 Thank you Dr. Cecila because I'm very honored to introduce you to the participants today. Dr. Cecila is the administrator and head of the institution and also a research guide in many universities. She's a member of the Research Advisory Board in India and founder and head of the Bill Ross Research Association. She's made a lot of presentations and published a lot of papers and has quite a number of very distinguished awards. So I'm very pleased to introduce Dr. Cecila and I hope that you find her presentation on a trial of physical activity for women with PIH. Very interesting. So I'll hand over to you now. Dr. Cecila would like to take questions after the session so please sit back and enjoy it and then we'll have a discussion afterwards. Thank you. Okay ma'am, thank you so much for introducing me. I am very pleased and honored to be a part of it. So I'm going to present a very small study. Actually, it is done on antinatal women. Okay, so this is like one minute. Okay, so the pregnancy induced hypertension is just form of high blood pressure. So it causes around 76,000. Can I use a pointer zone? Pointer? Okay. So it gives like 76,000 maternal deaths and 500,000 of infants each year. Why it has been so concerned is how to go down. Okay, so because it gives a lot of complications even during antinatal period like IUGF, stillbirth, asphyxia, and even sometimes death for mother and fetus, and intrapartum hemorrhage, pure shock like the complications or more. There are many studies done by people, but particularly these people have done studies saying that this could be very much preventable. Up to 1.9 to 18.7% is still preventable. And this person, Sibai, has done a study and he said that there are many methods to prevent PIS and this effect, and which includes one of the activities, one of the methods is the style of physical activity. So what is this style of physical activity? When I look into that, it's just any activity which is going to increase the fetal profusion can be done. That's what they have to do. Because this any physical activity which increase fetal outcome among all antinatal mothers improved by Mottala, then any exercises which can improve endopelial cell function and also reduce oxidative stress, which by doing this exercise, if there is no fetal stress, we can definitely go ahead and have it. So to have a better outcome, we should do some activity which is going to increase the fetal out profusion thereby the fetal outcome. So based on this concept, the study was taken up to assess the effectiveness of trial of physical activity on neonatal outcome among women with PIS, that is pregnancy induced hepatitis and selected hospitals in Chennai. So for this statement, we have formulated certain objectives that is to assess the neonatal outcome in two groups, compare between the groups and associate the background variables within neonatal outcome. So having this objective, the hypothesis for this formulated for this particular study is there is a significant improvement in the neonatal outcome among women with PTA than those without it. So with this, we went into that. So this is PTA like any activity, any type of activity the women can do at home by herself, which minimum of 30 to maximum of 60 minutes each day, which is going to increase the fetal position, which includes also very simple activities like left lateral position and day nap, all that was included. And we just instructed the women to go for how many hours of rest and how many hours of sleep, all that is being instructed. Okay, then like this how to sit, how to bend herself, how to do the circling exercises, half stretching and even brisk walking was included. So all these were given to her and this was like instructions was given and diary was given to her to maintain it, how many days, are she doing every day, all that was given. So this is just to have the supportive theoretical framework. We use Roy's adaptation model where it helps the women to adopt herself towards a particular concept. The antenatal mother with PIA was with all these variables that are considered as input and she went into the adaptive mode. That is, we introduced the PTA, the style of physical activity into her. So she adopt herself to do this every day and we believe that if she does every day, the assessment of this neonatal outcome will be like this. She will have a better birth rate of the baby, no IUGR, maturity will be termed. So this is what UPGAR score will be better. So based on this, we went into the study. So we have got into this methodology like evaluative research approach with post test only design. The design includes NCR such as manipulation, control randomization. The manipulation is nothing but PTA that is style of physical activity. Control is we had one group, the control group, and also we control all extraneous variables which is going to affect the study. And randomization was done through simple random sampling. Randomization was there. The sample selection was done by simple random sampling by lottery method. And we had a very basic criteria like primary gravity mothers, the station age between 12 to 16 weeks who comes to that hospital for the first visit. And also who got PIH at the age of 24 weeks. And mothers who plan to have delivery at the same hospital they selected. And previous slide. So the tools of the study, the tools were formed. One is a semi-spective questionnaire to collect background variables. And another one is checklist to collect the outcome