RAJIV GANDHI UNIVERSITY

OF HEALTH SCIENCES
BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

MRS.PARAMESWARI .V
1ST YEAR M.SC NURSING
SUSHRUTHA COLLEGE OF NURSING
NAME OF THE #23, PAPAIAH GARDEN, DIAGONAL
1 CANDIDATE AND ROAD,NEAR CHANAMMANAKERE,
ADDRESS ACHAKATTU BUS STOP, BSK 3RD
STAGE, BANGALORE-85

SUSHRUTHA COLLEGE OF NURSING

#23 PAPAIAH GARDEN DIAGONAL
ROAD, NEAR CHANAMMAMAKERE
NAME OF THE
2 ACHAKATTU BUS STOP, BSK 3RD
INSTITUTION
STAGE, BANGALORE

DEGREE OF MASTER SCIENCES IN

COURSES OF NURSING, OBSTETRIC &
3 STUDY AND GYNEACOLOGY OF NURSING
SUBJECT

3/6/2009
DATE OF
4 ADMISSION TO
COURSE
A STUDY TO ASSESS THE
KNOWLEDGE ON OBSTRUCTED
LABOUR AMONG STAFF NURSES
WORKING IN SELECTED MATERNITY
5 TITLE OF THE TOPIC HOSPITAL AT BANGALORE WITH A
VIEW TO DEVELOP AN
INFORAMATION PAMPHLET.
 BANGALORE

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

Mrs. PARAMESWARI.V
1st YEAR M.SC NURSING
SUSHRUTHA COLLEGE OFNURSING
BANGALORE.

2
6.0 BRIEF RESUME OF THE INTENDED WORK

“The higher your energy level, the more efficient your body, the more
efficient your body, the better you feel and the more you will use your talent
to produce outstanding results”

ANTONY ROBBINS

INTRODUCTION

Giving birth is a joyful event, even though it is a life threatening

situation to a woman. Labour events have got a great psychological,
emotional and social impact to the woman and her family. She experiences
stress, physical pain and fear of danger. The care giver should be tactful,
sensitive and respectful to her.

Normal labour always depends on the maternal and fetal conditions.

The world health organization (WHO1997) defines normal labour as low risk
throughout spontaneously in onset with the fetus presenting by the vertex,
culminating in the mother and infant in good condition following birth[1].

Once physiological labours commences its progress is measured by the

descent of the head and dilatation of the cervix. The criteria for distinguishing
from normal labour to abnormal labour based on time limits.

Recognition of the onset of the normal spontaneous labour is not

always easy. Sound midwifery judgement and understanding of the
physiology of the first stage of labour may lead the midwife to the diagnosis
of the latent phase of labour. Midwife being aware of the latent phase of
labour and allowing this time to pass with no intervention may prevent the
medical diagnosis of ”poor progress or failure to progress” later in labour [1].

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 Obstructed labour in one where inspite of good uterine contractions,
the progressive descent of the presenting part is arrested due to mechanical
obstruction[2].

A study conducted on in university of Nigeria teaching hospital,Enugu,

articles states that over a five years period 1985 to 1989,576 cases of
obstructed labour were recorded while11,299 deliveries were conducted
giving an incidence of 4.7%. the incidence of obstructed labour was much
higher for the unbooked patients 33% than for the booked patients 1.7%
cephalopelvic disproportion was the greatest cause of obstructed labour
67%[3].

Neglected obstructed labour will results in rupture of uterus due to

thinning of the lower uterine segment. This in turns results in haemorrhage
and death of mother and fetus[1].

Obstructed labour is a major contributor to maternal mortality figure

worldwide, being responsible for the death of approximately 78,000 women
each year. It is a major problem in those countries where women may go into
the labour without the help of trained attendants[4].

As a part of the safe motherhood initiative the WHO has developed

and introduced a partogram for use in developing countries. The aim is to
increase the detection of women with a obstructed labour and improve the
management of labour. The partograph alerts carrriers to those women with
abnormal progress and enables action to be taken. Maternal and fetal
morbidity and mortality is thus reduced (WHO 1996) [5].

6.1 NEED FOR STUDY

An article published at refferal hospital in Nigeria, states that audit of

115 consecutive maternal mortalities over a period of 10 years.There were
5,153 delieveries and 115 maternal deaths during the study period, with a

4
maternal mortality ratio of 2.232/100000 live births. The most common cause
of maternal mortality is obstructed labour 13.0% . The percentage of maternal
mortality for un booked mother was ten times that booked mothers,
unbooked status is a risk factor for maternal mortality[6].

