAMPLE
SECTION –B :-

Table 4.2.1 Knowledge level of FHW

Level of knowledge Frequency Percentage

Poor (0-15) 06 15%

Average (15-25) 32 80%

Good (25-30) 02 05%

Table 4.2.1 shows that among 40 sample of FHW had average knowledge i.e, 80%
and 05% FHW had good knowledge.

PERCENTAGE
90%
80%
80%
70%
60%
50%
40% PERCENTAGE

30%
20% 15%
10% 5%
0%
POOR AVERAGE GOOD

Figure 4.2.1 Knowledge level of FHW

29
Table 4.2.2 analysis and interpretation of FHW knowledge regarding
PPH and its management.

Maximum Mean score Mean Standard Mean

score Percentage Deviation Deviation

30 18.475 61.58% 3.75 3.01

Table 4.2.2 shows that analysis and interpretation of FHW knowledge regarding PPH
and its management showed that distribution of total sample 40, maximum score was
30, mean score was 18.475, mean deviation was 3.01 and standard deviation was 3.75
and mean percentage was 61.58%.

30
4.3 FINDINGS:
Findings shows that the mean knowledge score obtained by the samples in the
test is 18.475 and standard deviation is 3.75.

4.4 SUMMARY:
This chapter deals with analysis and interpretation of data collected from 40
samples of female health workers working in selected PHC of Patan District in
Gujarat State. To assess the knowledge regarding PPH and its’s management among
female health workers in selected in PHC of Patan District in Gujarat State.
From all the above findings, it can be concluded that samples had good
knowledge about PPH and its management.

31
CHAPTER Ⅴ

32
 CHAPTER Ⅴ
SUMMARY, MAJOR FINDINGS, CONCLUSION, IMPLICATION
AND RECOMMANDATION

The chapter present a brief summary of the study undertaken along with its
major findings, implication and conclusion drawn from findings, recommendation for
the further research in the field are also presented.

5.1 SUMMARY
In the introductory chapter of the study, the importance of the study has been
discussed. It includes background information about PPH.
The present research was on to assess the knowledge regarding postpartum
hemorrhage and its management among female health workers in selected PHC of
Patan district in Gujarat state.
In chapter Ⅱ, the review of the available studies has been made. The studies
were reviewing to get information on PPH.
In chapter Ⅲ , this chapter deals with the research approach, research setting,
target population ,sample & sample size, sample technique, selection of tool,
development of tool, description of tool, validity of tool, reliability of tool, pilot study,
procedure of data collection and plan for data analysis.
In chapter Ⅳ, this investigation had presented analysis and interpretation of
data gathered with the structured knowledge questionnaire in form of google sheet.
Tools were analyzed and interpreted in term of frequency and percentage and findings
were compared in accountancies with objectives and assumptions.

5.2 MAJOR FINDINGS OF THE STUDY

The subject according to the age group shows that 26(65%) belongs to the
age group of 21-30 year, 14(35%) belongs to age group of 31-40 year. Qualification
of sample indicates that 100% subject are FHW in which 32(80%) were qualified in
A.N.M Nursing and 8(20%) were qualified in G.N.M Nursing. In all subject
23(57.05%) were less than 5 year of clinical experience, 16(40%) were 6-10 years of
clinical experience, 01(2.05%) were 11-15 year of clinical experience.

33
 According knowledge of the sample, the mean score of the sample was 18.475,
mean percentage was 61.58 %, mean deviation was 3.01 and stander deviation was
3.75 on PPH and its management.
According to level of knowledge in FHW, 02 (05%) FHW had good
knowledge, 32 (80%) FHW had average knowledge and 06 (15%) FHW had poor
knowledge.

5.3 CONCLUSION
From all the above findings, it can be concluded that samples had average
knowledge about PPH and its management.

5.4 IMPLICATION
The findings of the study have several implication in Nursing Practice,
Nursing Education , Nursing Administration, Nursing Research.

NURSING PRACTICE
Having appropriate knowledge about PPH and its management which ensure
adequate knowledge among FHW with good knowledge is a base to initiative, the
assessment, planning and implementation of Active Management of Third Stage of
Labor. These type of practice help FHW to prevent PPH in community.

NURSING EDUCATION
The responsibility instructor is meeting learner’s need in acquiring relevant
knowledge require for PPH and its management. FHW working in PHC should be
given in-service education and continue education programmes and various type of
training to update knowledge regarding PPH and its management. It reduce morbidity
and mortality of mother.

NURSING ADMINISTRATION
Nursing administration should be facilitate and encourage the FHW to update
their knowledge of PPH and its management. Various seminar to introduced needed
knowledge among FHW.

