IOSR Journal of Nursing and Health Science (IOSR-JNHS

e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 6, Issue 1 Ver. VI (Jan. - Feb. 2017), PP 30-41
www.iosrjournals.org

Knowledge and Practices of Pregnant Women Regarding Danger

Signs of Obstetric Complications
Anaam Ebrahim El-Nagar1, Manal Hassan Ahmed2,Ghada Abd El-Salam Belal3
1
Domenstrator, Obstetric and Gynecological Nursing Dept, Faculty of Nursing, Tanta University, Tanta, Egypt
2
Prof & Chairman of Obstetric and Gynecological Nursing Dept, Faculty of Nursing, Tanta University, Tanta,
Egypt
3
Lecturer of Obstetric and Gynecological Nursing Dept, Faculty of Nursing, Tanta University, Tanta, Egypt

Abstract: Knowledge of the danger signs of obstetric complications is an essential step in recognition of
complications and enables women to take appropriate action to access emergency care.
Aim: The present study aimed to assess knowledge and practices of pregnant women regarding danger signs of
obstetric complications.
Subjects and Method: An exploratory descriptive study was conducted at 4 antenatal clinics (M.C.H centers)
affiliated to the different available geographical health zones in Tanta City including: Tanta rabae at Kohafa,
Medical center at Said, Tanta Khames at El agizy, and Medical center at Sager. A total sample of 200 pregnant
women selected randomly from the previously mentioned settings fulfilling the inclusive criteria was included in
the study (50 from each). A structured interview schedule sheet was used to collect the necessary data. It
comprised the following parts:
Part I: socio-demographic data such as age, level of education and occupation.
Part II: obstetric characteristics such as gravidity, parity, abortion, antenatal follow-up and presence of any
complications in previous pregnancies, deliveries and puerperium.
Part III: questions related to knowledge about danger signs of obstetric complications
Part IV: women's practices toward danger signs of obstetric complications.
The results of this study revealed that the most frequently recognized danger signs that may occur during
pregnancy were vaginal bleeding, followed by severe abdominal pain and gush of water from the vagina that
were mentioned by more than two third , more than half and nearly half of the women, respectively . While,
vaginal bleeding was the most commonly known danger sign mentioned by nearly one third and slightly more
than one third of the women during labor and puerperium, respectively. Also, the vast majority of the women
consulted a doctor when these danger signs appeared.
Conclusion: Poor level of knowledge was reported regarding danger signs of obstetric complications among
pregnant women. According to the actual practices taken by women to overcome their danger signs during
current pregnancy, consult doctor was the actual mentioned practice and it was also the anticipated practice
during labor/delivery and postpartum period. A significant correlation was found between women's level of
education, occupation, previous experience with obstetric complications, time of the initial antenatal visit and
their knowledge about obstetric danger signs.
Recommendations: the study recommended developing antenatal classes for all pregnant women about
obstetric danger signs and about the proper time to seek medical care. In addition, the mass media should be
utilized and community organizations mobilized to disseminate correct and relevant information about danger
signs of obstetric complications to women, families and communities.
Keywords: Obstetric danger signs, Knowledge, obstetric complications.

I. Introduction
Pregnancy and childbirth are special events in women's life and in the live of their families. This can be
a time of great hope and joyful anticipation; it can also be a time of fear, suffering and even death (1).
Complications of pregnancy and childbirth are often the leading causes of morbidity and mortality among
women in childbearing ages in the developing countries (2,3).At least 40% of all pregnant women will experience
some type of complications during their pregnancies. For about 15% of them, these complications will be
potentially life-threatening, and will require immediate obstetric care (1, 4, 5). WHO estimated that half a million
women die annually from pregnancy-related causes and that 99% of these deaths occur in developing
countries(6,7) . In Egypt, the national maternal mortality ratio in 2011 was 57 per 100.000 births. While, during
2007-2009, it was 123.94 per 100.000 births in Tanta University Hospital, Egypt (8,9).
The direct complications that account for more than 70% of maternal deaths are hemorrhage, infection,
unsafe abortion, eclampsia, and obstructed labor. While these are the main causes of maternal death;
unavailable, inaccessible, unaffordable, or poor quality care is fundamentally responsible (10, 11).

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 30 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