of the daily which includes all these variables. The term freedom of the daily, atom of the daily, weight of the daily, IUGR, UPGAR scoring, respiratory distress, neonatal genders, IUD, neonatal deaths and diseases. Validity and reliability was done. Like validity obtained from many nursing experts and research experts, reliability was done through interator method. Then we went into the main study. It's how we collected the data collection is after the pilot study. We follow all ethical considerations by getting an ethical committee approval from the head up the department, nursing superintendent and medical director. Obtained concern from all the mothers. Then we allowed the mothers into two groups through random allotment techniques. Then after we allotted, we have collected the background variables in both groups. So this was done. This is the study group. Like after we select routine care and information of antenatal care to study group and practice of TPA was given. Here the education on TPA was just given to them. What is the benefit and all? Routine care was followed for the control group. Then after we give education, then really we went into the demonstration of all sort of activity which is going to increase the fetal position. So this was done. So we did talk with that. I went into like after we give the mother is admitted in the high risk ward because she was the PIS. It's some complications and we teach them how to assist the fetal well-being by herself. This is the threat that what she has in her hand. So she has to assist the fetal movement every day. That was being taught to her and she has a diary to mark it and she will bring it every week whenever we call her for the follow-up. And also we told her the rest and the sleep, how to rest, what position and how many hours all that is being given. Then level of adherence. Whether she is really doing the TPA or not, that was followed up after 8 weeks almost every day through telephone and also the mothers were called up individually and also reinforcement was given for the mothers who were not able to do the TPA regularly. There the family members also were involved because here in India the mothers and mother-in-laws are very, they have to give permission to do anything. So that is all just given to her. Family was reinforced and follow-up of mothers were done till delivery in both groups. Neonatal outcome was assessed. This is the, even after delivery the neonatal outcome was assessed to the checklist. This is the analysis, the findings are this. So these study group and control group demographic variables, if you look at all the variables, it is all not much different. It indicates there is a homogeneity is there between both groups. If you look at this in the age, all belongs to this type of age group. Like 21 to 23, that's ideal age for childbirth and all had secondary majority of them. Like 50% of them had secondary level education and many of them were unemployed and type of work, if you see, they had a moderate type of work. This is in both groups. So there was not much difference and income if you look at this all were about 3000 rupees per month and habitants, many of them from urban in both groups and type of family if you look at both groups had nuclear family at about 50% to 60%. So this was the demographic variable between both groups and we see there is no difference. So this was strong support for our study and this is about the maternal fetal outcome when you look at this. In the age of the baby when you look here, there was no significant difference but if you look at here, most of the babies born in study group are between this like 1500 to 2000. The same age here also in control group. ABGA score not much different. This is the same in both groups and also termed babies, most of them have got termed baby. And about diseases if you look, three babies has got diseases in study group but in control group eight babies. So that is one thing there was there. There is a significant difference was there. And here in hypoglycemia, no difference. Both of them are almost same but as sexia not much different. Here four and eight babies that is almost double times in control group. And when we look at the neonatal death here none and there is one. And if you look there is none and there is two. And respiratory distress syndrome here is seven. It's much better in control group in fact. And about purposes here is only two. There is five. And birth injuries is one and it is four. And when you look at IGR here six and it is 18 almost. So there was a significant difference in that aspect. But though there was not much difference in about the variables but when you look at the overall neonatal outcome in both groups. The study group had a mean of 13.5 and control group had 8.5 standard deviation was 1.54 is 2.93. The calculated independent P value was 3.516. Then compared to the value the P level was I mean the P value was very much significant at the level of 0.001. So it shows that definitely there is an insignificant improvement by the trial of physical activity towards the physical outcome. So this is just a diagrammatic representation of mean and standard deviation. And you look at the discussion and finding as I told you there is a homogeneity between two groups. And when you compare to neonatal outcome there was a significant difference at the level of P is 0. Overall was P less than 0.001. So here we accepted the hypothesis which I have formulated earlier that there