INTRODUCTION:

There are no clearly identified criteria to distinguish between a “high”- or “low”-risk pregnancy; however, pregnancies in which the maternal and/or fetal condition pose a threat to life of the mother or fetus are considered as “high risk.” Maternal conditions most commonly associated with adverse prenatal outcomes include conditions such as diabetes (chronic and gestational), hypertensive disorders (chronic hypertension, and preeclampsia) and cardiac, renal, autoimmune, and thrombophiliac disorders. Fetal conditions associated with high-risk pregnancy (HRP) include fetal growth restriction, and placental insufficiency. Sound theoretical knowledge about various complicated conditions and diseases that may interfere with childbearing is essential in the care of pregnant women at high risk. Pregnant women at risk want to be treated as normal and help her get through pregnancy and birth with as little sickness and complication as possible Improvements in technology have increased the chances of survival for the micro-premature infant and the very low birth-weight infant but have significantly increased the financial burden of health care organizations. This economic burden has a significant impact on third-party payers and on society in general. of the annual U.S. 10.2 billion dollars spent on newborn care alone, 57% is disproportionately consumed by the 10% of infants who are born preterm. Therefore, it is important to take into consideration the economical and social dimension of woman when directing treatment during pregnancy.

The relationship between hypertension in pregnancy and poor maternal and fetal outcome had long been recognized and the thrust of prenatal care is laid on improving the pregnancy outcome associated with pregnancy induced hypertension.

1. Hypertensive disorders of pregnancy if unchecked will result in eclampsia with generalized convulsions. The majority of the studies indicated that primiparae, of all age group showed a high rate of pregnancy induced hypertension and it was five times higher among the mothers above 30.

2. Pregnancy invariably involves a situational stress. When complications develop, threatening the lives of the expectant mother and her fetus the client and the family face a far greater situational stress. Studies have demonstrated that platelet activation in women with pre-eclampsia increases plasma catecholamine levels compared with normal pregnancy. High levels of stress over a prolonged period certainly have lifelong impact on the development of the child.

3. It is acknowledged that techniques of relaxation and deep breathing go a long way in preparing pregnant women to cope with challenges and discomforts associated with child birth. Practicing relaxation and breathing techniques also have a positive effect on the fetus. Several studies are being conducted on the impact of relaxation techniques on hypertension. The results revealed that all relaxation therapies were effective in reducing blood pressure, especially progressive muscle relaxation compared to cognitive imagery relaxation.

4. The rate of maternal mortality due to hypertensive disorder during pregnancy is high, even where maternity services are highly improved. In India hospital facilities are less, even though there is high prevalence of pregnancy induced hypertension. The medical management of such case with drugs has its own disadvantages. For instance, anti hypertensive drugs will cause fetal complications like intrauterine growth retardation .So if such cases of hypertension are managed by non pharmacological measures it will be helpful for the mother and the fetus, especially the treatment of mild cases of pregnancy induced hypertension. It has been recommended that mild cases of pregnancy induced hypertension can be managed on an ambulatory basis by blood pressure monitoring, daily albumin checking, and daily fetal movement counting (DFMC) and rest and relaxation at home. During her clinical experience, the investigator, identified the majority of the women with pregnancy induced hypertension were overly worried about their high risk condition and poor health of the babies. This was devastated by the long hospital stays, finally ending in poor prognosis of the disease condition. Moreover, they showed symptoms like sleep disturbances, poor appetite and mood fluctuations. Although research has revealed the positive effects of relaxation techniques on women with pregnancy induced hypertension during the intra-partum period, little is known about the combined effect of progressive muscle relaxation, guided imagery and deep breathing exercises on the antenatal period. Hence the investigator recognized the need for a detailed study on the effect of relaxation therapy like guided imagery, progressive muscle relaxation and deep breathing-all simple, non intrusive and inexpensive methods which positively influence the outcome of pregnancy in women with pregnancy induced hypertension.

OBJECTIVES:

1. To assess the level of stress and physiological parameters among antenatal mothers with mild pregnancy induced hypertension.

2. To find out the effectiveness of yoga therapy module on maternal stress and physiological parameter among antenatal mother with mild pregnancy induced hypertension.

