PERCEPTION AND ATTITUDE OF WOMEN ATTENDING ANTENATAL CLINIC AT CENTRAL HOSPITAL TOWARDS CESAREAN SECTION
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PERCEPTION
AND ATTITUDE OF WOMEN ATTENDING ANTENATAL CLINIC AT CENTRAL HOSPITAL TOWARDS
CESAREAN SECTION
ABSTRACT
This study
was conducted to assess the perception and attitude of women attending the
antenatal clinic at central hospital towards caesarean sectionbetween 25th of
September to 20th of September 2014 at central hospital Sapele road
Benincity,Edo state.The study is a descriptive non experimental study carried
out amongst 155 clients in the antenatal clinic interviewed with a structured
questionnaire that solicited information’s about their socio demographic
characteristics, their perceptions , attitude and factors influencing their
attitude towards caesarean section ,the women had a very good awareness about
C/S 155(100% ) ,however only 59 (38%) thinks it is not an abnormal way of
having babies while 65.2% could accept it only if life was threatened.
logistics shows that cultural perceptions and level of education were
associated with non-acceptance of caesarean section .there is a need for
programs and avenues through which cultural perception s would be debunked
addressing each cultural beliefs and community understanding so that the women’s
perceptions may be modified and C/S can be accepted as a method of delivery in
Nigeria.
TABLE OF
CONTENT
Title
page--------i
Certification
page-------ii
Dedication--------iii
Acknowledgement-------iv
Abstract--------v
Table of
content-------vi
List of
abbreviations-------ix
List of
figures--------x
List of
tables--------xi
Appendix--------xii
CHAPTER ONE
1.0NTODUCTION------1
1.1
Background of the study------1
1.2
Statement of the problem------3
1.3
Objectives of the study------3
1.3.1Specific
Objective------4
1.4
Significance of study------4
1.5
Limitation of the study------4
1.6 Research
question /hypothesis-----5
1.7 Scope of
study-------5
1.8
Operational definition of terms-----6
CHAPTER TWO
2.0LITERATURE
REVIEW-----8
2.1perceived
reasons why C/S is rejected ---10
2.2Types of
C/S and their indications----11
2.2.1Contra
Indications for C/S-----12
2.3Risk and
Complications-----13
2.3.1Complications
for Infants-----13
2.3.2Long
term risk of C/S------14
2.4Conceptual
theoretical framework ----14
CHAPTER
THREE
3.0RESEARCH
METHODOLOGY----18
3.1Study
design-------19
3.2Study
setting-------19
3.3Target
population------20
3.4Sampling
Size------20
3.5 Sampling
techniques------20
3.6Instruments
for data collection----23
3.7Validity
/reliability of instruments.----23
3.8Method of
data collection ------23
3.9Method of
data analysis.-----24
3.10Ethical
consideration------24
CHAPTER FOUR
4.0ANALYSIS
OF DATA-----25
4.1Formulae
for testing hypothesis ----36
CHAPTER FIVE
5.1Discussion
of findings-----39
5.2Implication
for nursing ------40
5.3Summary
--------41
5.4Conclusion
-------41
5.5Recommendation------42
5.6Suggestion
for further study-----43
LIST OF
ABBREVIATIONS
C/S:CaesareanSection
W.H.O: World
Health Organization
LIST OF
FIGURES
FIGURE A
(representing the age distribution of the respondents)-25
FIGURE B:
Representing the religious distribution of the respondents26
FIGURE C:
Showing the respondent’s tribe---27
FIGURE D:
Showing respondent’s marital status---28
FIGURE E:
Representing respondent’s level of education-29
LIST OF
TABLES
TABLE
A--------31
TABLE
B--------33
TABLE
C--------35
TABLE
D--------37
APPENDIX
Sample
questionnaire for data collection
Formula for
calculating sample size
Formula for
testing hypothesis
Ethical
approvalCHAPTER ONE
1.0
INTRODUCTION
The
menstrual cycle is the cycle of natural changes that occurs in the uterus and
ovary as an essential part of making sexual reproduction possible. (Lentz et
al., 2012) Its timing is governed by endogenous(internal) biological cycles.
The menstrual cycle is essential for the production of eggs, and for the
preparation of the uterus for pregnancy. (Lentz et al., 2012) The cycle occurs
only in fertile female humans and other female primates. In human females, the
menstrual cycle occurs repeatedly between the ages of menarche, when cycling
begins, until menopause, when it ends.
In humans,
the length of a menstrual cycle varies greatly among women (ranging from 21 to
35 days), with 28 days designated as the average length. (Anderson et al.,
2003) Each cycle can be divided into three phases based on events in the ovary
(ovarian cycle) or in the uterus (uterine cycle).[Anderson et al., 2003].
The ovarian cycle consists of the follicular
phase, ovulation, and luteal phase whereas the uterine cycle is divided into
menstruation, proliferative phase, and secretory phase. Both cycles are
controlled by the endocrine system and the normal hormonal changes that occur
can be interfered with using hormonal contraception to prevent reproduction.