A study conducted on maternal mortality in western Nigeria,data on

maternal death were collected in the year 1972 and1973.An overall maternal
mortality rate of 3.8/1000 total births were recorded. The major cause for the
maternal mortality were obstructed labour[7].

A article state that every year 85,000 were died due to obstructed
labour and many more loss their baby and have debilitating physical damage
as a result[8].

An article published at teaching hospital in Sudan. During the period

207 cases were diagnosed of obstructed labour. The most sticking symptoms
are tachycardia and low blood pressure, while the common signs in the non
engagement of presenting parts. The most common complication is
septicemia, vesico-vaginal fistula, necrosis of the bladder of vaginal wall and
in urinary incontinence, fetal anoxia and rupture of uterus and possible death
for the mother and fetus[9].

Obstructed labour remains a major public health problem and

contributing significantly to perinetal and maternal morbidity and mortality in
developing countries. This problem mainly occours due to inadequate
antenatal care and the lack of trained birth attendants.

Maintenance of accurate vital statistics,adequate health

education,incorporation of traditional birth attendants into health care
programmes and the provision of more health care centre. This all are
necessary for the quality of obstetric care.

5
 Earlier detection and prompt referral for appropriate treatment are vital
to minimized the complication and ensure the safe delivery. This requires
particular attention in midwifery education.

6.2 REVIEW OF LITERATURE

DEFINITION

Review of literature provides valuable of help in the development of

knowledge of research project. A review of literature is an essential aspects of
scientific research. One of the major review of literature is to ascerting what is
already know relation to the problem of the interest and this help in
developing a broad conceptual framework into which a research will fit.

Review of a literature for this study has been organized under the
following;

A prospective blinded cross-sectional study was conducted on

perinatal death and morbidity occur with cephalopelvic disproportion as a
consequence of the complications of obstructed labour.it is unclear whether
overlap of fetal skull bone is associated with predictive of cephalopelvic
disproportion.In 1970s involving African women showed that overlap of skull
bone at the sagittal suture and to a lesser degree at the lambdoid suture were
associated with cephalopelvic disproportion and could be predictive.The
authors defined cephalopelvic disproportion as cesarean section for poor
progress in labour in the presence of adequate uterine activity,cephalopelvic
disproportion occurred in 113 of the 505 women (22%). The investigators had
no prior knowledge of the parity of the index women or clinical finding,and
did not participate in their obstetric care.the authors conclude that overlap at
the sagittal suture,although not necessiraly diagnostic, is useful for prediction
of CPD. Lambdoid stature overlap appears to be a normal intrapartum
phenomenon and of little predictive value[10].

6
 A study was conducted on to evaluate the contributory factors to the
high frequency of referred cases in obstructed labour at state’s referral
hospital, a questionnaire-based survey of 396 maternity care-providers from
66 randomly selected peripheral delivery units in ogun state, Nigeria was
conducted over a 2-month period, to evaluate their knowledge and use of the
partograph. The majority of the personnal were nurses/midwives (45.5%) and
community health extension workers(42.7%).of the 216 personnel(54.5%)
who were aware of the partograph ,36(16.7%),119 (55.5%) and 61 (28.2%)
demonstrated poor, fair and good levels of knowledge.No junior community
health extension had a satisfactory knowledge of the partograph.only
39(9.8%) of all the personnel routinely employed the partograph for labour
management and almost half of these individuals had a poor level of
knowledge.effort to limits the frequency of referred cases of established
obstructed labour to the hospital should include training of care-providers at
the peripheral delivery units,especially junior personnel in the effective use
of the partograph, in addition to employing quality assurance measures to
check inappropriate use[11].

A study was conducted on to monitor the effect of health care

programme on maternal mortality and to know if the recommended process
indicators are useful also in the least developed countries. In 1994, all 17
health facilities offering maternal health care in a rural province in Eritrea
were visited. An assessment was made of the obstetric services provided,
obstetric complications, and accessibility of health facilities. The study
revealed that necessary data were available for most indicators. The indicators
were helpful to follow the coverage of obstetric care and to identify problems
within the health care system. However, in countries where the coverage of
assisted deliveries is low with few obstetric complications seen within the
health care system, the indicators cannot be used as a tool to monitor the
effect of maternal health care programmes on maternal mortality[12].

