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| ARTICLE |
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| Year : 2018 | Volume
: 19
| Issue : 1 | Page : 109-112 |
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Knowledge of antenatal women regarding pregnancy induced hypertension
Symborian Anita
Professor, Jagadguru Shankaracharya CON, Raipur, India
| Date of Web Publication | 11-Jun-2020 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
Pregnancy Induced Hypertension (PIH) is one of the major causes of maternal and perinatal mortality and morbidity. Although early detection of PIH is essential, knowledge on care and prevention of complications is utmost to prevent life threatening complications in the mother and child. This study was conducted with the aim to assess the knowledge of antenatal women regarding PIH. Using convenience sampling technique 100 pregnant women attending antenatal clinic at a tertiary care centre in Chhattisgarh were included in the study. A structured interview schedule was used to collect data. The study findings revealed that about 14% of pregnant women had good knowledge, 55% had average knowledge, and 31% had poor knowledge regarding PIH. The study also revealed that there was a significant association of knowledge with education, occupation, family history of hypertension, family history of PIH and parity of pregnant women. Based on the findings, a health education leaflet was prepared covering the different aspects of pregnancy induced hypertension and given to the subjects.
Keywords: Pregnancy Induced Hypertension, antenatal women, knowledge
How to cite this article:
Anita S. Knowledge of antenatal women regarding pregnancy induced hypertension. Indian J Cont Nsg Edn 2018;19:109-12 |
| Introduction | |  |
Pregnancy and child birth is a normal physiological process with an expected and positive outcome. However, the process of carrying, labouring and delivering a baby has its own risks, for both the mother and the baby especially in developing countries like India, which are well documented.
Globally almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in Subsaharan Africa and almost one third in South Asia. The maternal morbidity ratio in developing countries in 2016 was 239 per 1, 00, 000 live births versus 12 per 1,00,000 live births in developed countries (World Health Organisation [WHO], 2018).
The preeclamptic toxaemia and eclampsia is an important cause of maternal deaths. The prevalence of hypertensive disorders in pregnancy is 8-10% of all pregnancies in the population worldwide (Ghulmiyah & Sibai, 2012). Hypertensive disorders during pregnancy are classified into 4 categories, as recommended by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy: 1) chronic hypertension, 2) preeclampsia-eclampsia, 3) preeclampsia superimposed on chronic hypertension, and 4) gestational hypertension (Barton, O’brien, Bergauer, Jacques, & Sibai, 2001). Globally, preeclampsia and eclampsia account for 10 - 15 % of maternal deaths. The national incidence of Pregnancy Induced Hypertension (PIH) is 15.2% in India and it is four times higher in primipara women than in multipara (Dutta, 2002). PIH is a life threatening condition during pregnancy which can cause premature delivery, intrauterine growth retardation, abruptio placenta, intrauterine death and maternal mortality and morbidity.
| Need for the Study | | |
Hypertension is the most common medical condition encountered in and complicates pregnancy, with significant implications on maternal and perinatal morbidity and mortality (Karthikeyan & Lip, 2007). Preeclampsia places both mother and fetus at risk (Mammaro et al., 2009). Environmental factors such as exercise, infections, seasonal variation, and socioeconomic factors have been proposed to influence pre-eclampsia risk (Trogstad, Magnus, & Stoltenberg, 2011). PIH can cause serious effects such as abruptio placentae, haematological disturbances in the kidney, lungs, liver, and brain. Fetal manifestations may occur before, with, or in the absence of maternal manifestations, and consist of oligohydramnios, Intrauterine Growth Retardation (IUGR) (up to 30%), abnormal umbilical artery doppler velocimetry, decreased fetal middle cerebral artery resistance, an abnormal ductus venosus waveform, and/or stillbirth (Magee, Helewa, Moutquin, & Von Dadelszen, 2008). In the fetus PIH can cause low birth weight, fetal hypoxia, intrauterine death and preterm delivery. Pregnant women need to be aware of the warning signs of PIH and seek medical help at the earliest (Dutta, 2002). Early diagnosis and initiation of appropriate intervention can significantly improve maternal survival. Nurses being the primary caregivers have immense responsibility in improving the knowledge of the mother on various problems associated with pregnancy.