There are also three levels of delays that contribute to these deaths which are known as barriers in
seeking emergency obstetric care when maternal complications occur. These levels are: delay in making
decision to seek care, delay in arrival at a health facility, and delay in receiving adequate treatment (12).
Most maternal deaths are avoidable through well-functioning health system that provides accessible
and high quality care from household to hospital level during antenatal, natal and postnatal period. These deaths
could be also prevented significantly, if women and their families recognize obstetric danger signs and promptly
seek health care (13,14,15).
Obstetric danger signs includes: persistent vomiting, severe abdominal pain, vaginal bleeding during pregnancy
and delivery, severe vaginal bleeding after delivery, swelling of the face, fingers, or feet, blurring of vision, fits
during pregnancy, severe headache, high grade fever, marked change in fetal movements, and high blood
pressure. In addition sudden escape of fluid from the vagina, dysuria, oliguria or anuria, prolonged labor, loss of
consciousness, and retained placenta (16,17).
The provision of care for women during preconception, pregnancy and childbirth periods is essential to
ensure a healthy and successful outcome of pregnancy for the mother and her newborn (18). Preconception care
provides important opportunities for women and their health care providers to identify and manage any health
problems through disease screening by risk assessment, prevention and health promotion (19,20). Antenatal care
also detects and manages high-risk pregnancies early, and represents a window of opportunity for education and
communication to pregnant women so that they well make appropriate choices especially when they are in
danger (21).
Moreover, natal and postnatal cares are very crucial because these periods represent the period of
highest risk of death and disability for both the mother and her newborn (22). Information, education and
counseling provided during these periods are key in management of complications as it would improve early
detection of complications and reduces the delay in deciding to seek obstetric care (21,23).
So, one of the most important responsibilities of the nurse is to increase awareness of the pregnant woman and
her family about the potential danger signs during pregnancy, labor and delivery and during the postpartum
period (24).
Significance of the study
This study therefore aims to assess the current status of knowledge and practices of pregnant women
toward danger signs of obstetric complications. This information are necessary for service providers and health
management teams for improving the quality of antenatal care services provided to women and will aid them to
provide realistic measures to help women deal with it.

Aim of the study

The aim of this study was to assess knowledge and practices of pregnant women regarding danger signs of
obstetric complications.
Research Questions:
1. What is the knowledge of pregnant women about danger signs of obstetric complications?
2. What are the actions to be taken by the pregnant women toward danger signs of obstetric complications?

II. Subjects and Methods

Research Design:
An exploratory descriptive study design was adopted to conduct this study.
Setting:
This study was carried out at 4 antenatal clinics (M.C.H centers which were randomly selected from all M.C.H
centers in Tanta city) affiliated to the different available geographical health zones in Tanta. The settings
include:
1) Tanta rabae at Kohafa.
2) Medical center at Said.
3) Tanta Khames at El agizy.
4) Medical center at Sager.

Subjects:
 A total sample of 200 pregnant women attending the antenatal clinics was randomly selected from each of
the four previously mentioned settings to be included in this study (Fifty from each one).
 The subjects of this study were selected according to the following criteria:
- Pregnant women with gestational age of at least 12 weeks gestation.
- Primigravida and/or multigravida.
- Pregnant women with normal current pregnancy course.
- Aged 18-35 years.

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 31 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

Tools for data collection:

A specially-designed structured interview schedule sheet was constructed based on the recent review of
literatures to collect the required data regarding the study elements. The interview schedule sheet covered the
following parts:

Part one: It assessed the socio-demographic characteristics of women such as: age, residence, level of
education, and occupation.

Part two: It included questions related to obstetric characteristics of women such as ; gravidity, parity,
number of abortions, presence of obstetrical complications in previous pregnancies, deliveries and puerperium ,
mode and place of last delivery, time, place of antenatal care, and number of antenatal visits.

Part three: This part assessed women's knowledge about danger signs of obstetric complications. It included
14 questions about: danger signs that may occur during pregnancy, labor and postpartum period, obstetric
complications that may occur during pregnancy, delivery and puerperium; whether danger signs are different
from obstetric complications, and the women's sources of knowledge about danger signs.

The scoring system regarding women's knowledge was as follow:

 Women who mentioned more than two danger signs of pregnancy, of childbirth and of postpartum period =
good knowledge (was given score 2).
 Women who mentioned two danger signs of pregnancy, of childbirth and of postpartum period = fair
knowledge (was given score 1).
 Women who mentioned one danger sign during pregnancy, childbirth or postpartum period or not
mentioned any danger signs at all and/or don’t know = poor knowledge (was given score zero).

The total knowledge score level calculated by (13 questions× 2 = 26) which categorized was as follows:
1) Good level of knowledge >75% = (>20 scores).
2) Fair level of knowledge 50% - < 75% = (13- < 20 scores).
3) Poor level of knowledge < 50%= (<13 scores).

Part four:
This part related to women's practices toward danger signs of obstetric complications that may occur
during pregnancy, labor and postpartum period. It included questions about: practices performed by pregnant
women to overcome danger signs, anticipated practices and/or measures that may be taken by women regarding
any aroused danger signs during labor & delivery and during postpartum period.

Method:
Official permission to conduct the study was obtained from the responsible authorities through official
letters from Faculty of Nursing explaining the purpose of the study to the Ministry of Health administrative
authorities in order to obtain their acceptance to collect necessary data from the selected settings. Then, the
permission was obtained from the center's administrative authorities. Tools were developed by the researcher
after review of the relevant literature in addition to experts' opinion. A pilot study was carried out on10% of the
sample ''20'' pregnant women from 4 M.C.H centers to ascertain the clarity and applicability of the tool.
Women's informed consent was obtained to participate in the study after explaining the purpose of the
study. Also, confidentiality and privacy were ascertained regarding the data collected. Data collection lasted 5
months started from, September 2012 and ended by January 2013and were accomplished in the morning from
9:00 a.m. to 1:00 p.m. Three times per week according to the identified days of the week for antenatal care at the
four previously mentioned M.C.H centers.

Statistical design:
Statistical analysis of the data was carried out and the collected data was organized, categorized,
computerized, tabulated and analyzed by statistical package for social science (SPSS version 17).