34
NURSING RESEARCH
Research is systematic search for answer to question about facts and
relationship between facts. So there is a strong indication that every nurse should be
involved in research. Nursing research is essential aspects of nursing as it unifies the
profession and develops new nursing norms and body of knowledge. Research on to
assess the knowledge regarding PPH and its management among FHW. In further
investigator can use the finding and methodology as reference material. Other
researcher , conducting further studies in the same field can utilize the suggestion and
recommendation .

5.5 RECOMMANDATION FOR THE FURTHER STUDY

The following recommendations are made on the basis of findings of present study :
1) A similar study can be done on a large sample covering the entire FHWs who are
work in community.
2) A similar study can be done in different settings.
3) A similar study can be conducted for effectiveness of pamphlet.
4) A similar study can be done by using various tools and techniques.
5) A study can be done to improve and update the knowledge of FHWs.

35
BIBLIOGRAPHY

36
 BIBLIOGRAPHY

BOOKS

1. Annamma Jacob, “ A Comprehensive Textbook of Midwifery & Gynecological

Nursing”, 5th edition, Published by Jaypee Brothers Pvt. LTD. Page No.
358-364.

2. BT Basavanthappa, “ NURSING RESEARCH & STATICS’’, 3rd edition,

published by Jaypee, brothers Medical pub, Page No. 472.

3. C.R. Kothari, “ RESEARCH METHODOLOGY METHODS AND

TECHNIQUES’’, 2nd edition, published by New age international
publisher, Page No. 8.

4. D.C Datta, “ Textbook Of Obstetrics And Midwifery”, 9th edition, Published by

Hiral Kumar new central book Agency. Page No.385-392.

5. EW Treece & JW Treece, “ ELEMENTS OF RESEARCH IN NURSING’’, 2nd

edition, published by The C.V. Mosby Co., St Louis, Page No.239.

6. Janet Medforth, “ OXFORD HANDBOOK OF MIDWIFERY”, 3rd edition,

published by oxford university press .Page No. 494-497.

7. Lily podder, “Fundamentals Of Midwifery and Obstetrical Nursing’’, 1st

edition, published by [Link] No. 333-340.

8. Muthuvenkatachalam S, “TARGET HIGH’’.CBS(PGMEE)” 5th premium

colored international edition, year 2019, Page No. 896.

37
9. Myles, “ Textbook Of Midwives”, 17th edition, Published by Jaypee Brothers
Pvt. LTD. Page No. 535

10. Neelam Kumari, Shivani Sharma, Dr. Preeti Gupta, “ A TEXT BOOK OF
MIDWIFERY AND GYNECOLOGYCAL NURSING “ , Updated
edition, published S. VIKAS & COMPANY ( Medical Publishers ) INDIA.
Page No. 574 – 580.

11. P R Yadav, “COMPETITIVE HANDBOOK OF NURSING’’(Volume-1), 4th

edition, published by Aravali Publication, Page No. 374.

12. Suresh K. Sharma, “ TEXTBOOK OF NURSING RESEARCH AND

STATICS’’,3rd edition, published by Elsevier India Private Limited,
Page No. 116, 193, 588.

JOURNALS
1. Indian journal of Obstetrics and Gynecology Research.
2. International journal of Reproduction, Contraception, Obstetrics and
Gynecology 8(5).

38
WEBSITES
1. [Link]
2. [Link]
3. [Link]
4. [Link]
5. [Link]
6. [Link]
7. [Link]
8. [Link]
9. [Link]
10. [Link]
11. [Link]
12. [Link]
13. [Link]
14. [Link]

39
APPENDICES

40
 APPENDIX –A
CERTIFICATE CONSERN TO CONSENT
LETTER OF STUDY SAMPLE

CONSENT FORM

Code No:- ___________

I, undersigned person, hereby ready to take part in the following research study and
willing to cooperate with the investigator by providing necessary information. I had
been informed that the information provided would be kept confidential and used only
for the below mentioned study purpose.

Topic:-
“A Study to assess the knowledge regarding Post Partum
Hemorrhage and it’s management among the Female Health Worker working in
selected PHC of patan district in Gujarat state.”

Date :-

( Participants sign )

41
 APPENDIX B
Structured Knowledge Questionnaire schedule to assess the Knowledge on
overall Knowledge about Introduction, causes, sign & symptoms, prevention and
management of PPH among female health workers in selected PHC of Patan
District in Gujarat State.