Preserving maternal health is one of the key component in Millennium Development Goals put forth by (WHO, 2011). Health maintenance is an important aspect of prenatal care. Participation of the mother in her care ensures the prompt reporting of the possible problems. Prenatal care is one of the models of primary and secondary prevention of disease. In order to reduce the increasing maternal mortality rates, women with hypertensive disorders in pregnancy should be informed of their disease and satisfactory medical information should be provided by their health care providers. Developed countries have reduced maternal mortality not only by medical improvements, but also due to advanced general health, education, and social position of the women. Making motherhood safe is essential to reduce the maternal mortality and morbidity. This can be done by various activities like providing quality care to the women during antenatal, intranatal and postnatal period, creating awareness regarding care during these periods. By keeping this in mind, the investigator planned to assess the knowledge of antenatal women regarding PIH and also to develop a health education leaflet to improve the knowledge of pregnant women.
Awareness regarding PIH and availability of easily accessible and affordable health care services to all is important which shall be helpful in reducing the PIH related morbidity and mortality. Early diagnosis and treatment through regular antenatal check-up is a key factor to prevent hypertensive disorders of pregnancy and its complications. Therefore, it is the need of hour to test the knowledge of PIH in women and to educate on the management of hypertension in pregnancy as well as maternal and child complications.
| Objectives | | |
- To assess the knowledge of antenatal women regarding PIH
- To find the association between the knowledge of antenatal women regarding PIH with selected socio- demographic variables.
| Methods | | |
A cross sectional descriptive research design was used in the current study for assessment of knowledge regarding PIH among antenatal women. Antenatal OPD of a tertiary care hospital in Chattisgarh was selected for the study. The target population consisted pregnant women of age group 18-35 years. The sample for the present study comprised of 100 pregnant women between the age of 18 to 35 years. Convenient sampling method was used to select subjects into the study. The structured interview questionnaire was constructed and administered for assessing the knowledge regarding PIH among antenatal women.
Instruments
The structured interview questionnaire had two sections. Section A consisted of socio demographic data and Section B included the interview schedule consisting of 28 questions. The questionnaire was split into four parts: PIH and its clinical features, risk factors, management and complications. Each correct answer was given a score of 1 and a wrong response was given score of 0. Content validity of tool was determined by eight experts for their opinion from different specialties. Reliability of the tool was calculated and the reliability coefficient was 0.85.
After the pilot study, the data for the main study was collected. Antenatal women who consented to participate were included in the study. The investigator enrolled the next subject after the data was collected from one subject. The investigator spent 25-30 min with each mother. At the end of interview 3 to 5 minutes were utilized to provide information regarding PIH and the educational pamphlets were distributed.
Data were analysed using mean and percentage for the socio-demographic variables and the levels of knowledge. Chi square test was used to find association between knowledge and socio demographic variables.
| Results | | |
With regards to the socio-demographic variables, 61% of pregnant women were in the age group of 24-29 years, 22% were between 18-23 years and 17% were between 30-35 years old. In relation to education 59% were graduates and above, 32% had high school education, 6% were educated up to middle school education, 2% had primary school education and only 1% were illiterate. Majority of the women (93%) were house wife and 7% were employed. Fifty five percent of women expressed that they had monthly family income of Rs. 5000 - 10,000, 25% were in the monthly income category of 10,000 - 15,000, 15% of them had a monthly family income of below 5000 and only 5% had monthly income of 15,000 and above. History of hypertension was evident in 33% of the mother’s families. PIH was present in family members in 43% of women. Among the subjects 51% were primigravida and 49% were multigravida.
The first objective was to assess the knowledge of antenatal women regarding PIH. Analysis of overall knowledge scores regarding PIH depicted that 55% of pregnant women had average knowledge regarding PIH, 31% had poor knowledge, 14% had good knowledge (see [Figure 1]). The mean knowledge score was 9.89 ± 3.98 out of the total score of 28. This indicates that pregnant women had poor knowledge regarding PIH. Similar results of poor awareness was also seen in 76.2% of pregnant women in an Iranian study (Ganjali, Sepehri, Amjadi, Bagheri, & Davoodi, 2017). | Figure 1: Knowledge of Antenatal Women regarding Pregnancy Induced Hypertension
Click here to view |
Sub-scale analysis of knowledge regarding PIH was assessed. In the area of management of PIH, mean knowledge score percentage was 50.3% whereas the mean knowledge score percentage was 41.5% with regards to the meaning of hypertension. In the area of clinical features mean knowledge score percentage was 32.3% and the mean knowledge score percentage was 29% for being aware of complications. The lowest mean knowledge score percentage was 19.4% in the area of risk factors of PIH.