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 32 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

III. Results
Table (1): Socio-demographic characteristics of the women
Socio-demographic data Women n = 200
n %
Age(years):
18 - < 24 64 32.0
24 - < 30 97 48.5
30 - 35 39 19.5
Range 18-30
Mean±SD 25.71±4.09
Residence:
Urban 112 56.0
Rural 88 44.0
Educational level:
Illiterate 15 7.5
Read and write 11 5.5
Primary/preparatory 18 9.0
Secondary/diplom 87 43.5
University 69 34.5
Occupation:
Housewife 153 76.5
Working 47 23.5
Total 200 100

Table (1): Illustrates the socio-demographic characteristics of the women. It was observed that slightly
less than half of the women (48.5%) were aged from 24 to less than 30 years old, with mean age of 25.71±4.09
and more than half of the women (56%) were urban and (44%) were rural. Regarding the educational level, it
was found that about one third (34.5%) of the women had university education and (43.5%) had secondary/
diplom education. Concerning the occupation, it was showed that slightly more than three quarters of the
women (76.5%) were housewives, and (23.5%) were workers.

Table (2): Obstetrical history of the women

Women
Obstetrical history n = 200
n %
Gravidity:
1 81 40.5
2-3 96 48.0
>3 23 11.5
Parity:
Nullipara 93 46.5
1 54 27.0
2-3 51 25.5
>3 2 1.0
Type of last delivery(N=107):
Normal 59 55.1
Cesarean section 48 44.9
Place of previous delivery (N=107):
Home 12 11.2
Governmental hospital 48 44.8
Private hospital/ doctor's clinic 47 43.9
Number of abortions:
None 163 81.5
1-2 34 17.0
>2 3 1.5

Table (2): Demonstrates the distribution of the women according to their obstetrical history. It was
observed that slightly less than half of the women (48.0%) were pregnant two to three times, while 46.5% of the
women were nullipara. As regard to the type of last delivery, more than half of the women (55.1%) had normal
spontaneous vaginal delivery and the rest of them (44.9%) delivered by cesarean section. The governmental
hospital was the most commonly reported place of previous last delivery mentioned by (44.8%) of the women.
The table also illustrates that more than three quarters of the women (81.5%) had no history of abortions, while
only (1.5%) had a history of abortions more than two times.

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 33 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

Table (3): Distribution of the women according to their attendance of antenatal care
Women
Antenatal care attendance n =200
n %
Time of the initial visit:
First trimester 157 78.5
Second trimester 37 18.5
Third trimester 6 3.0
Place of antenatal care:**
Governmental hospital 8 4.0
Private hospital/private doctor's clinic 144 72.0
Health centers/MCH 164 82.0
Number of antenatal visits:
Once 7 3.5
Twice 17 8.5
Three times 31 15.5
Four times 33 16.5
More than four 112 56.0
** More than one answer
Table (3): Illustrates distribution of the women according to their attendance of antenatal care. It was
observed that more than three quarters of the women (78.5%) sought initial antenatal visit at first trimester and
only (3.0%) had their initial visit at third trimester. The table also showed that 82.0% of the women received
antenatal care at Health centers, and Maternal and Child Health centers, while (72.0%) of the women received
antenatal care at private hospital and doctor's clinic and only (4.0%) of the women received antenatal care at
governmental hospital. The table also illustrated that more than half of the women (56.0%) had more than four
antenatal visits during their current pregnancy, followed by (15.5%, and 16.5% respectively) of the women had
from 3-4 antenatal visits.
Table (4): Distribution of the women according to presence of maternal and fetal complications
Maternal and fetal complications Women n =200
n % X2 P
Presence of complications in previous pregnancies:
Yes 38 19.0 76.88 0.001*
No 162 81.0
Maternal complications**
Miscarriage 37 97.4
Placenta praevia 3 7.9
Abruptio placenta 1 2.6
Preterm labor 5 13.2
Pre-eclampsia 6 15.8 60.18 0.022*
Anemia 7 18.4
Hydramnios 2 5.3
RH incompatibility 2 5.3
Fetal complications**
IUFD 1 2.6
Congenital malformations 1 2.6 16.94 0.007*
Abortion 10 26.3
Presence of complications in previous deliveries:
Yes 6 3.0 176.72 0.001*
No 194 97.0
Maternal complications**
Bleeding 4 66.7 184.24 0.001*
Fetal complications**
Prolapsed umbilical cord 1 16.7
Fetal distress 1 16.7 0.500 0.778
Stillbirth 2 33.3
Presence of complications in previous puerperium:
Yes 13 6.5 151.2 0.001*
No 187 93.5
Maternal complications**
Postpartum hemorrhage 4 30.8
Puerperal infection 5 38.5 3.18 0.364
Anemia 4 30.8
Fetal complications**
Still birth 1 7.7
Meconium aspiration syndrome 3 23.1
Respiratory distress syndrome 2 15.4 3.545 0.737
Perinatal asphyxia 1 7.7
SGA 2 15.4
Neonatal infection 1 7.7
IUFD = Intrauterine fetal death. SGA= Small for gestational age. * Significant (P <0.05) ** More than one answer

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 34 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

Table (4): Shows distribution of the women according to presence of maternal and fetal complications.
It was observed that more than three quarters and the majority (81.0%, 97% and 93.5% ) of the women had no
complications in previous pregnancies, deliveries and puerperium, respectively and the rest of them (19% , 3%,
6.5%) had complications. As regard to maternal complications, miscarriage was the most frequent complication
occurred in previous pregnancies mentioned by the majority of the women (97.4%), while bleeding was the only
reported complication present in previous deliveries mentioned by two third (66.7%) and more than one third of
the women (38.5%) had puerperal infection, followed by postpartum hemorrhage (30.8%) in previous
puerperium.