SECTION A
Note :- Please read the following statement and put a tick mark against the
correct answer in the column along with it.
PERSONAL DATA

Sample No.:-

1. Age
[ ] 21 to 30 age
[ ] 31 to 40 age
[ ] 41 to 50 age
[ ] 51 & above

2. Education
[ ] G.N.M Nursing
[ ] A.N.M. Nursing

3. Experience
[ ] 0 to 5 years
[ ] 6 to 10 years
[ ] 11 to 15 years
[ ] 16 to 20 years
[ ] 21 to 25 years
[ ] Above 26 years

4. Have you ever attend any In service education programme regarding

PPH?
[ ] Yes
[ ] No

42
 SECTION B
Structured Knowledge Questionnaire schedule to assess the Knowledge on
overall Knowledge about Introduction, causes, sign & symptoms, prevention and
management of PPH among female health workers in selected PHC of Patan
District in Gujarat State.
Instructions for Participant :-
 Your answer will be kept confidential.
 Please try to give answers of all the questions.
 Please read the questions and their alternatives carefully and tick mark in
appropriate box think most appropriate.

1. PPH is Stands For…..

A) Past Partum Hemorrhage
B) Post Partum Hemorrhage
C) Past Partum Hystrectomy
D) Post Partum Hystrectomy

2. In Vaginal Delivery, The Blood Loss is More than….

A) 500 ml
B) 400 ml
C) 200 ml
D) 1000 ml

3. Primary PPH is…

A) Hemorrhage occur within 24 hour following
birth of baby
B) Hemorrhage occur beyond 24 hours
following birth of baby
C) A and B
D) None of above

4. Hemorrhage occur beyond 24 hours and within Puerperium….

43
A) Primary PPH
B) Primary APH
C) Secondary PPH
D) Secondary APH

5. Secondary PPH is also known as…

A) Late puerperial hemorrhage
B) Early puerperial hemorrhage
C) Third stage hemorrhage
D) True post partum hemorrhage

6. True about Secondary PPH…

A) Hemorrhage occur within 24 hour
B) Most commonly hemorrhage occur within 2 hour
C) Most common cause is cervical laceration
D) Most commonly occur between 8th to 14th Post partum day

7. The most common cause of PPH is…

A) Atonic uterus
B) Retained products
C) Trauma
D) Bleeding disorder

8. The Atonic Uterus is more common in …

A) Cesarean section
B) Multigravida
C) Primigravida
D) Breech delivery

9. The following complication during pregnancy increase the Risk of post partum
hemorrhage except…
A) Hypertension
B) Twin pregnancy
C) Macrosomia
44
D) Hydramnios

10. Common cause of secondary PPH is…

A) Atonic uterus
B) Bleeding disorder
C) Cervical laceration
D) Retained bite of cotyledons

11. The first sign of PPH is…

A) Shock
B) High Blood Pressure
C) Diuresis
D) Bradypnea

12. Symptoms of secondary PPH include …

A) Trachypnea
B) Uterine Tenderness
C) Fever
D) All of above

13. Characteristics of Atonic hemorrhage is…

A) Uterus is found well contracted
B) Vaginal injury
C) Dislocation of uterus
D) Uterus is found flabby

14. Characteristics of Traumatic hemorrhage is…

A) Uterus is found flabby
B) Uterus is found well contracted
C) Increase in size of uterus
D) Uterine prolapsed

15. Measure to prevent PPH in Antenatal women…

A) Identify the high risk antenatal women
45
B) Improvement of the health status of antenatal women
C) Placental site determine by USG / MRI
D) All of above

16. Effective strategy to prevent PPH is…

A) Mgso4
B) Expectant management of 3rd stage of labor
C) Active management of 3rd stage of labor
D) Metronidazole

17. PPH Prevention in cesarean section…

A) Paracetamole
B) Metronidazole
C) Oxytocin
D) Diclofenac sodium

18. The Dose of Tablet Misoprostol during home delivery is…

A) 600 µg
B) 300 µg
C) 200 µg
D) 500 µg

19. Tranexemic acid is used for mainly…

A) To prevent bleeding
B) To prevent nausea and vomiting
C) To prevent convulsion
D) To prevent constipation

20. AMTSL means…

A) Active manual of Third stage labor
B) Active management of Third stage labor
C) Action management of Third stage labor
D) Action manual of Third stage labor

46
21. CCT stands for…
A) Constrict cord therapy
B) Constrict cord Traction
C) Controlled cord Therapy
D) Controlled cord Traction

22. During manual Removal of Placenta Mother should placed in….

A) Supine Position
B) Lithotomy Position
C) Side lateral Position
D) Prone Position

23. If Placenta is not separated by controlled Cord Traction The Method use for Removal
of placenta is…
A) Manual Removal of Placenta
B) Bimannual Compression
C) Tight uterine packing
D) Constrict cord technique