7
 A study was conducted on incidence of obstructed labour at eastern
Nigeria over a five year period 527 cases of obstructed labour were recorded,
while 11,299 deliveries were conducted and given an incidence of 4.7%. The
majority of the mother of 59% were primigravida. The incidence of
obstructed labour was much higher for unbooked patient (33%) than for the
booked patient (1.7%). The study concluded education of primary health
providers and traditional birth attendants on the referral is suggested to reduce
the incidence of the condition[3].

A evaluate study conducted on the incidences if severe obstructed

labour, in medical records of the 3669 women admitted in the obstetric wards
of which 515 severely morbid conditions were recorded, for 468 women, 320
were obstructed labour. There were 113 cases of pre-ellampsia, 82 of post
partum hemorrhage, documentation for the diagnosis of obstructed was often
incomplete. condition severity and standard of care varied among hospitals.
Incomplete diagnosis, documentation & evidence of substandard care
common, which warrants auditing for such problem and providing feedback
to health care professionals[13]

A case study conducted on metastatic retroperitoneal adenocarcinoma

presenting as obstructed labour. An unbooked 35 years old multipara came to
our casualty in obstructed labour at 38 weeks of pregnancy. A palpable
retropertoneal mass was found behind the gravid uterus and servix after
delivery of a live baby during emergency casarean section. Surgeons should
be aware of this extremely entity and it highlights the importance of proper
antenatal care to pick up such pathology at an early stage by careful
examination and ultrasound to minimize the morbialbly and mortality[14].

A study conducted on the causes and pattern of death among patients

admitted to the federal medical centre at Nigeria. A total of 104 cases out of
114 patients that died were reviewed. Total admission was 1819 for the year.
Annual death rate was 6.3%. Overall infectious causes of death was the most

8
common 22.1 % this was followed by deaths from pregnancy and neonatal
preterm related causes 18.3% prolonged obstructed labour was the leading
cause of death (periodic review of hospital deaths could be important in
knowing the changing pattern of mortality) [15].

Comparative study was conducted on a short maternal stature is

associated with an increased risk of obstructed labour due to cephalopelvic
disproportion in two village Tanzania. In Idula 54% of casarean sections were
in the 4% of women under ISO cm and 39% of short women delivere in
hospital. In Ikwiriri 23% of parturients were under 150 cm. There are
indications that fertility rate is reduced in short women in Ilula but not
nIkwiriri, a result of the problem and risks of cesarean section for women [16].

A study was conducted on Socio-demographic profiles and more of

clinical presentations and with uterine ruphere in pregnancy in caliber,
Nigeria, reviewed the medical record of 67 patients managed for ruptured of
uterus over 10 years. An incidence of 1 in 213 of all deliveries well ROV and
the majority of 49.2% were aged between 31 to 40 years and 43.3% had no
formal education. Unemployed patients were 29.9%, 42.3% did not book for
antenatal care while 32.8% were attended to by traditional birth affendents the
commonest clinical presentations was ROU the majority of 50.7% results
from neglected obstructed labour rupture uterus is a problem of ignorance
among women of low socioeconomic group with most of them having
unskilled and substandard care during pregnancy and delivery[17].

A study conducted on the partograph for the prevention of obstructed

labour at who, Geneva. States the obstructed labour is an important causes of
maternal and perinatal mortality and morbidity. Partograh represent key
events in labour and provides an early warning system. Expereince with world
health organization and other types of partograph is low resources settings
sugest that when used by the health care professionals with defined

9
management protocols, this inexpensive tool can effectively monitor labour
and prevent obstructed labour[18].

A study was conducted to assess and improve the management of

obstructed labour in materinity units in Malavi, Management practices were
assessed by a retrospective review 44 cases notes, compared with local
standards established by a multidisciplinary gap current practice was
identified, reasons discussed and recommendations made and implemented.
There was significant improvement in the attainment of four standatrds,
draining of urinary bladder, administration of broad spectrum antibiotics,
cesarean section within 1 Hr. or deliver of the fetus within 2 Hrs of diagnosis
and maintaining an observation chart Criterian based audit can improve the
management of obstructed labour with limited resources[19].