Table (5): Distribution of the women according to their knowledge regarding obstetrical complications
Women
Knowledge regarding parameters of obstetrical complications n =200 X2 P
n %
Knowledge of obstetrical complications:
Yes 161 80.5 205.69 0.001*
No 39 19.5
Knowledge regarding maternal complications during pregnancy:** (n=161)
Miscarriage 68 42.2
Ectopic pregnancy 1 0.6
Molar pregnancy 1 0.6
Placenta praevia 6 3.7
Abruptio placenta 2 1.2
Preterm labor 10 6.2
Gestational diabetes 12 7.5
Heart disease 3 1.9 457.05 0.001*
Pre-eclampsia 31 19.3
Eclampsia 6 3.7
HELLP syndrome 1 0.6
Hyperemsis gravidarium 14 8.7
Anemia 22 13.7
Hydramnios 9 5.6
RH incompatibility 1 0.6

Knowledge regarding fetal complications during pregnancy:**

IUFD 1 0.6
IUGR 2 1.2
Congenital malformations 1 0.6 0.600 0.241
Small-for-gestational age 1 0.6
Knowledge regarding maternal complications during labor:**
Dystocia 13 8.1
Preterm labor and birth 7 4.3
Premature rupture of membranes 1 0.6
Intrauterine infection 9 5.6
Bleeding 58 36.0 335.25 0.001*
Post term pregnancy 2 1.2
Rupture uterus 1 0.6
Cephalopelvic disproportion 3 1.9
Pre-eclampsia 5 3.1
Eclampsia 4 2.4
Infection 3 1.9
Knowledge regarding fetal complications during labor:** (n =161)
Prolapsed umbilical cord 4 2.5
Fetal distress 1 0.6
Still birth 2 1.2 2.001 0.572
Malposition 3 1.9
**Knowledge regarding maternal complications during
puerperium:**
Postpartum hemorrhage 37 23
Eclampsia 19 11.8
Puerperal infection 33 20.5
Thromboembolic disease 4 2.5 43.32 0.001*
Knowledge regarding fetal complications during puerperium:**
Respiratory distress syndrome 1 0.6
Congenital malformations 1 0.6 0.00 1.00
* Significant (P <0.05) ** More than one answer

Table (5): Illustrates the distribution of the women according to their knowledge regarding obstetrical
complications. It was found that more than three quarters of the women (80.5%) had knowledge of obstetrical
complications that may occur during pregnancy, labor, and puerperium, while only (19.5%) had no knowledge.

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 35 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

Regarding the knowledge of maternal complications during pregnancy, labor, and puerperium, it was
observed that miscarriage, bleeding, and postpartum hemorrhage were the most commonly known
complications by (42.2%, 36%, and 23%) of the women, respectively.

Table (6): Distribution of the women according to their knowledge regarding danger signs of obstetric
complications
Women
Knowledge regarding danger signs of obstetric complications n =200 X2 P
n %
Knowledge regarding danger signs of obstetric complications:
Yes 149 74.5
No 51 25.5 55.12 0.001*

Are danger signs that may occur during pregnancy, labor or

puerperium are different from obstetric complications?
Yes 123 61.5 10.58 0.001*
No 77 38.5
Are the danger signs predisposing to obstetric complications?
Yes 133 66.5 21.78 0.001*
No 67 33.5
What are danger signs during pregnancy?** (n =149)

Vaginal bleeding 103 69.1

Swelling of the face and fingers 14 9.4
Continuous severe headache 31 20.8
Vision changes 14 9.4
Decreased urine output 5 3.4
High blood pressure 26 17.4 48.02 0.002*
Convulsion 1 0.7
Severe backache 66 44.3
Severe abdominal pain 91 61.1
High grade fever 17 11.4
Severe vomiting 8 5.4
Gush of water from the vagina 70 47
Abnormal fetal movements 52 34.9
Burning sensation with urination 11 7.4
Regular uterine contraction 23 15.4
What are danger signs during labor?**
Vaginal bleeding 45 30.2
Prolonged labour 1 0.7
Severe headache 1 0.7
High or low blood pressure 4 2.7
Retained placenta 1 0.7 310.79 0.002*
Inadequate or prolonged contractions 3 2.0
High grade fever 4 2.7
Increasing apprehension 2 1.4
High or low fetal heart rate 10 6.7
Prolapsed umbilical cord 1 0.7
What are danger signs during puerperium?** (n =149)

Vaginal bleeding 55 36.9

Increase pulse rate 1 0.7
High grade fever 44 29.5
Foul-smelling lochia 5 3.4 57.52 0.011*
Severe headache 2 1.3
Uterine atony 1 0.7
High or low blood pressure 2 1.3
Convulsion 1 0.7
Loss of consciousness 1 0.7
Calf pain 1 0.7
Depression 1 0.7
* Significant (P <0.05) ** More than one answer