24. The Drug of choice to treat post partum hemorrhage except

A) Oxytocin
B) Ergometrine
C) Prostaglandin
D) Estrogen

25. Treatment of Post partum hemorrhage may include…

A) Medication to Stimulate uterine contraction
B) Massage of uterus
C) Removal of Retained Product of placenta
D) All of above

26. Therapeutic use of oxytocin is…

A) Uterine Atony
B) Incomplete Abortion
47
C) Induction of labor
D) All of above

27. Methargine is contraindicated in…

A) Pregnancy with Thyroid dysfunction
B) Pregnancy with Hypertensive disorder
C) Pregnancy with Psychological Problem
D) Pregnancy with Endocrine disorder

28. If oxytocin is not available community health worker can use for the management of
post partum hemorrhage is…
A) Tab. Methyldopa
B) Tab. Misoprostol
C) Tab. Nifidipine
D) Tab. Magnesium sulfa

29. The Dose of oxytocin should be given to the mother after the delivery of baby is…
A) 10 IU
B) 15 IU
C) 20 IU
D) 25 IU

30. Generally, The time of oxytocin administration during labor is…

A) After expulsion of placenta
B) After baby’s expulsion
C) After Delivery of anterior shoulder of baby
D) After Delivery of posterior shoulder of baby

48
 વિભાગ - અ

૧. ઉંમર

( ) ૨૧ થી ૩૦ િર્ષ

( )૩૧ થી ૪૦ િર્ષ

( ) ૪૧ થી ૫૦ િર્ષ

( ) ૫૧ થી િધારે

૨. અભ્યાસ

( ) જી . એન. એમ નવસિંગ

( ) એ . એન . એમ નવસિંગ

૩. અનુભિ

( ) ૦ થી ૫ િર્ષ

( ) ૬ થી ૧૦ િર્ષ

( ) ૧૧ થી ૧૫ િર્ષ

( ) ૧૬ થી ૨૦ િર્ષ

( ) ૨૧ થી ૨૫ િર્ષ

49
( ) ૨૬ થી િધુ

૪. તમે પ્રસ્તુવત બાદ રક્ત સ્ત્રાિ વિર્ે ની અભ્યાસ કે નોકરી દરવમયાન તાલીમ લીધેલી છે ?

( ) હા

( ) ના

50
 વિભાગ - બ

* સ ૂચનાઓ : -

- તમારા જિાબો અંગત રખો

- શક્ય હોય તો િધુ માાં િધુ પ્રશ્નનો ના જિાબ આપિા .

- કૃપા કરી પ્રશ્ર્ન ને શાાંવત થી િાાંચો , જિાબ વિચારો અને એને અનુરૂપ જિાબ ( ) બોક્ષ માાં ( ✓ ) કરો.

૧. PPH નુ ાં પ ૂરુાં નામ...

( અ ) પાસ્ટ પાટષ મ હેમરે જ

( બ ) પોસ્ટ પાટષ મ હેમરે જ

( ક ) પાસ્ટ પાટષ મ હહસ્ટરે ક્ટોમી

( ડ ) પોસ્ટ પાટષ મ હહસ્ટરે કટોમી

૨. યોવનમાગષ પ્રસ ૃવત માાં રક્ત નો વ્યય _ કરતા િધુ છે

( અ ) ૫૦૦ વમલલ

( બ ) ૪૦૦ વમલલ

( ક ) ૨૦૦ વમલલ

( ડ ) ૧૦૦ વમલલ

૩. પ્રાઈમરી પોસ્ટ પાટષ મ હેમરે જ એટલે .........

51
( અ ) પ્રસ ૃવત ના પહેલા ૨૪ કલાક માાં થતુ ાં હેમરે જ

( બ ) પ્રસ ૃવત ના ૨૪ કલાક બાદ થતુ ાં હેમરે જ

( ક ) અ અને બ

( ડ ) કોઈ પણ નહહ

૪. પ્રસ ૃવત બાદ ના પ્રથમ ૨૪ કલાક બાદ થી લઈ ૬ અઠિાહડયા સુધી ના રક્ત વ્યય ને કહે છે ….

( અ ) પ્રાઈમરી પી. પી. એચ

( બ ) પ્રાઈમરી એ. પી. એચ

( ક ) સેકન્ડરી પી. પી. એચ

( ડ ) સેકન્ડરી એ. પી. એચ

૫. સેકન્ડરી પી. પી. એચ એટલે.......