Question wise analysis of knowledge of antenatal women regarding PIH was assessed. Majority (53%) of pregnant women knew about normal blood pressure and only 30% knew the meaning of PIH. In relation to risk factors of PIH, majority (34%) of pregnant women answered that hypertension before pregnancy is a risk factor of PIH and only 10% knew that twin pregnancy can also be a risk factor of PIH. In relation to management of PIH , majority (73%) had knowledge about regular blood pressure monitoring. Regarding complications of PIH, 34% knew about fetal complication such as intrauterine distress and 24% knew about antepartum haemorrhage and seizures as maternal complications of PIH.
The second objective was to find the association between the knowledge of antenatal women regarding PIH with selected socio-demographic variables.
Analysis of association between knowledge of antenatal women regarding PIH with socio demographic variables revealed that there is a significant association between knowledge and education (χ2=27.54, p< 0.05), occupation (χ2=11.61, p< 0.05), family history of hypertension (χ2=6.32, p < 0.05), family history of pregnancy induced hypertension (χ2=12.52, p < 0.05) and parity ( χ 0.05). There was no significant association between knowledge with age and monthly income.
In a similar study conducted in Iran results showed educational level and job had an impact on awareness of pregnant women (p < .05), while their awareness was not associated with pregnancy, parity, age at pregnancy, history of abortion, age group and source of information. Also, age group, job, educational level, and source of information for pregnant women was associated with their attitude (p < .05), while no relationship was observed between attitude and parity, age at pregnancy and history of abortion (Ganjali et al., 2017).
Women with PIH were at higher risk of adverse pregnancy outcomes than those without. Poor knowledge of management of PIH and inadequate resources are a threat to the proper management of PIH (Muti, Tshimanga, Notion, Bangure, & Chonzi, 2015).
| Conclusion | | |
The study emphasises the importance of an education programme on PIH to the public especially pregnant women to enable a reduction in complications of PIH. As an outcome of this study a leaflet was prepared with the major subheadings as causes, signs and symptoms, and management of PIH. Nurses play not only the curative but also the preventive, promotive, and rehabilitative role. Nurses working in obstetric departments can educate and provide information regarding PIH mainly the risk factors of PIH to antenatal women and their families, thus reducing maternal mortality and morbidity rate.
Conflicts of Interest: The author has declared no conflicts of interest.
| References | | |
| 1. | Barton, J. R., O’Brien, J. M., Bergauer, N. K., Jacques, D. L., & Sibai, B. M. (2001). Mild gestational hypertension remote from term: progression and outcome. American Journal of Obstetrics and Gynecology, 184(5), 979-983.  |
| 2. | Dutta D.C. (2002). Text book of Obstetrics (4 th ed.). Calcutta: New Central. |
| 3. | Ganjali, M., Sepehri, Z., Amjadi, N., Bagheri, S., & Davoodi, M. (2017). Knowledge, attitude and functioning toward pregnancy induced hypertension in pregnant women referred to health centers in Zabol, 2014. Indian Journal of Forensic Medicine & Toxicology, 11 (2). |
| 4. | Ghulmiyyah, L., & Sibai, B. (2012). Maternal mortality from preeclampsia/eclampsia. Seminars in Perinatology, 36(1), 56-59. |
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| 6. | Magee, L. A., Helewa, M., Moutquin, J. M., & Von Dadelszen, P., (2008). Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Journal of Obstetrics and Gynaecology Canada, 30(3) Supplement 1, S1-48. |
| 7. | Mammaro, A., Carrara, S., Cavaliere, A., Ermito, S., Dinatale, A., Pappalardo, E. M., … & Pedata, R. (2009). Hypertensive disorders of pregnancy. Journal of Prenatal Medicine, 3(1), 1. |
| 8. | Muti, M., Tshimanga, M., Notion, G. T., Bangure, D., & Chonzi, P. (2015). Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare, Zimbabwe. BMC Cardiovascular Disorders. doi:10.1186/s12872-015- 0110-5 |
| 9. | Trogstad, L., Magnus, P., & Stoltenberg, C. (2011). Preeclampsia: Risk factors and causal models. Best Practice & Research Clinical Obstetrics & Gynaecology, 25(3), 329-342. |
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[Figure 1]
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