Table (6): Demonstrates the distribution of the women according to their knowledge regarding danger
signs of obstetric complications. It showed that more than half of the women (61.5%) gave correct answers
regarding the concept that danger signs during pregnancy, labor, and puerperium are different from obstetric
complications and almost two third (66.5%) of the women reported that danger signs are predisposing to
obstetric complications. As regard to knowledge of danger signs during pregnancy, it was found that the most
frequently recognized danger signs that may occur during pregnancy were vaginal bleeding mentioned by more
than two third (69.1%) of the women, followed by severe abdominal pain (61.1%) and gush of water from the
DOI: 10.9790/1959-0601063041 www.iosrjournals.org 36 | Page
 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

vagina (47%). While, vaginal bleeding also was the most commonly recognized danger sign during labor that
mentioned by (30.2%) of the women and during puerperium, the most commonly known danger signs by the
women were vaginal bleeding, and high grade fever that were mentioned by (36.9% and 29.5%) of the women,
respectively.

Figure (1): Distribution of the studied women according to their overall knowledge total score level regarding
danger signs of obstetric complications.

100
90
80
70
60

50
40 64,5
30
20 34
1,5
10

0
Poor Fair Good

Figure (1): Revealed the distribution of the women according to their overall knowledge total score
level regarding danger signs of obstetric complications. It was noticed that about two thirds (64.5%) of the
women exhibited poor knowledge regarding danger signs of obstetric complications compared to slightly more
than one third of the women (34.0%) that had fair knowledge, while only (1.5%) of the women exhibited good
knowledge about such signs.

Table (7): Distribution of the women according to their practices regarding danger signs of obstetric
complications
Women
Practices items n =200 X2 P
n %
Practices to overcome danger signs during current pregnancy
(N=70):**
Contact with a doctor 67 95.7
Going to hospital 35 50.0 35.46 0.001*
Get more rest 23 32.9
Anticipated practices to overcome any arose danger signs
during labor & delivery and postpartum period :**
Consult others (mothers and relatives) 10 7.6
Self-care practices (treat myself / self-prescribed medications) 3 2.3
Sleep on my back and don't move 3 2.3
Go to hospital 47 36.2 125.42 0.021
Contact with a doctor 55 42.3
* Significant (P <0.05) ** More than one answer

Table (7): Presents the distribution of the women according to their practices regarding danger signs of
obstetric complications. Regarding practices performed by the women toward danger signs during current
pregnancy, the majority of the women (95.7%) contact with a doctor, while anticipated practices to overcome
any arosed danger signs during labor & delivery and postpartum period will consult a doctor and go to hospital
mentioned by nearly half and more than one third (42.3% and 36.2%) of the women, respectively.

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 37 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

Table (8): Correlation between knowledge total score level regarding danger signs of obstetric complications of
the women and their socio-demographic characteristics.
Sociodemographic Knowledge total score level
characteristics Poor Fair Good
(<50) (50-<75) (>75) F P
n % n % n %
Age
18-<24 46 35.7 18 26.5 0 0.0
24-<30 54 41.9 40 58.8 3 100.0 0.056 0.946
30-35 29 22.4 10 14.7 0 0.0
Level of education
Illiterate 13 10.1 2 2.9 0 0.0
Read and write 7 5.4 4 5.9 0 0.0
Primary/preparatory 14 10.9 4 5.9 0 0.0
secondary/diplom 61 47.2 26 38.2 0 0.0 5.105 0.001*
University 34 26.4 32 47.1 3 100.0
Occupation
Housewife 102 79.1 51 75.0 0 0.0 5.362 0.005*
Working 27 20.9 17 25.0 3 100.0
Residence
Urban 68 52.7 42 61.7 2 66.7 0.805 0.449
Rural 61 47.3 26 38.2 1 33.3
* Significant (P <0.05)

Table (8): Reveals the correlation between knowledge total score level regarding danger signs of
obstetric complications of the women and their socio-demographic characteristics. The table illustrated that
there is a significant relationship between women's level of education, occupation of the women and their
knowledge total score level regarding danger signs of obstetric complications, and the difference was
statistically significant (p= 0.001 and 0.005) respectively.

Table (9): Correlation between knowledge total score level regarding danger signs of obstetric complications of
the women and their obstetrical history.
Total knowledge score
Obstetrical history Poor Fair Good
(<50) (50-<75) (>75) F P
n % n % n %
Parity
Nullipara 61 47.3 29 42.6 3 100.0 1.528 0.220
1 33 25.6 21 30.9 0 0.0
2-3 35 27.1 16 23.5 0 0.0
>3 0 0.0 2 2.9 0 0.0
Previous occurrence of maternal and fetal complications (n =107)
Yes 20 31.2 30 75.0 1 33.3 5.25 0.001*
No 44 68.8 10 25.0 2 66.7
05.25
Time of the initial antenatal visit
First trimester 92 71.3 62 91.2 3 100.0 5.501 0.007*
Second trimester 32 24.8 5 7.3 0 0.0
Third trimester 5 3.9 1 1.5 0 0.0
Number of antenatal visits
>4 visits 40 31.5 15 22.1 0 0.0 1.66 0.191
<4 visits 89 69.0 53 77.9 3 100.0
Place of previous last delivery
Home 10 14.7 2 5.1 0 0.0
Governmental hospital 34 50.0 14 35.9 0 0.0
Private hospital/private doctor's 24 35.2 23 59.0 3 100.0 1.588 0.207
clinic
* Significant (P <0.05)