( અ ) પ્રસ ૃવત ના ૨૪ કલાક થી ૬ અઠિાહડયા નો મોડો તબક્કો

( બ ) પ્રસ ૃવત ના ૨૪ કલાક થી ૬ અઠિાહડયા નો િહેલો તબક્કો (

( ક ) ત્રીજા તબક્કા નો હેમરે જ

( ડ ) સાચો પોસ્ટ પાટષ મ હેમરે જ

૬. સેકન્ડરી પી. પી. એચ વિર્ે સાચુ ાં છે ......

( અ ) પ્રસ ૃવત બાદ ના પ્રથમ ૨૪ કલક નુ ાં હેમરે જ

52
( બ ) મુખ્ય હેમરે જ કે જે પ્રસ ૃવત ના ૨ કલક માાં થાય

( ક ) મુખ્ય કારણ સિાષઇકલ લેશરે શન છે

( ડ ) પ્રસ ૃવત ના ૮ માાં અને ૧૪ માાં હદિસ ની િચ્ચે નુ ાં હેમરે જ

૭. પી. પી. એચ થિાનુ ાં મુખ્ય કારણ ........

( અ ) એટોવનક ગભાષશય

( બ ) ગભાષશય માાં શેર્ રહેલા પદાથષ

( ક ) ઈજા

( ડ ) રક્તસ્ત્રાિ ની લબમારી

૮. એટોવનક ગભાષશય મુખ્યત્િે ___માાં જોિા મળે છે .

( અ ) વસઝેહરયન સેકશન

( બ ) મલ્ટીગ્રેવિડા

( ક ) પ્રાઈમીગ્રેવિડા

( ડ ) બ્રીચ પ્રસ ૃવત

૯. નીચે પૈકી પોસ્ટ પાટષ મ હેમરે જ થિાના જોખમો માાંથી નથી....

( અ) હાઈપરટેન્શન

( બ ) જોહડયા બાળકો

53
( ક ) મોટા કદ નુ ાં બાળક

( ડ ) હાઇડ્રામનીઓસ

૧૦. સેકન્ડરી પી. પી. એચ થિાનુ ાં મુખ્ય કારણ.......

( અ ) એટોનીક ગભાષશય

( બ ) રકત સ્ત્રાિ ની લબમારી

( ક ) સિાષઈકલ લેશરે શન

( ડ ) ગભાષશય માાં શેર્ પદાથષ

૧૧. પી. પી. એચ નુ ાં પ્રથમ લચન્હ ....

( અ ) શોક

( બ ) ઊંચુ ાં રુવધર નુ ાં દબાણ

( ક ) િધુ મ ૂત્ર વનમાષણ

( ડ ) ધીમા શ્વાસદર

૧૨. સેકન્ડરી પી.પી.એચ ના લચન્હો......

( અ ) િધુ શ્વાસદર

( બ ) ગભાષશય ની કોમળતા

( ક ) તાિ

54
( ડ ) ઉપર ના તમામ

૧૩. એટોવનક ગભાષશય ની લાક્ષલણકતાઓ.......

( અ ) ગભાષશય નુ ાં સાચુ ાં સાંકોચન

( બ ) યોવનમાગષ ની ઈજા

( ક ) ગભાષશય નુ ાં અસામાન્ય સ્થાન

( ડ ) નરમ ગભાષશય

૧૪. આઘાતજનક હેમરે જ ની લાક્ષલણકતાઓ......

( અ ) નરમ ગભાષશય

( બ ) ગભાષશય નુ ાં સાચુ ાં સાંકોચન

( ક ) ગભાષશયના કદ માાં િધારો

( ડ ) ગભાષશય નુ ાં બહાર આિી જવુ ાં

૧૫. એન્ટીનેટલ મહહલાઓમાાં પી.પી.એચ અટકાિિાના

પગલાઓ....

( અ ) િધુ જોખમી એન્ટીનેટલ મહહલાઓની ઓળખ

( બ ) એન્ટીનેટલ મહહલાઓના સ્િાસ્થ માાં િધારો

( ક ) પ્લેસેન્ટા નુ ાં સ્થાન સોનોગ્રાફી થી નક્કી કરવુ ાં

55
( ડ ) ઉપર ના તમામ

૧૬. પી.પી.એચ અટકાિાની મજબ ૂત રણનીવત.......

( અ ) મેગ્નેવશયમ સલ્ફેટ

( બ ) પ્રસ ૃવત ના ત્રીજા તબક્કા નુ ાં અપેલક્ષત સાંચાલન

( ક ) પ્રસ ૃવત ના ત્રીજા તબક્કા નુ ાં સહિય સાંચાલન

( ડ ) મેટ્રોવનડાઝોલ

૧૭. પી.પી.એચ નો અટકાિ વસઝેહરયન સેકશન માાં ........