A case controlled study was conducted in lamphun hospital, case were

identified 87 pregnant women delivered by cesarean section due to
cephalopelvic disproportion groups were compared by t-test and exact
probability test as appropriate risk indicator's were analysed by odd ration
from univariable and multivariable logistic reghression, risk indicating
significancy associated with cesarean section due to cephalopelvic
disproportion include sympysis fundal height greater than 35cm, nulliparity
less than 152 cm and weight gain more than 15 Kg. Nurse has to recognize
potential obstructed labour and prepare for safe delivery in advance[20].

An article states that among the common causes are cephalopelvic

disproportion malpresentation and malposition. Recognizing the causes of
obstructed labour is important if the complication are to be prevented.
Adequate prevention can be achieved only through a multidisciplinary
approach aimed, in the short term at identifying high risk cause and in the
long term at improving nutrition, early motherhood should be discouraged
and efforts are needed to improve. Nutrition during infancy childhood, early
adulthood and pregnancy improving the access to and promoting the use of

10
reproductive and contraceptive servies will help reduce the prevalence of this
complication[21].

A study was conducted on obstructed labour encountered at the

University Teaching Hospital, Lusake, Zambia. The study was analysed and
found 63 cases are fond, for the same period there were 27,348 deliveries and
1432 caesarean secions. The management of choice was caesarean section
because of lack of experienced, medical staff and poor result obtained
together with the serioud complications which follow destructive operations
before vaginal. Deliveries 85% of babies were delivered alive, no maternal
death, 26% mother remaines in hospital for longer than 10 days. Tehre was 1
case of a burst obdomen[22].

A retrospective study was conducted on knowledge of the incident of

maternal complication and associated maternal mortality in a zone hospital. A
total of 7249 mother delivery 16.5% of the mother were below the age 20,
44.9% of the mother were below the age 20, 44.9% were multiparous and
grant multiparity accounted for 12.5% of them, most (56.2%) had Antenatal
care. The main complication identified were 3.5% obstructed labour,
malpresentation 8.7%. There, were 32 maternal deaths and presumed cause of
deaths were ruptured Uterus 25% obstructed labour 78.8%. The highest case
fatality ratio was found with ruptured uterus hemorrhage. The frequency of
severe maternal morbidity is high and is associated with high case fatality
ratio. This indicates the need to improvement in the quality of obstetric care to
prevent maternal compliation[23].

A study was conducted on to determine causes and contributing sectors

to maternal deaths in a remote area of the Gambia, include all maternal
deaths. The results showed the leading causes of death followed by
Haemorrhage, obstructed labour, Anaemia, majority of the death occur due to
substantial obstetric care, substantial inadequencies revealed at the hospital,
characterized by oeperational difficulties and on uncoordinated emergency

11
preparedness including failure to obtain operative delivery, poor birth
monitoring and lack of trained personnal, electricity medical equipment and
drugs. It was concluded that intervention, addressing the profound
deficiencies within the health care system and increasing access to
emergency obstetric care are warranted to reduce maternal death in a poor
setting[24].

A study conducted on obstructed labour using better technologies to

reduce mortality, the author sought systematic reviews of randomized orials,
individual randomized trials, and in the absemnce of randomized data, non-
randomised studies and clinical consensus, obstructed labour causes
approximately 8% of maternal death and indirectly contributes to a greater
percentage proven or widely accepted technologies that incluces
contraception, external ceptalic version, vaccum extraction, cesarean section,
symphysiotomy and destructive procedures for non-viable fetus. Paratogram
augmentation of labour, selective amniotom, selective episiotomy. Access to
well established technology particularly safe cesarean section can reduce
maternal mortality in resource poor countries[25].

PROBLEM STATEMENT

A STUDY TO ASSESS THE KNOWLEDGE ON OBSTRUCTED

LABOUR AMONG STAFF NURSES WORKING IN A SELECTED
MATERNITY HOSPITAL AT BANGALORE ,WITH A VIEW TO
DEVELOP AN INFORMATION PAMPHLET .

6.3 OBJECTIVES

 To assess the knowledge of staff nurses on obstructed labour.

 To develop an information pamphlet on obstructed labour for
staff nurses.
 To find out the association between the knowledge and selected
demographic variables.

12
6.3.1 HYPOTHESIS

H1= There will be significant association between the level knowledge of

staff nurses and selected demographic variables.

H0= There will not be significant association between the level knowledge
of staff nurses and selected demographic variables.