(Klumpet al., 2013)
By
convention, the length of an individual menstrual cycle in days is counted starting
with the first day of menstrual bleeding. Stimulated by gradually increasing
amounts of estrogen in the follicular phase, discharges of blood (menses) slow
then stop, and the lining of the uterus thickens. Follicles in the ovary begin
developing under the influence of a complex interplay ofhormones, and after
several days one or occasionally two become dominant (non-dominant follicles
atrophy and die). Approximately mid-cycle, 24–36 hours after the Luteinizing
Hormone (LH) surges, the dominant follicle releases an ovum, or egg, in an
event called ovulation. After ovulation, the egg only lives for 24 hours or
less without fertilization while the remains of the dominant follicle in the
ovary become a corpus luteum; this body has a primary function of producing
large amounts of progesterone. Under the influence of progesterone, the
endometrium (uterine lining) changes to prepare for potential implantation of
an embryo to establish a pregnancy. If implantation does not occur within
approximately two weeks, the corpus luteum will involute, causing sharp drops
in levels of both progesterone and estrogen. The hormone drop causes the uterus
to shed its lining and egg in a process termed menstruation (Klumpet al., 2013)
In the
menstrual cycle, changes occur in the female reproductive system as well as in
other bodily systems (which can lead to breast tenderness or mood changes, for
example). A woman's first menstruation is termed menarche, and occurs typically
around age 12-13. The end of a woman's reproductive phase of life is called the
menopause, and this commonly occurs somewhere between the ages of 45 and 55
(Sioba´n D et al., 2004).
The
menstrual cycle is characterized by cyclical fluctuations in the levels of FSH,
LH, estrogen and progesterone The hormones are known to have an effect on
oxygen carrying capacity, immune response, bleeding and also changes in serum
electrolytes which may be responsible for variable physical, psychological
symptoms and autonomic changes. It is suggested that stressful situations
during ovulatory periods and menstruation may cause increased 17-hydroxy
corticosterone levels with resulting eosinopenia (Feuring M et al., 2002)
Platelet function is periodically altered during the ovarian cycle due to the
influence of progesterone and estrogen on Von Willebrand factor concentrations
(Sioba´n D et al., 2004). Ovarian hormones influence almost all the systems of
the body.
They are
known to alter the immune system like depression of the suppressor T cell
activity Human & animal studies suggest that there is a change in the
distribution of immune cells during different phases of menstrual cycle
(Pehlivanoglu B et al., 2001) 5–20% of women reporting severe dysmenorrhea
(painful menstruation) which may be associated with reproductive morbidities
like infection (Sioba´n D et al., 2004), thus estimation of leucocyte count is
an important tool. Females have more asthma throughout the reproductive years.
Female sex steroids are pro-inflammatory and will increase the susceptibility
to atopy(Sioba´n D et al., 2004),.
Red blood
cell (RBC)indicesassist in classifying anemias. In general,besuretofullyassess
apatient’snutritional status andconsultadietitianforfurther workupand
interventionas appropriate. Wound healingcan begrossly affectedbynutritionalanemias,andpatientsmayrequireiron,
zinc, and vitaminCsupplementsto promote surgicalwoundhealing.Patients will also
re- quire teaching andneed encouragementtoinclude iron rich foods such asliver,
red meat, raisins, peas, apricots,kidney beans, andfortifiedcerealsandbreads
intheir diets (Sioba´n D et al., 2004).
Platelets
are irregularly shaped, disk-like fragments of their precursor cell, the
megakaryocyte. They are one fourth to one third the size of erythrocytes
(1.5–3.0 μm). As megakaryocytes develop, they undergo a process of
fragmentation that results in the release of over 1,000 platelets per cell.
Several factors stimulate megakaryocytes to release platelets within the bone
marrow sinusoids. This includes the hormone thrombopoietin, which is mainly
generated by the liver and the kidneys and released in response to low numbers
of circulating platelets. Platelets have no defined nucleus but possess
important proteins, which are stored in intracellular granules and secreted
when platelets are activated during coagulation.
Platelet
adherence can be initiated by a variety of substances. For instance, factors
released by platelets cause the upregulation of adherence proteins (integrins)
on endothelial cells. One critical substance released by endothelial cells and
also megakaryocytes is called von Willebrand factor. It enhances platelet
adhesion to the endothelium by forming a bridge between platelet surface
receptors and collagen in the subendothelial matrix. The most common hereditary
bleeding disorder is von Willebrand disease, caused by an inherited deficiency
of the factor. Ruptured cells at the site of tissue injury release adenosine
diphosphate (ADP), causing the aggregation of more platelets, which are, in
turn, stabilized by fibrinogen. Clinically, penicillin in high doses can coat
platelets and prevent aggregate formation.
BLOOD
CLOTTING
Damage to
the vasculature quickly leads to massive bruising and, if unrepaired, to
extreme blood loss and consequent organ failure.The blood’s response to blood
vessel injury can be viewed as four…
Hemostasis
(the cessation of blood loss from a damaged vessel) can be organized into four
separate but interrelated events: compression and vasoconstriction; the
formation of a temporary loose platelet plug (also called primary hemostasis);
formation of the more stable fibrin clot (also called secondary hemostasis),
and finally, clot retraction and dissolution.
The four
steps are explained in more detail in the following sectionsSherwood et
al.,2013).
Aim and
Objectives
In this
present study the Aim and Objectives of this study is to correlate the effect
of Menstruation on the internal hemostasis and platelet function in female
student of child bearing ages who experience normal menstrual cycle as an
adjunct to determine the deleterious or the indifferent effect of the menstrual
phases, blood losses during menstrual cycle on the platelet consistency.
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