( અ ) પેરાસીટામોલ

( બ ) મેટ્રોવનડાઝોલ

( ક ) ઓક્ક્સટોસીન

( ડ ) ડાઈકલો ફેનેક સોહડયમ

૧૮. ઘરે પ્રસ ૃવત માટે ટેબલેટ વમઝોપ્રોસ્ટોલ નો ડોઝ.......

( અ ) ૬૦૦ માઈિોગ્રામ

( બ ) ૩૦૦ માઈિોગ્રામ

( ક ) ૨૦૦ માઈિોગ્રામ

( ડ ) ૫૦૦ માઈિોગ્રામ

56
૧૯. દિા ટ્રેનેકઝેવમક એવસડ નો િપરાશ મુખ્યત્િે......

( અ ) રક્તસ્ત્રાિ અટકાિિા

( બ ) ઉબકા અને ઊલ્ટી અટકાિિા

( ક ) ખેંચ અટકાિિા

( ડ ) કબજજયાત અટકાિિા

૨૦. AMTSL એટલે.......

( અ ) એક્ક્ટિ મેન્યુઅલ ઓફ થડષ સ્ટેજ લેબર

( બ ) એક્ક્ટિ મેનેજમેન્ટ ઓફ થડષ સ્ટેજ લેબર

( ક ) એકશન મેનેજમેન્ટ ઓફ થડષ સ્ટેજ લેબર

( ડ ) એકશન મેન્યુઅલ ઓફ થડષ સ્ટેજ લેબર

૨૧. CCT એટલે.......

( અ ) કોંક્સ્ટ્રક કોડષ થેરાપી

( બ ) કોંક્સ્ટ્રક કોડષ ટ્રેકશન

( ક ) કાંટ્રોલ કોડષ થેરાપી

( ડ ) કાંટ્રોલ કોડષ ટ્રેકશન

57
૨૨. મેન્યુઅલ રીતે પ્લેસેન્ટા ને દુર કરિા માટે માતા ને __ ક્સ્થવત માાં રાખિા માાં આિે છે .

( અ ) સુપાઈન પોલઝશન

( બ ) લીથોટોમી પોલઝશન

( ક ) બાજુની બાજુની પોલઝશન

( ડ ) પ્રોન પોલઝશન

૨૩. જો પ્લેસેન્ટા કાંટ્રોલ કોડષ ટ્રેકશન થી દુર ના થાય તો નીચે ના માાંથી ___ પદ્ધવત દ્વારા પ્લેસેન્ટાને

દુર કરિામાાં આિે છે

( અ ) મેન્યુઅલ રીતે પ્લેસેન્ટા ને દુર કરિી

( બ ) બાયમેન્યુઅલ સાંકોચન

( ક ) ચુસ્ત ગભાષશય નુ ાં પેહકિંગ

( ડ ) કોંક્સ્ટ્રક કોડષ ટેકવનક

૨૪. પોસ્ટ પાટષ મ હેમરે જ માટે ની દિા વસિાય ની દિા ........

( અ ) ઓક્ક્સટોસીન

( બ ) અગોમેટ્રીન

( ક ) પ્રોસ્ટાગ્લાાંડીન્સ

( ડ ) ઇસ્ટ્રોજન

58
૨૫. પોસ્ટ પાટષ મ હેમરે જ ની સારિાર માાં સમાિેશ થાય છે ...

( અ ) ગભાષશય ના સાંકોચન માટે ની દિા

( બ ) ગભાષશયનો મસાજ

( ક ) ગભાષશય માાં પ્લેસેન્ટા ના રહી ગયેલા ભાગ ને દુર કરવુ ાં

( ડ ) ઉપર ના તમામ

૨૬. ઓક્ક્સટોસીન નો ઉપચારાત્મક ઉપયોગ ............

( અ ) એટોવનક ગભાષશય

( બ ) અપ ૂણષ ગભષપાત

( ક ) પ્રસ ૃવત ઉતેજીત કરિા

( ડ ) ઉપર ના તમામ

૨૭. વમથારજીન ___માાં ના આપી શકાય.......

( અ ) માતા થાયરોઈડ થી પીહડત હોય

( બ ) માતા હાયપરટેન્શન થી પીહડત હોય

( ક ) માતા માનવસક રોગ થી પીહડત હોય

( ડ ) માતા કોઈ ગ્રાંવથ ના રોગ થી પીહડત હોય

59
૨૮. જો ઓક્ક્સટોસીન નો ડોઝ ઉપલબ્ધ ન હોય તો , સામ ૂહહક આરોગ્ય કાયષકર પી. પી. એચ . ના

સાંચાલન માટે િાપરશે.......