Table (9): Illustrates the correlation between knowledge total score level regarding danger signs of
obstetric complications of the women and their obstetrical history. The table revealed that there is a significant
relationship between previous occurrence of maternal and fetal complications, and time of the initial antenatal
visit and knowledge total score level regarding danger signs of obstetric complications of the women, and the
difference was statistically significant (p= 0.001 and 0.007) respectively.

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 38 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

IV. Discussion
Essentially, all women in developing countries are at risk of obstetric complications. These
complications are virtually inconceivable to anticipate and hard to forestall .Medical and nursing management
for women with obstetric complications begins with the recognition of danger signs. Because lack of knowledge
about danger signs of obstetric complications often delays decision-making for health care service seeking,
resulting in tragic consequences, where women die at home or in their way to the health facility (25,26).
This study therefore aimed to assess the current status of knowledge and practices of pregnant women
toward danger signs of obstetric complications. Concerning the overall knowledge total score level regarding
danger signs of obstetric complications, the findings of the present study revealed that about two thirds of the
women exhibited poor knowledge regarding danger signs of obstetric complications. These results could be
explained according to Egypt Demography and Health Survey (2008)(13,27),who stated that slightly more than
one quarter of Egyptian pregnant women didn't receive antenatal care. However, among those who receive
antenatal care only one third of them received minimal information about danger signs of obstetric
complications and where and when to seek medical assistance.
This finding is in agreement with Pembe et al.(2009) (28), and Hasan &Nisar (2002) (29). They reported
that women generally had poor knowledge of danger signs of obstetric complications. Also, this finding was
concur with a study conducted by Hailu et al (2010) (30), and Kabakyenga et al. (2011) (31), who reported low
levels of knowledge of obstetric danger signs. While, this finding disagree with Rashad &Essa(2010)(27).They
found that almost only one-quarter of their subjects had poor knowledge of obstetric danger signs which reflect
lack of knowledge regarding such signs.
On the other hand, the results of the current study showed that slightly more than one third of the
women had fair knowledge regarding danger signs of obstetric complications. This could be explained by the
fact that one quarter of the women in the current study were working and one third had university education
which may give them opportunity to share knowledge and experience with others. These results go in line with
Rashad &Essa (2010) (27), who reported that nearly one half of their study subjects had fair knowledge of
obstetric danger signs.
Unfortunately, the findings of the current study also revealed that only very few women exhibited good
knowledge about obstetric danger signs. This corresponds with Rashad &Essa (2010)(27), who mentioned that
only one quarter of their study subjects exhibited good knowledge about obstetric danger signs. Knowledge of
obstetric danger signs is important to shape health seeking behaviors which contribute to save women’s life that
stressed by many authors as Myer & Harrison (2003) (32), Smith et al. (2004)(33), Stekelenburg et al.(2004)(34),
and Sugiarto (2007)(35).
Regarding practices taken by women to overcome danger signs during current pregnancy, the
present study indicated that the vast majority of the women stated that they consulted a doctor when danger
signs appeared. These findings are different as compared with Sangal et al (2012) (36),who mentioned that more
than half of women consulted a health worker/ doctor, and approximately three-quarters of women didn't have
any consultation despite knowing their danger signs. Bimala (2011)(37), also indicated that most of the
respondents had visited health facility when they had danger signs, while slightly more than one tenth either had
contact with health personnel or did nothing during such conditions. This discrepancy may be due to difference
in perception of the severity of obstetric danger signs among women, knowledge level or difference in cultural
background which may affect their practices.
On the other hand, if these danger signs appeared during labor/delivery and postpartum period, the
current study revealed that less than half of women mentioned they will consult a doctor. These findings
disagree with a result carried out by Mutiso et al. (2008)(38), who noticed that the majority of their respondents
would seek urgent medical consultation in case of an emergency as opposed to one tenth who would either pray
or didn't know what to do.
As regard correlation between knowledge total score level of the women regarding danger signs of
obstetric complications and their sociodemographic characteristics, the current study reported that a statistical
significant correlation was present between women's level of education , occupation and between knowledge
about obstetric danger signs. These results are in agreement with Rashad &Essa (2010) (27) and Raoof Al-
Hadithi (2011) (39). The similarity between the previous studies and the result of the present study could be
justified by the fact that Literate women were more likely to gain knowledge about danger sign from printed
media in comparison to illiterate women. In other words, the risk of adverse prenatal outcome goes down as the
length of education increases, due to women's ability to follow instructions, start prenatal care early, and attend
more visits. Also, working women have better opportunity to share experiences with others than housewives.
Regarding correlation between knowledge total score level of the women knowledge regarding danger
signs of obstetric complications and their obstetrical history, the present study reported that the previous
occurrence of maternal and fetal complications and time of the initial antenatal visit were significantly
associated with knowledge of women about obstetric danger signs. These results are similar with Rashad &

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 39 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.