METHODOLOGY:

Research approach:

A quasi- experimental approach was adopted. A quasi experiment involves the manipulation of an independent variable and it lacks randomization or a control group. Research design is the overall plan for obtaining answer to the research questions for testing the research hypotheses. The design selected for this study was one group pretest post test design. All subjects were given a pretest; those in the experimental group were instructed to practice yoga techniques. Then groups were asked to take a post test. The pretest was carried out on two days for assessing demographic data, physiological parameters and stress. Teaching section of yoga therapy was carried out for a period of four weeks, six days a week in the morning, between 10am to 11 am.

Variables:

1. Dependent Variables: Level of maternal stress, Physiological parameters.

2. Independent Variable: yoga techniques, which include pregnancy yoga standing, half moon pose, prenatal spinal twist, prenatal meditation and relaxation.

3. Extraneous Variables: Age, education, monthly income, location of the home, obstetrical score, religion, occupation and diet.

Setting of the study:

The study was conducted at Arun hospital, No. 15. Thiyagarajapuram, Vellore. The reason for the selection of these hospitals was the availability of the required number of antenatal mothers with mild PIH.

Population:

The population selected for the study comprised of 30 antenatal mothers with mild pregnancy induced hypertension.

Sample and sampling technique:

The sample size consisted of 30 antenatal mothers with mild pregnancy induced hypertension. The sampling technique used was non probability, purposive sampling technique.

Sampling criteria:

The samples were selected on the following criteria.

Inclusion criteria:

1. Antenatal mothers with mild pregnancy induced hypertension

2. Antenatal mothers between 30-38 weeks of gestation

3. Antenatal mothers with multiple pregnancies,

4. Antenatal mother with extremes of age, i.e., <20 or > 35 years,

5. Antenatal mother with BMI > 30,

6. Antenatal mothers who know to read and write Tamil and English.

Exclusion criteria:

1. Antenatal mothers with complications like diabetes, bleeding disorders, multiple pregnancy, renal and heart diseases.

2. Antenatal mothers less than 30 weeks of gestation

3. Antenatal mothers who are not cooperative.

4. Pregnancy induced hypertension women with (1) major medical (cardiac, renal or neurological diseases) or mental illnesses (psychosis, neurosis, addictions, etc.) or with any structural abnormality of reproductive system and

5. Normal pregnancy.

Data collection instrument:

“Data collection is the gathering of information needed to address the research problem.” The present study was planned primarily to determine the effectiveness of yoga therapy on level of stress and physiological parameters of antenatal mothers with mild pregnancy induced hypertension, by using observation checklist and rating scale. Data collection was done by demographic data, assessing physiological parameters by using observation checklist before and after therapy and assessing stress by rating scale before and after yoga therapy.

Selection and development of the tool:

The investigator developed the tool after consulting the subject experts and reviewing the literature on relevant topics. The tool selected for the study were, demographic Performa, observation checklist, rating scale and yoga therapy was developed.

Content validity of the tool:

The prepared tool with the problem statement, objectives and criterion checklist was given to 4 experts to ensure content validity. Four experts were from the filled of obstetrics and gynecological nursing speciality and obstetrics and gynecological specialty (doctors). The criterion checklist contained three columns of Agree, Disagree and Remarks/suggestion by the experts. The investigator had undergone 15 days Yoga and Relaxation Therapy training under Sivalaya yoga and naturopathy clinic. Pre testing of the tool after obtaining the permission from the medical superintendent and the obstetrician of Arun hospital, Vellore, the tool was pre-tested on a sample of 5 patients. The main purpose of pre-testing was to find out the clarity of the item. The respondents found the language of the rating scale were simple and understandable. The average time taken for pre-testing the tool was 30 minutes and was acceptable to the subject.

Reliability of tool:

To ensure the reliability, the tool was administered to 10 antenatal mothers with mild pregnancy induced hypertension, admitted in Arun Hospital, Vellore, after obtaining permission from the medical superintendent. The reliability coefficient of the tool was found using split half method following Spearman Brown Prophecy Formula.

Description of the tool:

The following tools were developed to collect data for evaluating the effect of yoga therapy on women with mild PIH.

Tool-I: Socio-demographic data collected by using a semi structured Interview schedule.

Tool-II: An observation check list to assess the various signs and symptoms of clients with pregnancy induced hypertension.

Tool-III: A stress inventory to assess the level of stress.

Tool-IV: yoga techniques.

Pilot Study:

After obtaining the written permission from the medical superintendent of Arun hospital, vellore, and Sivalaya yoga centre a pilot study was conducted on 15-01-2020 to 06-02-2020 among 10 antenatal mothers. The objectives of the study were explained to each subject. Assessing the level of stress and physiological parameters by using check list and rating scale, yoga therapy was administered to the subjects and reassessed the parameters and stress. The tool was found feasible and practicable. No change was made after the pilot study. The data was analyzed using descriptive and inferential statistics. The investigator decided to carry out the actual data collection after the pilot study.