( અ ) ટેબ વમથાઈલડોપા

( બ ) ટેબ. વમઝોપ્રોસ્ટોલ

( ક ) ટેબ વનફેહડપીન

( ડ ) ટેબ. મેગ્નેવશયમ સલ્ફેટ

૨૯. બાળક ના જન્મ પછી માતાને ઓક્ક્સટોસીન નો ડોઝ આપય......

( અ ) ૧૦ યુવનટ

( બ ) ૧૫ યુવનટ

( ક ) ૨૦ યુવનટ

( ડ ) ૨૫ યુવનટ

૩૦. સામાન્ય રીતે પ્રસ ૃવત દરવમયાન ઓક્ક્સટોસીન દાખલ કરિાનો રોજબરોજ નો સમય.....

( અ ) પ્લેસેન્ટા બહાર નીકળી ગયા બાદ

( બ ) બાળક બહાર નીકળી ગયા બાદ

( ક ) બાળક નો આગળ નો ખભો બહાર નીકળી ગયા બાદ

( ડ ) બાળક નો પાછળ નો ખભો બહાર નીકળી ગયા બાદ

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 APPENDIX C
ANSWER KEY
Key answer of structure knowledge Questionnaire assessing the knowledge of FHW.
QUESTIONS NUMBER CORRECT ANSWER

1 B
2 A
3 A
4 C
5 A
6 D
7 A
8 B
9 A
10 D
11 A
12 D
13 D
14 B
15 D
16 C
17 C
18 A
19 A
20 B
21 D
22 B
23 A
24 D
25 D
26 D
27 B
28 B
29 A
30 C

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 APPENDIX D
MASTER SHEET SHOWING SCORE OF SOCIO DEMOGRAPHIC DATA
QUE 1 2 3 4
NO.
CODE A B C D A B A B C D A B
NO.
1    
2    
3    
4    
5    
6    
7    
8    
9    
10    
11    
12    
13    
14    
15    
16    
17    
18    
19    
20    
21    
22    
23    
24    
25    
26    
27    
28    
29    
30    
31    
32    
33    

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34    
35    
36    
37    
38    
39    
40    

63
 MASTER SHEET SHOWING DATA COLLECTION OF MAIN STUDY

Q. NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1
2 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 0 1
3 1 1 1 1 1 0 1 1 1 0 1 1 1 1 0 1 1 1 1 1

4 1 1 1 1 1 0 1 1 1 1 1 0 0 0 0 0 1 1 1 0

5 1 1 0 1 1 0 1 1 1 0 1 0 0 1 0 0 1 0 0 0
6 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 1 1 1 0
7 0 0 1 1 0 0 1 1 1 0 1 1 1 0 0 1 1 1 1 0
8 0 0 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 0 1
9 1 1 1 0 0 0 1 1 1 0 1 0 0 0 0 0 1 0 1 0

10 0 0 0 0 0 0 1 1 1 0 1 0 1 0 0 0 1 1 0 0

11 1 1 1 1 0 1 0 1 1 1 1 0 0 1 1 0 1 1 0 1

12 1 0 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 0 1 1
13 1 0 1 1 1 0 0 1 1 0 1 0 1 0 0 0 1 0 1 0

14 1 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 1 1 0 0
15 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 0 1 1
16 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 0

17 1 0 1 1 1 1 1 1 1 1 1 0 0 0 1 0 1 1 1 1

18 1 1 0 1 1 0 0 1 1 0 0 1 1 1 1 1 0 0 1 1

19 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 0 1 1 1 1

20 1 1 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 1 1 0
21 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1
22 1 1 1 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1
23 1 1 0 1 1 1 0 1 0 0 0 1 1 1 1 0 1 1 0 0

24 0 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 0 0
25 1 1 1 0 1 0 0 1 1 1 0 0 1 0 1 1 1 0 1 1
26 0 1 1 0 0 1 0 0 1 0 0 0 1 1 0 1 0 0 1 1
27 1 1 0 1 1 1 1 1 1 0 0 1 0 0 1 1 0 0 0 1

28 0 0 1 1 1 1 1 1 1 0 1 0 1 1 1 1 0 0 1 1
29 1 1 0 1 1 0 0 0 1 1 0 0 1 1 1 0 1 0 1 1
30 1 1 1 1 0 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1
TOTAL 21 19 20 24 18 14 17 27 26 13 19 13 16 15 17 16 22 16 19 19

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Q. NO 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