Essa (2010) (27)and Pembe et al.(2009) (28).The similarity between the previous studies findings and the findings
of the present study could be justified by the fact that women with previous complications had their own
experience which is an important source of information. Whereas; early initiation of antenatal care provides
women with an excellent opportunity for information and early detection of any complications or risk factors.
Accordingly, empowering women with information enables them to understand and articulate their
health needs and to seek assistance without delay. Failure to give information keeps women ''in the dark" and
creates a barrier between the consumers and service providers. Therefore, women's empowerment is a key
strategy for maternal mortality reduction through danger sign education and early intervention because it
provides them with the capacity to make critical decisions about their own health. It also enables them to seek
care when they think they need it, follow medical procedures, and participate in health activities and education
programs (40,41,42).

V. Conclusion
Poor level of knowledge was reported regarding danger signs of obstetric complications among
pregnant women. According to the actual practices taken by women to overcome their danger signs during
current pregnancy, consult doctor was the actual mentioned practice by women during current pregnancy and it
was also the anticipated practice during labor/delivery and postpartum period. A significant correlation was
found between women's level of education, occupation, previous experience with obstetric complications, time
of the initial antenatal visit and their knowledge about obstetric danger signs.

VI. Recommendations
The study recommended developing antenatal classes for all pregnant women about obstetric danger
signs and the proper time to seek medical care. In addition, the mass media should be utilized and community
organizations mobilized to disseminate correct and relevant information about danger signs of obstetric
complications to women, families and communities. Further studies are needed in this field to assess the effect
of health education program on women's knowledge and practices regarding obstetric danger signs during
pregnancy, labor and postpartum period.

References
[1]. Radhika K .A study to assess the knowledge of selected warning signs in pregnancy among primi-gravida women in Kempa
Cheluvamba general hospital, Master thesis, Bangalore, Rajiv Gandhi University of Health Sciences, Sarvodaya College of
Nursing,2005.
[2]. International Institute for Population Sciences, A qualitative assessment of emergency obstetric care in three districts of
Maharashtra: A border district cluster strategy for women's right to life and health (summary report), Mumbai, 2004.
[3]. United Nations Population Fund, The promise of equality: Gender equity, reproductive health and the millennium development
goals, New York, 2005.
[4]. Gupta N. Maternal mortality: Magnitude causes and concerns, Journal of Obstetrics and Gynaecology Today, 2004; 9(9):555-58.
[5]. Boro E. A study to assess the effectiveness of self instructional module on self-care strategies of antenatal mothers attending
outpatient department in selected hospital, Master thesis, Bangalore, Rajiv Gandhi University of Health Sciences, Goutham College
of Nursing ,2007.
[6]. Kayode T, Titilayo C, Olapeju A, et al . New paradigm old thinking: The case for emergency obstetric care in the prevention of
maternal mortality in Nigeria, BioMed Central Women's Health, 2010; 10(6): 2-8.
[7]. Agus Y, and Horiuchi Sh. Factors influencing the use of antenatal care in Rural West Sumatra, Indonesia, BioMed Central
Pregnancy and Childbirth,2012;12(9):1-8.
[8]. Salah El-din A. The last moments in the delivery room, Shorouk Journal, 2013; 1565.
[9]. El-Gharib M, Rakha S, Awara A, et al. Causes of maternal deaths in Tanta University Hospital,Clinical Medicine Reviews in
Women's Health Journal, 2010;2:79-83.
[10]. Kavitha P, Prasath R, and Krishnaraj P. A study to assess the effectiveness of structured teaching program on warning signs
during pregnancy in terms of knowledge, practice, and attitude among antenatal mothers, Journal of Science, 2012; 2(1):1-5.
[11]. World Health Organization, EMRO country profile, retrieved from http://www.emro.who.int/emrinfo/index.asp?Ctry=egy,
available at 5/8/ 2010.
[12]. Doctor H, Findley S, Cometto G, et al. Awareness of critical danger signs of pregnancy and delivery, preparations for delivery
and utilization of skilled birth attendants in Nigeria, Journal of Health Care for the Poor and Underserved, 2013; 24(1):152-70.
[13]. El-Zanaty F, and Way A. Egypt Demography and Health Survey, Egypt, 2008.
[14]. Tamrakar A. A study to evaluate the effectiveness of planned teaching program on knowledge of primigravida regarding selected
aspects of safe motherhood in selected hospitals, Master thesis, Bangalore, Rajiv Gandhi University of Health Sciences, Pavan
College of Nursing, 2007.
[15]. Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO).Birth preparedness and
complication readiness: A matrix of shared responsibilities, USA, 2004.
[16]. Ahmed A, Chaudhry A, Hussain S, et al. Ramification of complications occurring during pregnancy, Science International
(Lahore) Journal,2013; 25(1):119-22.
[17]. Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO). Monitoring birth
preparedness and complication readiness: Tools and indicators for maternal and newborn health, Baltimore, 2004.
[18]. Tuladhar H, Khanal R, Kayastha S, et al. Complications of home delivery: Our experience of Nepal Medical College Teaching
Hospital, Nepal Medical College Journal,2009;11(3): 164- 69.
[19]. American College of Obstetricians and Gynecologists (ACOG), The importance of preconception care in the continuum of
women’s health care, Obstetrics and Gynaecology,2005 ;106(3):665– 66.