6.3.2 OPERATIONAL DEFINITIONS

ASSESS
It refers to evaluation or judgement of nurses knowledge on obstructed
labour.

KNOWLEDGE

Refers to correct answer given by nurses about obstructed labour.

OBSTRUCTED LABOUR

Obstructed labour is one where in inspite of good uterine contractions,

the progresive descent of the presenting part is arrested due to mechanical
obstruction.

STAFF NURSES

Refers to the professional trained individual who are working as nurses in the
selected maternity hospital.

INFORMATION PAMPHLET

A concised form of information related to knowledge on obstructed labour.

13
6.3.3 RESEARCH VARIABLE

INDEPENDENT VARIABLE

Demographic variables such as age, year of experience, year of

experience in labour ward, professional qualification, exposure to previous
health information regarding obstructed labour.

DEPENDENT VARIABLE
Knowledge on obstructed labour.

6.3.4 ASSUMPTION
Staff nurses who are working may have moderately adequate of
knowledge.

6.3.5 DELIMITATIONS
The study is limited to the staff nurses working in selected maternity
hospital.

7.0 MATERIAL AND METHODS

7.1 SOURCES OF DATA

Staff nurses those who are working in the selected hospitals will be
sources of the data.

7.2 METHOD OF COLLECTION OF DATA

Data will be collected by using structured interview schedule.

7.2.1 RESEARCH DESIGN

Descriptive method.

14
7.2.2 RESEARCH APPROACH
Quantitative approach

7.2.3 RESEARCH SETTING

Study will be conducted in selected maternity hospitals at Bangalore.

DURATION OF STUDY
Study will be conducted for a period of 6 weeks.

7.2.4 POPULATION
The population of the present study consist of staff nurses working in
selected maternity hospitals.

7.2.5 SAMPLE SIZE

The sample of the study consists of 80 staff nurses who are working in
selected maternity hospitals at Bangalore.

7.2.6 SAMPLE TECHNIQUE

Convenient sampling technique.

7.2.7 SAMPLING CRITERIA

Inclusive criteria
 Staff nurses who are willing to participate in the study.
 Female those who are working in that particular hospital.
 Staff nurses who are available during the period of data collection.
 It includes both experienced and fresh staff nurses who can read
and understand English.

15
Exclusive criteria
 Staff nurses who are not present at the time of data collection.
 Staff nurses who are not willing to participate in study.

7.2.8 TOOL FOR DATA COLLECTION

Questionnaire method,
It consists of two parts, part I and part II.

Part I
Items on demographic variables like age, professional qualification,
years of experience, years of experience in labour ward, exposure to previous
health information regarding obstructed labour.

Part II
Questions to assess the knowledge on obstructed labour.

7.2.9 DATA ANALYSIS METHOD

Data analysis will be through descriptive statistics and inferential
statistics.

DESCRIPTIVE STATISTICS
Frequency, percentage, mean, median, mode, standard deviation will
be used.

INFERENTIAL STATISTICS
Chisquare (alpha square) test will be used to find out the association
between the test knowledge scores with selected demographic variables.

16
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION
OR INTERVENTION TO BE CONDUCTED ON NURSES
OR OTHERS?
Yes: A Questionnaire will be administered to assess the knowledge on
obstructed labour among the staff nurses.

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED

FROM YOUR INSTITUTION?
 Permission will be obtained from research committee of Sushrutha
College of nursing, Bangalore-85
 Permission will be obtained from the authorities of selected maternity
hospital Bangalore.
 Consent will be obtained from the staff nurses who are participating in
the study.

17
 8. LIST OF REFERENCE

Books and Journals Reference :

1) Myles. Text book for Midwives, 14th ed. London, Churchill

Livingstone, 2007

2) Thresyamma C P. "A Guide to midwifery students", 1st ed, New

Delhi, Jaypee brother, 2003.

3) Uchegbu H, Ozumba "Incidence and Management of Obstructed

labour", Aust N Z J Obstet. Gynaecol. 1991, Aug;31(3).; 213-6.

4) Sujoy Dhar "International Women's day", India. Brapples with high

maternal death rate" 2009.

5) Tank D.K. Suha Krishna, "Pregnancy at risk. Curretn concepts" 3rd

ed; New Delhi, Jayppe brother, 1997.

6) Ebeigbe PN, Igberase GO, "Maternal Mortality J Obstet Gynaecol.

2007; Dec ;84(12);1172-4.