1 1 1 1 1 0 1 0 1 1 1 1 0 0 1 1 0 1 1 0 1
2 1 0 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 0 1 1
3 1 0 1 1 1 0 0 1 1 0 1 0 1 0 0 0 1 0 1 0
4 1 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 1 1 0 0
5 1 1 1 1 1 1 1 1 1 1 1 1 1 0 1 0 1 0 1 1
6 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 0
7 1 0 1 1 1 1 1 1 1 1 1 0 0 0 1 0 1 1 1 1
8 1 1 0 1 1 0 0 1 1 0 0 1 1 1 1 1 0 0 1 1
9 1 1 1 1 1 1 0 1 1 1 1 1 0 1 1 0 1 1 1 1
10 1 1 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 1 1 0
11 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1
12 1 1 1 1 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1
13 1 1 0 1 1 1 0 1 0 0 0 1 1 1 1 0 1 1 0 0
14 0 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 0 0
15 1 1 1 0 1 0 0 1 1 1 0 0 1 0 1 1 1 0 1 1
16 0 1 1 0 0 1 0 0 1 0 0 0 1 1 0 1 0 0 1 1
17 1 1 0 1 1 1 1 1 1 0 0 1 0 0 1 1 0 0 0 1
18 0 0 1 1 1 1 1 1 1 0 1 0 1 1 1 1 0 0 1 1
19 1 1 0 1 1 0 0 0 1 1 0 0 1 1 1 0 1 0 1 1
20 1 1 1 1 0 1 0 1 0 0 0 0 1 1 1 1 0 0 1 1
21 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1 1 1 1 1 1
22 1 1 1 1 1 0 1 1 1 0 1 1 1 1 1 1 1 1 0 1
23 1 1 1 1 1 0 1 1 1 0 1 1 1 1 0 1 1 1 1 1
24 1 1 1 1 1 0 1 1 1 1 1 0 0 0 0 0 1 1 1 0
25 1 1 0 1 1 0 1 1 1 0 1 0 0 1 0 0 1 0 0 0
26 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 1 1 1 0
27 0 0 1 1 0 0 1 1 1 0 1 1 1 0 0 1 1 1 1 0
28 0 0 0 0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 0 1
29 1 1 1 0 0 0 1 1 1 0 1 0 0 0 0 0 1 0 1 0
30 0 0 0 0 0 0 1 1 1 0 1 0 1 0 0 0 1 1 0 0
TOTAL 23 14 24 17 12 22 17 22 19 20 21 19 16 11 23 19 20 17 16 16

65
66
APPENDIX E

67
 APPENDIX F
LETTER GRANTING PERMISSION FOR RESEARCH STUDY

68
 APPENDIX G
CERTIFICATE CONCERN TO VALIDITY OF TOOL

69
70
71
72
73
ABSTRACT

74
 ABSTRACT
A study to assess the knowledge regarding post partum hemorrhage and its
management among female health workers in selected PHC of patan district in
Gujarat state. The study was conducted by Group-B in the fulfillment of the award of
bachelor of nursing at Government college of nursing Dharpur, Patan. The objective
of study (1) To assess the existing knowledge of female health workers regarding
post partum hemorrhage and its management.
The investigator used purposive sampling technique for selecting the 40
samples in view of the nature of the topic and the accomplishment of the objectives of
the study. Structured knowledge questionnaire were prepared to assess the knowledge
of the samples. Content validity of the developed tools was established by 5 experts
and necessary modification were made as suggested by them. The pilot study was
conducted on date 29th October 2022 ,with 5 samples from Balisana PHC, Patan
district in Gujarat state. In the result mean score was 21, mean percentage was 70%,
and standard deviation was 4.30. The pilot study is completed without any problem.
Reliability of the tool was ascertained by karl person’s correlation, coefficient
formula. The reliability coefficient of the questionnaire was 0.7 which is more than
0.5; hence the questionnaire was found to be reliable.
The data was collected on 5th November 2022 for final study. The obtained
data was analyzed by using both descriptive and inferential statistics in terms of mean,
mean percentage and standard deviation. The distribution of samples by frequency
and percentage by their age, educational status and experience. The survey method
suggested that as regard to age majority of sample were in the age group 21-30 years,
frequency was 26 and percentage was 65%. As regard to education majority of sample
were in frequency was 40 and percentage was 100% in A.N.M nursing. As regard to
experience majority of sample 0-5 years, frequency was 23 and percentage was
57.05%.
In research study mean score of FHW’s knowledge was 18.47, mean
percentage was 61.58%, standard deviation was 3.75 and mean deviation was 3.01.
Hence, the study concluded that majority of FHW have adequate
knowledge about PPH and it’s management.

75