Data collection process:

The Data was collected from Arun hospital, Vellore. A formal letter was sent to the medical superintendent of the hospital and a written permission was obtained to conduct the study. The consent was taken prior to the study from the subject and the nature of study was explained to the participants. The subjects were made comfortable and yoga therapy was administered after assessing pre-therapy stress and physiological parameters, by means of observation check list and rating scale. The yoga therapy was administered for 30 minutes daily for 2 weeks followed by assessment of post therapy scores.

RESULTS AND DISCUSSION:

Section I:

The sample characteristics of 30 antenatal mothers with mild PIH were described in terms of frequency and percentage. The findings of the study demonstrated that, among the subjects, majority were in the age group 18 to 26 years, majority had the income of 4501 to 6000, majority were Hindus, housewives, subjects from rural background, with high school education. 50% of subjects were vegetarians and 50% were mixed groups. Majority did not have previous history of PIH, had not undergone medical treatment for hypertension and PIH in previous pregnancy.

Section II:

a. Effect of therapy on stress The data on the level of stress were analyzed in terms of mean, minimum score, maximum score, standard deviation and ‘t’ value, the mean of pre-relaxation score (17.40) was significantly higher than the mean of post relaxation score (7.17). Hence, the null hypothesis was rejected and research hypothesis was accepted.

b. Effect of yoga therapy on physiological parameters The data on physiological parameters were analyzed in terms of mean, minimum score, maximum score and standard deviation. The mean pre-therapy scores of diastolic BP (91.00) and Systolic BP (141.67) was significantly higher than the mean of post therapy scores of diastolic BP (88.03) and systolic BP (137.80). Hence, the null-hypothesis was rejected and the research hypothesis was accepted. The mean of pre-therapy scores were weight (2.13), proteinuria (4) pitting edema (4), headache (2.20), edema (3.47) epigastric pain (2.53) sleep (2.03) and the mean of post therapy scores were, weight (1.90), proteinuria (4), pitting edema (4) headache (3.07) edema (4.10) epigastria pain (2.70) and sleep (2.47). There was a significant positive change in mean of pre-therapy scores and post therapy scores of weight, headache, edema, epigastric pain and sleep and there was no significant difference in the mean of pre therapy scores and post therapy scores of proteinuria and pitting edema.

Section III:

In order to find the correlation between of physiological parameters and stress score, the following null hypothesis was tested. The data presented in the r value for pre-therapy scores were, diastolic BP (r = - .060), systolic BP (r = - .104), weight (r=-.019), proteinuria (r = 0), pitting edema (r=0), headache (r= .137), edema (r = .109), epigastric pain (r = .317) sleep (r = .33). There was no significant correlation between pre-therapy scores of diastolic BP, systolic BP, weight, edema, headache and sleep and pre relaxation score (r and silence on stress response, the findings suggested that cognitive cues provided by stress management techniques contributed to relaxation.

Section IV:

In order to find the association between pretherapy scores of the level of stress and the selected variables such as age, obstetrical score, diet, occupation and religion, the following null hypothesis was tested. ChiSquare test of association was computed to determine the association between pre-therapy scores of the level of stress and the selected variables such as age, obstetrical score, diet, occupation and religion.

LIMITATIONS:

As the study is limited to 30 samples, and sampling technique being non probability purposive, generalization of the finding is limited. The changes in the physiological status after administering the post test are not taken into account. Yoga therapy was practiced only for a duration of 2 weeks due to high attrition rate of the sample. Being quasi experimental, one group pretest and post test design and its internal validity is open to question. The investigator could not control the effect of antihypertensive drugs due to ethical reasons.

RECOMMENDATIONS:

A similar study can be replicated on a larger sample using probability sampling techniques. A study can be conducted by using yoga therapies for a longer period of time. A similar study can be replicated in another setting. Another study can be conducted to monitor the effect of yoga therapies during the postnatal period on women with pregnancy induced hypertension. A comparative study can be done to evaluate the effect of yoga therapy in two groups without the treatment of drugs.

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Received on 20.05.2020 Modified on 21.07.2020

Asian J. Nursing Education and Research. 2021; 11(1):11-14.

DOI: 10.5958/2349-2996.2021.00004.5