will be a significant difference between the group. The first group which who is undergoing TTA then who is not able to do. And this is there are two variables neonatal seizures and birth injury has got some significant difference between study and control group at this level such as T less than 0.01. For this particular finding there are many studies, supportive studies are there. And when we look at the association no significant association revealed it control group but in study group with education level of the mother and neonatal outcome. There was some association at the level of P less than 0.005. So the mother's needs to be educated if the education status that also can improve the neonatal outcome. The demands for the conclusion of the study is the women needs to be told the advantages of practicing TTA regularly. The evidence based results can be transformed through conferences like this and in service education program so that the nurses will enhance the pregnant women towards this particular concern. And these are all my references. So the outcome of the study is just to facilitate the women towards the trial of physical activity. Thank you. Thank you for the opportunity given. Thank you very much doctor. Thank you. Thank you so much ma'am. Can I clarify with you on the slide where you presented the overall outcome score. Maybe I'll go backwards a little bit if you don't. I wonder how you calculated the score for this one. What does the score refer to? What is that ma'am? This one? This is independent T test ma'am. How did this is independent T test? Yes ma'am. What is it measuring? Not the T test. Not the T test. So what is the mean? This is T test, independent T test ma'am. We call it as independent T test ma'am. What is the mean that you're measuring? The mean of what? I'm not getting you ma'am. What is the T test? Independent T test ma'am. This is called as independent T test. This is for... The sample size is not too big. Yes ma'am. Now I understand the test. I'm not sure what the characteristic is that you're measuring. What is the mean of? It's not very wide. So what is the score that you have there? This one ma'am. This one? The mean is actually the number of observations divided by the number that what we have ma'am. The total score divided by the obtained score that is percentage we'll get my mean percentage. At this one scoring we have given negative scoring and positive scoring was there ma'am. So the people who had... For example if you go into IUGR so IUGR if it is not there we will give less one. If it is like that ma'am. We had 10 to 13 variables ma'am. With that we had a score of 1 and 2 ma'am. The total score is 20 actually. Yes ma'am. Yes that's what I was trying to understand. How you calculated the score. What the characteristics were. Yes ma'am. We have two things like what is that negative and positive scoring ma'am. Like if there is no outcome like IUGR if you say if they have IUGR more like people who had IUGR will give no scoring. That is 0. If they have no IUGR then we'll give score of number 1. So like that the total score was actually 20 and we had different like weights and all we have given like the weights example 1500 to 2000 we give score of 1 and 2000 to 2500 we have a 2. So I got different scoring pattern by myself and it was validator then we went into that the meaning was like total score obtained score divided by total score into percentage. Like that we went ma'am. Hello. Yes I understand. Thank you. That's very interesting. Yes ma'am. Thank you so much ma'am. Thank you ma'am. If I have any questions for you. By my paper listing if you want to put up put up your hand using the icon if you want to type your question. Yes ma'am. Yes ma'am. I have an answer ma'am. That's my thanks for the question. Okay. Let's just give them a name and I can see somebody is typing. I have a nice presentation ma'am. They have a really good they have a good name. It is. Thank you so much for being that. For listening. Why are we waiting for some questions? Can I ask you also about compliance with the physical activity? What are the difficult things for women to sit into their. Really ma'am. Really ma'am. Really ma'am. Complaint. This was you can see this. I told you reinforcement was done. See ma'am reinforcement was done because this women particularly complained to me that like ma'am in-laws are not allowing me to do the exercises. So we called this particular family like not only for this is an example. Many in-laws were called and we gave we told them to help these people to practice this CCA. The complains was really good once they understood the the physiological process how the physical position is going into the uterus. All that we explained through the video presentation and diagrammatic representation so they understood ma'am definitely. Yes. I think some of the other presentations I've heard today from India and Bangladesh and things like women's lives are very busy. Especially in the mother-in-law time. Yes ma'am. Yes ma'am. Yes ma'am. Yes ma'am. Yes ma'am. Yes ma'am. Yes ma'am. Yes ma'am. Yes ma'am. Yes ma'am. We have done trial of physical activity that is any exercises or any activity which is going to increase the fetal profile they have to do for 30 minutes to 60 minutes every day. 30 minutes is the minimum and 60 is the maximum. But they have to do at least one per day, must. They can do even 2 times after their ability. And all will be masked in the diary and we have one more study also this the mother who went into TPA more time had better come than the mother who had less time. So that is the question they have asked me. I think I answered. How long do the ladies do the exercise? 