7) Oluodumtari S. "Maternal Mortality" 1975.

8) Kwast BE "obstructed labour its contribution to maternal mortality"

Midwifery, 1992. Mar, 8 (1);1-2.

9) Dafallah SE, Ambago J, EI-Agib F, "Obstructed labour in a

teaching hospital in Sudan" Saudi Med J 2003 Oct;24(1):1102-4.

10) Elena, Libhaber, ECK Chart J, Buchmann, Perinatal death and

Morbidity occur with cephalopelvic disproportion as a consequence
of the complications of obstructed labor. Obstetrics Labour and
Delivery 2008, 63 (12).

11) Adam .I, A.A. Ali "Knowledge and use of the partograph among
health care personnel. Obstetrics and Gynaecology 2006. 26.6.

18
12) Dr. Philip Gottlieb, "to monitor the effect of health care
programmes on maternal motality, Afr. J. Reprod Health
2002;6(2):13-22.

13) Liabsue krakul T, Promvifit T, Pattanapisalsak L, Silalai S,

Ampawa T, "A criterion-based obstetric morbidity audit in southern
Thailand Int. J. Gynaeco. 2008 Nov;103(2):166-71.

14) Ghosh SB, Tempe A, "Reproperitoneal adenocarcinoma cause of

obstructed labour" Arch Gynecol. Obstet. 2009 Mar;279(3):427-9.

15) Adekunle O, olatun de IO, Addu NateeF RM "Causes and pattern

of death in a tertiary health institution in south Western Niger
Postgrad 2008 MedJ. Dec;15(4);247-50.

16) Moller B, Lindmark G, "Short stature an obstetric risk factor Act a

obstet Gynecol Scand 1997, May;76(5).

17) Ekanem EI, Eluk SJ, Ekott MI, Ekabua JE Iklaki C "Socio
Demographic profile and presentations of patient with ruptured
gravid uterus" Niger J Med 2008, Mar;17(1):78-82.

18) Mathai M. "The partograph for the prevention of obstructed labour"

Clin Obstet Gynecol. 2009 Ju,;52(2):256-69.

19) Kongnyuy EJ, Mlava G, van den broek N "A criterion based audit
of the management of obstructed labour" Arch Gynecol. Obstet;
May, 279 (5) : 649-54.

20) Khunpradit S, Patumanond J, Tawichasri C. Risk indicators for

cesarean section due to cephalopelvic disproportion J Med ASSOC
Thai, 2005 Oct;88(2)563-8.

21) Konje JC, Ladipo OA "Nutrition and obstructed labour" AMJ Clin
Nutr. 2000 : Jul;72:2915-2978.

19
 22) Mphablele M, Van der Meulen AJ "obstracted labour encountered"
S. Afr Med J 1975, Jul 16;49(30).

23) Gressessew A. "Maternal complicationis" 2007 Jan;45(1):47-54.

24) Cham M, Vangen S, Sundby J :Maternal deaths in rural Gambia"

Glob Public Health 2007 : 2(4) : 359-72.

25) Hofmeyr GJ "Obstructed labour using better technologies to reduce

mortality" Int J. Gynaecol Obstet 2004, Jun;85 Suppl:562-72.

INTERNET REFERENCE :

1) http://www.internationalwomensday.com/article.asp? m=11&e=55.
2) www.google.com
3) www.pubmed.gov.in
4) www.medline

20
9. SIGNATURE OF THE STUDENT:

10. REMARKS OF THE GUIDE : THE TOPIC IS RELEVANT

AND IT HELPS TO
ENHANCE THE
KNOWLEDGE OF STAFF
NURSES REGARDING
OBSTRUCTED LABOUR.

11. NAME & DESIGNATION OF GUIDE: Mrs.Annie Annal

Vice Principal

11.1 GUIDE NAME & ADDRESS : Mrs.Annie Annal

Head of the Department,
Obstetric and
Gynaecological Nursing,
Sushrutha College of
Nursing,
B.S.K.3rd Stage
Bangalore.

11.2 SIGNATURE OF GUIDE :

11.3 HEAD OF THE DEPARTMENT : Mrs.Annie Annal

Head of the Department
Obstetric and
Gynaecological Nursing

11.4 SIGNATURE OF HOD :

12.1 REMARKS OF THE PRINCIPAL :

12.2 SIGNATURE OF THE PRINCIPAL :

21