الفهرس 
Purpose of the StudyOnly 14 pages are availabe for public view
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Abstract
Nausea and vomiting of pregnancy is a common condition that
affects the health of a pregnant woman and her fetus. It can diminish a
woman’s quality of life and also significantly contributes to health care
costs and time lost from work (Piwko et al., 2016). Because morning
sickness is common in early pregnancy, some women do not seek
treatment because of concerns about the safety of medications
(Matthews, Haas, O’Mathúna & Dowswell, 2016). Once nausea and
vomiting of pregnancy progresses, it can become more difficult to control
symptoms. (Ezberci et al., 2016).
Treatment of nausea and vomiting in the early stages may prevent
more serious complications, including hospitalization. Safe and effective
treatments are available for more severe cases, and mild cases of nausea
and vomiting of pregnancy may be resolved with lifestyle and dietary
changes (Magtira et al., 2018). The woman’s perception of the severity
of her symptoms plays a critical role in the decision of whether, when,
and how to treat nausea and vomiting of pregnancy (Vandraas et al,.
2016).
In recent years, there has been increased pressure from funding
agencies and local governments for greater effectiveness and
accountability of prevention and intervention programs that deal with
female issues (Viljoen, Visser, Koen & Musekiwa, 2015). This rising
demand for program quality and evidence of that quality has fueled a
growing interest in clinical practice guidelines (Spring and Bonnie,
2016).The prevalence of nausea and vomiting, across the world is about an
average of 75% of pregnant women, but there is considerable variation
among countries (35% to 84% of women) (Franko, & Spurrell, 2017).
from reviewing literature; nausea and vomiting is the most common
medical condition in pregnancy and adversely affected quality of life and
work efficiency.
The purpose of the current study was to evaluate the effect of
clinical practice guidelines on nausea and vomiting during early
pregnancy.
The present study was carried out at Maternal and Child Health
Centers at Shebin El-Koom (Qebli) ,Menoufia Governorate..
A quasi- experimental study design )with pre and post tests( was used
to carry out the present study.
The target population of this study was pregnant women who
attended at the Maternal and Child health Center (Qebli) at Shebin El-
Koom Menoufia Governorate and fulfilling the following inclusion
criteria: Suffer from morning sickness, nausea and vomiting in the first 12
weeks of gestation. Sample size of this study was 202 pregnant women.
Tools of the study: Throughout the course of the present study, data
were collected using four tools which were developed by the researcher
and reviewed by a jury of qualified experts to test for content validity and
reliability. Those instruments were written in English then translated back
into Arabic to be appropriate for participant women. Tools were:
Instrument I: Structured Interviewing Questionnaire included socio-
demographic data, past history, medical history, previous Obstetric
history, and data about present pregnancy.Instrument II: - Nausea and Vomiting in Pregnancy Health Related
Quality of Life (NVP HRQL) Questionnaire included physical
symptoms, environmental stimuli, emotional function, and social
domestic occupational function.
Instrument III: - A Modified 24-hour Pregnancy-Unique
Quantification of Emesis/Nausea (PUQE) Scoring Index
Questionnaire for assessment of severity of NVP by assessing average
of feeling nausea per day, average of vomiting per day, and average in a
day of retching without bringing anything up.
Instrument IV: Clinical Practice Guidelines for Management of
Nausea and Vomiting during Early Pregnancy Questionnaire
included:-
- First-line intervention for mild-moderate nausea and vomiting in
pregnancy: as dietary/lifestyle interventions, vitamins, use of herbs,
acupressure, acupuncture, and aromatherapy.
- Second-line intervention for moderate-severe nausea and vomiting in
pregnancy: as antiemetic drugs, and intravenous fluids.
- Third-line intervention for moderate-severe nausea and vomiting in
pregnancy: as corticosteroids, enteral feeding, and total parenteral
nutrition.
Ethical considerations: An official approval from the Committee
of Hearing and Ethics was obtained from Faculty of Nursing Menoufia
University on 22/12/2015. Approaches to ensure ethics were considered
in the study regarding confidentiality and the informed consent.
Confidentiality was achieved by the use of locked sheets with the names
of the participating pregnant women replaced by numbers. All pregnant
women were informed that the information they provided during thestudy would be kept confidential and used only for statistical purpose
after finishing the study, the findings would be presented as a group data
with no personal participant’s information remained.
After explanations prior to enrollment in the study, informed consent
was obtained from all pregnant women. Each woman was informed that
participation in the study was voluntary, and that she could withdraw
from the study whenever she decided to and each one was given the
opportunity to freely refuse participation. They were free to ask any
question about the study details.
Main Results: The main findings of the current study were as
follows:
The mean age of the study participants was twenty seven years.
There was s significant relation between age and severity of NVP
of the studied participants.
There was a significant relation between parity and severity of
NVP of the studied participants.
There was a highly statistically significant differences (p<0.001)
found at the post and follow-up intervention related to dietary
habits changes before and during pregnancy.
There was a highly statistically improvement of the BMI of the
studied pregnant women related to effect of dietary changes during
post and follow up sessions.
There was a statistically significant difference found at the post
intervention between lifestyle habits changes and severity of NVP
of the study participants.There was a highly statistically significant difference found at the
post and follow-up interventions related to vitamins intake
(V.B6&V.B12) and severity of NVP of the study participants.
There was a highly statistically significant difference found at the
post and follow-up interventions related to use of herbs (Ginger)
and severity of NVP of the study participants.
There was a highly statistically significant difference found at the
post and follow-up interventions related to use of acupressure and
severity of NVP of the study participants.
There was a highly statistically significant difference found at the
post and follow-up interventions related to use of aromatherapy
and severity of NVP of the study participants.
There was a highly statistically significant difference found at the
post and follow-up interventions related to the use of antiemetic
drugs and severity of NVP of the study participants.
There was a negative correlation between degree of severity of
NVP and normal functioning quality of life of the studied
participants.
The present study findings supported the study hypotheses and
concluded that using of clinical practice guidelines had a greater effect on
reducing severity of nausea and vomiting during early pregnancy post
intervention. This supported the research hypothesis (1) which was,
pregnant women who follow the clinical practice guidelines will have
lower scores of the severity of nausea and vomiting during early
pregnancy than those who do not follow the guidelines. There was also an
improvement of normal functioning quality of life of the pregnant women
after using clinical practice guidelines post intervention. This supported
the research hypothesis (2) which was, pregnant women who follow theclinical practice guidelines during early pregnancy will have higher
scores of normal functioning quality of life than those who do not follow
the guidelines.
The study findings recommended that, early guidance with clinical
practice guidelines during early pregnancy helps reduce degree of
severity of nausea and vomiting and leads to fetal and maternal well-
being. Nausea and vomiting during early pregnancy negatively impact
the normal functioning quality of life of the pregnant women. So she
needs support to be able to cope with the pregnancy problems.