30 to 60 minutes, ma'am. More and so many. How much do you feel? And what part of the thing did you most often, was there one particular exercise that you found that I was doing more often? Yes, ma'am. This is the exercise, ma'am. I'll just show you, ma'am. This is the exercise. I'll just show you, ma'am. This is the one. Let's let this is one minute. I have this picture. One minute. I have a picture. I'll just show the pictures. Yeah, ma'am. Actually, we told them to do this brisk walking. And whenever they sit, they have to sit like this. And there were some top stretching exercises and shoulder circling exercises. So these four exercises, we were so carefully introducing and lying in left lateral position. Whenever they take rest, we told them to lie down in the left lateral. And this is the exercise. See, they have to lie down. And whenever they stand, they have to support the back so that the compression is being relieved. Whenever they want to lie down, they have to see that the position is being increased to the opress. So these type of activities, we have definitely told them to do it. Whenever they lie down, they have to lie, not like this. They have to lie down. This is before exercise. She's taking warming up. We have taught them. Left lateral position was ideally speaking. We introduced everyone. And we told them to go for day nap every day, at least for two hours in left lateral position. We're quite active here, ladies. And we can talk. I have in my studies, you see, ma'am, control group was really like, we have given a routine information was continuously given as they have received. See here, this is the control group, ma'am. Routine care and information on antenatal care was given because ethically, we respect them. We did not deprive anything towards them. Later on, we gave a information booklet to them to practice. But initially, to this group, we were given a lot of reinforcement and demonstration. But for the other group, we were not able to give the reinforcement. But exactly the information was given to them. All routine information was given to them for both groups. And for only study group, we assessed the level of adherence. For that group, we did not do reinforcement for study group. Follow-up in both groups, we have done. And also, see, till delivery, both groups were followed up. Then, neonatal outcome was assessed, ma'am. In India, all ladies are active, ma'am. But the problem is, they do some activities which reduce the fetal profession. So that has also been told them not to do this house, not to sit, why they have to, some people will be standing very long. I mean, every listing, the way they bend, the way they sit, which is giving fetal distress, all these being told. So that is what actually trials is, trial of physical activity. It's not only exercises. I told you already, any activity which is going to increase fetal profession was being introduced. But activities which is reducing the fetal profession have also told them not to do. That is what we were doing, ma'am. What have things changed in your hospital as a result of this study? Yes, ma'am, this is in the hospital, ma'am, Chennai. This is the Ramachandra Medical and Research Institute. It's a research institute where we do a lot of projects. We have a big research committee for it. We have an ethical committee. We have a research director. And we have people to do guides and do things for us. Like we have presented this study also there, not the study findings, but they gave, like, we have to give our methodology, how many samples we are going to take, all the ethical committee approval I mean. So all these we have taken from the hospital. And the hospital has given permission to do this study, ma'am. And it is very easy to do because many mothers use to come every day to the OPD. Almost 50 to 100 mothers, antenatal mothers, will come and visit the OPD. So it was like easy, ma'am. And how many happened at the hospital? How many deliveries, ma'am? How many deliveries, yes. How many deliveries? You are asking, ma'am, normal deliveries? Normal deliveries, if you think three per day, like every day, three to five normal deliveries, regional deliveries, with the help of efficacy attenu and oxytocin, we will have as usual the labor process will be there. A normal delivery, a normal regional delivery, with efficacy attenu will be three to five, ma'am, every day. And caesarean will be almost five to eight. It will be more than normal delivery. Is that because it's a cancer for women who have complex health? No, ma'am. It is because, ma'am, many people will come as under-registered, ma'am. All registered people who came from the time of registration will have, most of them will have a normal delivery. The people who are not registered and just like that coming on the way, most of them will end in caesarean. And another thing, in India, ma'am, they have a practice like, they have till eight months they will be with the husband, and nine months they also come to the mother's house. So when they come to mother's house, before they get registered into any hospital by themselves, they'll go get labor pain, and they will not assess their complications. They'll just like that. They'll come for any hospital whichever is near. So that is another reason also, ma'am. What