الفهرس 
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Abstract
Pregnancy is a normal state that includes physiological and psychological changes during this period. Nausea and vomiting are the most common symptoms that about 50%-90% of pregnant women suffer from nausea and vomiting during the first trimester. Approximately 20% of women will continue to experience symptoms past the 20th week (Ebrahimi et al., 2010; pelliteri, 2014).
Ginger as a herbal nonpharmacological method. It has been found to be effective in treating nausea and vomiting during pregnancy due to its ability to increase gastrointestinal motility (White, 2007). Also, Acupressure is another nonpharmacological method can be used safely in pregnancy to overcome nausea and vomiting, Pressure on P6, acupressure point opens up the connections between all the yin channels to support the heart and its blood - which, promote circulation of blood, the harmony of yin and yang, and the secretion of neu¬rotransmitters, thus maintaining normal body functions and enhancing well-being (Clogstoun, 2015; Fraser& Cooper, 2009).
So, the aim of the study was to evaluate the effect of using the Nei-Guan point (p6) acupressure versus ginger on relieving nausea and vomiting during pregnancy. A quasi-experimental study design was adopted to achieve the aim of the study. The study was conducted at Ismailia Maternal Child Health (MCH) centers; Hai Al-Salam and AL Shohadaa centers. A Purposive sample of 120 pregnant women were recruited in this study Forty pregnant women applied pressure on P6 point (1st group) and 40 pregnant women were included in the 2nd group who received ginger. And forty pregnant women will be recruited as a control group who received routine medical treatment that, which may be health education or antiemetic drugs as recorded by the obstetrician. Three tools were used for data collection first, structured interview tool that includes demographic data, past obstetrical history, and present obstetrical history. Second, visual analogue scale; to assess severity of nausea, vomiting and retching scored by a 10 mm visual analog scale (VAS),0 representing no pain, 1-3 representing mild, 4-7 moderate and 8-10 representing severe pain. Third, Rhodes index scale., it is used to assess the objective and subjective factors of nausea, vomiting and retching in a separately scores in addition to Total score: sum of nausea, vomiting and retching experiences.
After preparation and interviewing (Appendix A) with suitable pregnant women, we started started to ask the studied pregnant women about the onset of nausea and vomiting and what was aggravated factors for both and measures that was followed to overcome nausea and vomiting. Also, assess the severity of pain using Visual Analogue Scale VAS (Appendix B). Finally used Rhodes index to assess nausea and vomiting for about frequency, duration, intensity. But assess for frequency and intensity only for retching and Rating Scale (Appendix C). The investigator teaches the studied groups how to apply the intervention, then, the investigator evaluate the studied pregnant women in the study twice daily for 4 days using VAS and Rhodes index Scale.
The main findings of the present study are the following:
1. There were statistical insignificant results between studied groups related to socio-demographic characteristics, retching and vomiting before evaluation, but there is a statistical significant difference related to frequency and duration of nausea before evaluation (p= .046, .024) for acupressure group.
2. During current pregnancy; food odor was more frequently described by women as aggravated factor. Nausea and vomiting were more frequently occur at morning.
3. There was a continuing statistical significant decrease of pain along evaluations related to acupressure and ginger groups compared to control group.
4. There was statistical significant improvement in nausea for acupressure and ginger groups when compared to control group.
5. Acupressure was effective than ginger group in decreasing sense of nausea. It was not only decrease frequency and feeling of distress of nausea but also, decrease of its duration.
6. There was a decrease of characteristics of retching for ginger group than other groups in all evaluations but without statistical significant differences.
7. Ginger was significantly effective than acupressure and control group regarding to the characteristics of vomiting ( frequency, amount and feeling of distress) (p<.05).
8. The mean difference of pain in ginger group was more than acupressure group then the control group.
9. There was a statistical significant difference between acupressure and control groups regarding Rhodes index scale.
10. There was a statistical significant difference between ginger and control groups regarding Rhodes index scale.
11. There was no statistical significant difference between ginger and acupressure groups regarding Rhodes index scale.
12. For acupressure group; there was a statistical significant decrease of pain related to the mean difference of VAS and Rhodes index scale before and after intervention.
13. For ginger group; there was a statistical significant decrease of pain related to the mean difference of VAS and Rhodes index scale before and after intervention.
14. For control group; there was a statistical significant decrease of pain related to the mean difference of VAS and Rhodes index scale before and after intervention.
Finally, this study concluded that, ginger and acupressure were effective compared to medical treatment standard during pregnancy. It was recommended to involve application of acupressure procedure and applying ginger supplement as a method of management of nausea and vomiting during pregnancy at MCH centers.