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 40 | Page

 Knowledge and Practices of Pregnant Women Regarding Danger Signs of Obstetric Complications.
[20]. Atrash H, Johnson K, Adams M, et al. Preconception care for improving perinatal outcomes: The time to act, Maternal and Child
Health Journal, 2006;10(5): 3-11.
[21]. Brugada A. Delivery of prenatal health education and pregnancy outcomes in selected Aeta Tribes in Bataan, International Journal
of Public Health Research, 2011;17(49): 11-19.
[22]. Pearson L, Larsson M, Fauveau V, et al. Childbirth care, retrieved from www.who.int/pmnch/media/publications/ aonsection
III-3.pdf, available at 17/8/2013.
[23]. Bisika T. The effectiveness of the TBA programme in reducing maternal mortality and morbidity in Malawi, East African Journal
of Public Health ,2008 ;5(2):103-10.
[24]. John D, and Catherine T. Guidelines for pregnancy care and management of common obstetric complications by medical officers,
retrieved from jknrhm.com/Guideline/Normal delivery and management of obstetric, available at 24 /6/2005.
[25]. Jammeh A, Sundby J, and Vangen S. Barriers to emergency obstetric care services in perinatal deaths in Rural Gambia: A
qualitative in-depth interview study, International Scholarly Research Notices Obstetrics and Gynaecology, 2011;10(5): 1-10.
[26]. Khanum P, Quaiyum M, Islam A, et al. Complications of pregnancy and childbirth: Knowledge and practices of women in Rural
Bangladesh, retrieved from www.icddrb.org/.../ 1073complications-of-pregnancy-and-childbirthknowledge and practices-of-
women-in-rural-bangladesh,availableat22/1/ 2000.
[27]. Rashad W, and Essa R. Women’s awareness of danger signs of obstetrics complications, Journal of American Science,2010;
6(11): 802-9.
[28]. Pembe A, Urassa D, Carlstedt A, et al . Rural Tanzanian women’s awareness of danger signs of obstetric complications, BioMed
Central Pregnancy and Childbirth, 2009;9(12): 1-8.
[29]. Hasan I, and Nisar N. Women's perceptions regarding obstetric complications and care in a poor fishing community in Karachi,
Journal of Pakistan Medical Association,2002; 52(4):148-52.
[30]. Hailu M, Gebremariam A, and Alemseged F. Knowledge about obstetric danger signs among pregnant women in Aleta Wondo
district, Sidama Zone, Southern Ethiopia, Ethiopian Journal of Health Science,2010; 20(1):25-32.
[31]. Kabakyenga J, Ostergren P, Turyakira E, et al. Knowledge of obstetric danger signs and birth preparedness practices among
women in rural Uganda, Reproductive Health, 2011; 8(33): 1-10.
[32]. Myer L, and Harrison A. Why do women seek antenatal care late? Perspectives from rural South Africa, Journal of Midwifery and
Women’s Health, 2003; 48(4): 268-72.
[33]. Smith K, Dmytraczenko T, Mensah B, et al. Knowledge, attitude and practices related to maternal health in Bla, Mali: Result of a
baseline survey, Maryland, 2004.
[34]. Stekelenburg J, Kyanamina S, Mukelabai M, et al. Waiting too long: Low use of maternal health services in Kalabo, Zambia,
Tropical Medical and International Health, 2004;9(3): 390-98.
[35]. Sugiarto T. Knowledge and practice of maternal health care in Indonesia, Journal of Kependudukan Indonesia, 2007; 2(2):1-16.
[36]. Sangal R, Srivastava R, Singh A, et al. Knowledge and practices regarding obstetric danger signs in women attending ante-natal
care clinic at Baba Raghav Das Medical College, Gorakhpur, Indian Journal of Preventive and Social Medicine, 2012;43(1):11-18.
[37]. Bimala B. An exploratory study of prevailing, knowledge, attitude and practice of husband in regards to factors affecting in
supporting activities during pregnancy, delivery and post-partum periods, Journal Of Nobel Medical College,2011; 1(1):45-52.
[38]. Mutiso S, Qureshi Z, and Kinuthia J. Birth preparedness among antenatal clients, East African Medical Journal, 2008; 85(6):
275-83.
[39]. Raoof A, and Al-Hadithi T. Antenatal care in Erbil City-Iraq: Assessment of information, education and communication strategy,
Duhok Medical Journal, 2011;5(1): 31-40.
[40]. Kuo Ch. A study on community awareness of maternal and perinatal danger signs in Rural Haiti, Master Thesis, North America,
University of Connecticut Health Center, 2006.
[41]. Hashem Sh. A study to assess the quality of immediate postpartum nursing care provided to women after cesarean section in Tanta
City, Master thesis, Tanta, Tanta University, Faculty of Nursing, 2012.
[42]. Kebalepile T. An evaluation of the quality of care midwives provided during the postpartum period in Northern Botswana, Master
thesis, Southern Africa, Oslo University, Faculty of Medicine, 2001.

DOI: 10.9790/1959-0601063041 www.iosrjournals.org 41 | Page