does under-registered mean? Under-registered means the hospital will view, soon after the women enter into the hospital, they will view a number for the registration. All the data will be entered. So even if she forget her records, when she tells the register number, that means registered means she's been followed up. All the files, all the reports, all the scanned reports, mother and the fetal growth, the fetal growth will be completely assessed by the team of the hospital members. That means it's registered. So what is India's rate of caesarean section? Yes. Rate of caesarean section, ma'am, actually is here in India. It's more, ma'am, than normal delivery because normal delivery, we are getting about 40 percent. Caesarean is almost 60 percent, ma'am. Yes, that's very high. Why do you say under-registered women have caesarean? Is it needed as caesarean? Is it needed or not? It is not like that, ma'am. Under-registered women will come there. They will not know that what complications they have and clear obstetricians will not have time to assess them completely. If the service is not open and the labor is not progressing, they have to go for it. If the women is registered, the whole history is reduced. So definitely they will wait for that particular women to go for a normal delivery. This is what we are just saying about it. And many women who come without registration, just like that, they'll have more hands of going for caesarean. This is only like some studies we have done. The mother who come regularly registered at the first visit and come regularly doing follow-up will have more much safer delivery. That is what we mean actually. And this is a policy if someone has had a previous caesarean section, that next time they have a caesarean section. No, we are knowing. Any women who had this caesarean section earlier, we still try to be back. That is the regional birth after caesarean section. We have a process and we are doing it. And if not, only then we go back. I have a question here also. Vaginal birth or vaginal birth, let's tell them. We have a vaginal birth with epithetamine, not an instrument. Instruments nowadays we are not using it. Instead of applying the posters, we believe that caesarean is better. We don't go for it. But one to two percent still we are having a poster and vacuum delivery still going on. If it is at the last minute, we are having some instruments like horses and vacuumers. Otherwise, the vaginal birth are left alone as long as the progress is fine. Epithetamine is not a routine procedure. But in hospitals, it is a routine procedure because there is not an hospital as a policy of having epithetamine as a routine. But we have a government center. Government centers, it is not a routine procedure. We wait for the normal birth without epithetamine. Thank you. Dr. Cecila, are you going to implement physical activity as an intervention for women who have heart blood pressure after the results of your study? Yes, ma'am. So I say that the trial of physical activity definitely is going to improve their fetal profession whereby the neonatal outcome is going to be better, ma'am. I understand. There is nothing normal about an instrumental birth. I am saying that... I didn't say that it is normal. For vaginal birth, if instrument is needed, then it is called as operational delivery. What instrument we use, we call it as post-delivery or vacuum delivery, ma'am. I told you if the mothers are normal, there is no need of having an instrument. Then we will have this vaginal birth. We don't introduce any instrument unnecessarily unless otherwise we are in the last minute. I have delivered... have told me epithetamine or routine in their country. No, ma'am. Not routine in all countries, ma'am. All hospitals and all centres. There are hospitals where the policies have been formulated where epithetamine is routine because they don't want birth injuries to happen. But in government centres, there are some private hospitals also saying that epithetamine is not routine, ma'am. Yes. Without even epithetamine, we have delivered many, ma'am. Many, many, many. It's not very simple. I mean, not very less numbers. We are delivering in most of the government centres, primary health centres, we deliver the people without epithetamine. Epithetamine is not an injury. Epithetamine is just an opening to help the women to have the baby. Easy access, that's all. Epithetamine is just one obstetrical procedure. Yes, ma'am. Any other questions, ma'am? I wanted if the study is going to be published. So, has it been published already? Yeah, sure, ma'am. No, not yet, ma'am. Not yet. It's the first time I'm presenting. So, after that, I have to publish, ma'am, definitely. So, I will do the policy. The local works are doing it. Yes, ma'am. We look forward to meeting it. Epithetamine reduces... Thank you. Definitely. Yes, ma'am. Epithetamine is reducing... Yes, a lot of studies also help in this. I think we work in such very... Ma'am? ...concepts. That way, and we... Not all of them. See, there are... We are saying that... Thank you. So, thank you. So, I'm really finilating the audience... Yes, ma'am. ...created a lot of debate. A lot of questions and comments. Okay, thank you. I'm just going to remind myself to turn off the recording. And we're making a slide, so open to close the conference. Thank you for that. So, if you've got a photo of yourself... Hello. Any participants? Thank you, Dr. Cecila. Please email it to us at adminatvidm.org. Thank you.