Summary
Pregnancy is a normal state that includes physiological and psychological changes during this period. Nausea and vomiting are the most common symptoms that about 50%-90% of pregnant women suffer from nausea and vomiting during the first trimester. Approximately 20% of women will continue to experience symptoms past the 20th week (Ebrahimi et al., 2010; pelliteri, 2014).
Ginger as a herbal nonpharmacological method. It has been found to be effective in treating nausea and vomiting during pregnancy due to its ability to increase gastrointestinal motility (White, 2007). Also, Acupressure is another nonpharmacological method can be used safely in pregnancy to overcome nausea and vomiting, Pressure on P6, acupressure point opens up the connections between all the yin channels to support the heart and its blood - which, promote circulation of blood, the harmony of yin and yang, and the secretion of neu¬rotransmitters, thus maintaining normal body functions and enhancing well-being (Clogstoun, 2015; Fraser& Cooper, 2009).
So, the aim of the study was to evaluate the effect of using the Nei-Guan point (p6) acupressure versus ginger on relieving nausea and vomiting during pregnancy. A quasi-experimental study design was adopted to achieve the aim of the study. The study was conducted at Ismailia Maternal Child Health (MCH) centers; Hai Al-Salam and AL Shohadaa centers. A Purposive sample of 120 pregnant women were recruited in this study Forty pregnant women applied pressure on P6 point (1st group) and 40 pregnant women were included in the 2nd group who received ginger. And forty pregnant women will be recruited as a control group who received routine medical treatment that, which may be health education or antiemetic drugs as recorded by the obstetrician. Three tools were used for data collection first, structured interview tool that includes demographic data, past obstetrical history, and present obstetrical history. Second, visual analogue scale; to assess severity of nausea, vomiting and retching scored by a 10 mm visual analog scale (VAS),0 representing no pain, 1-3 representing mild, 4-7 moderate and 8-10 representing severe pain. Third, Rhodes index scale., it is used to assess the objective and subjective factors of nausea, vomiting and retching in a separately scores in addition to Total score: sum of nausea, vomiting and retching experiences.
After preparation and interviewing (Appendix A) with suitable pregnant women, we started started to ask the studied pregnant women about the onset of nausea and vomiting and what was aggravated factors for both and measures that was followed to overcome nausea and vomiting. Also, assess the severity of pain using Visual Analogue Scale VAS (Appendix B). Finally used Rhodes index to assess nausea and vomiting for about frequency, duration, intensity. But assess for frequency and intensity only for retching and Rating Scale (Appendix C). The investigator teaches the studied groups how to apply the intervention, then, the investigator evaluate the studied pregnant women in the study twice daily for 4 days using VAS and Rhodes index Scale.
The main findings of the present study are the following:
1. There were statistical insignificant results between studied groups related to socio-demographic characteristics, retching and vomiting before evaluation, but there is a statistical significant difference related to frequency and duration of nausea before evaluation (p= .046, .024) for acupressure group.
2. During current pregnancy; food odor was more frequently described by women as aggravated factor. Nausea and vomiting were more frequently occur at morning.
3. There was a continuing statistical significant decrease of pain along evaluations related to acupressure and ginger groups compared to control group.
4. There was statistical significant improvement in nausea for acupressure and ginger groups when compared to control group.
5. Acupressure was effective than ginger group in decreasing sense of nausea. It was not only decrease frequency and feeling of distress of nausea but also, decrease of its duration.
6. There was a decrease of characteristics of retching for ginger group than other groups in all evaluations but without statistical significant differences.
7. Ginger was significantly effective than acupressure and control group regarding to the characteristics of vomiting ( frequency, amount and feeling of distress) (p<.05).
8. The mean difference of pain in ginger group was more than acupressure group then the control group.
9. There was a statistical significant difference between acupressure and control groups regarding Rhodes index scale.
10. There was a statistical significant difference between ginger and control groups regarding Rhodes index scale.
11. There was no statistical significant difference between ginger and acupressure groups regarding Rhodes index scale.
12. For acupressure group; there was a statistical significant decrease of pain related to the mean difference of VAS and Rhodes index scale before and after intervention.
13. For ginger group; there was a statistical significant decrease of pain related to the mean difference of VAS and Rhodes index scale before and after intervention.
14. For control group; there was a statistical significant decrease of pain related to the mean difference of VAS and Rhodes index scale before and after intervention.
Finally, this study concluded that, ginger and acupressure were effective compared to medical treatment standard during pregnancy. It was recommended to involve application of acupressure procedure and applying ginger supplement as a method of management of nausea and vomiting during pregnancy at MCH centers.