INTRODUCTION:

The period of time a foetus develops inside a woman's womb or uterus is known as a pregnancy. When counting from the last menstrual cycle through delivery, a pregnancy typically lasts about 40 weeks, or just over 9 months. Pregnancy is divided into three trimesters by medical professionals.¹The physiological process of a developing foetus inside the mother's body is called pregnancy (gestation).

Health care professionals use the term "high risk pregnancy" to describe a pregnancy in which the mother, her foetus, or both are more likely than in a typical pregnancy to experience difficulties during pregnancy or childbirth. Pre-existing diseases, such as diabetes or high blood pressure, difficulties from a prior pregnancy, or conditions present during pregnancy or delivery can all lead to high-risk pregnancy.²When compared to straightforward pregnancies, a high-risk pregnancy has a higher probability of negative outcomes for the mother or the foetus. There are currently no clear rules for differentiating between "high-risk" and "low-risk" pregnancies, however some investigated conditions have been proven to put the mother or foetus at a higher risk of negative outcomes.³ These conditions can be classified into three main categories: health problems in the mother that occur before she becomes pregnant, health problems in the mother that occur during pregnancy, and certain health conditions with the fetus.⁴High-risk pregnancies prevalence was 14.4%. 7.5% of the women were labelled as red, 6.9% as yellow, 72.0% as green, and 13.6% as white based on the color-coded risk stratification. Extreme maternal morbidity conditions during labour were 4.2 times more likely to occur in high-risk pregnant women.⁵According to Coopland’s high-risk pregnancy scoring, among the participants, 40.4% of the pregnant women had low-risk scores, 45.9% had high-risk scores, and 13.7% had severe-risk scores. The foetal outcomes of nearly 29.5% of high-risk pregnancies were poor. The likelihood of producing a healthy foetus reduced as Coopland's score in the high-risk group rose, and this link was discovered to be statistically significant.⁶According to the most recent report from the national Sample Registration system (SRS) statistics, India's Maternal Mortality Ratio (MMR) for the period 2016–18 is 113/100,000 live births, a decrease of 17 points from 130/100,000 live births in 2014–16. This corresponds to 2,500 more moms being saved each year in 2018 than in 2016. From 33800 maternal deaths in 2016 to 26437 fatalities in 2018, the number of expected annual maternal deaths decreased.⁷Around 800 women will die each day in 2020 from pregnancy- and childbirth-related avoidable causes, according to the WHO. In 2020, there was a maternal death roughly every two minutes. Maternal mortality ratio (MMR, number of maternal deaths per 100 000 live births) decreased by roughly 34% globally between 2000 and 2020. Low- and lower middle-income countries accounted for over 95% of all maternal deaths in 2020.⁸The study conducted by Delfia R. et al (2020) shows that 30% of the antenatal mothers had low level of knowledge, 57% of the antenatal mothers had moderate knowledge and 13% of the antenatal mothers had adequate knowledge regarding knowledge on warning symptoms of high risk pregnancy there was significant association between the knowledge and the selected demographic variables.⁹Johncyrani R et al. (2018) conducted a descriptive study to evaluate prenatal moms' knowledge of a number of health issues that can complicate pregnancy. Out of 100 prenatal women, 83% had insufficient understanding and 17% had information that was just moderately appropriate. The knowledge of expectant women was significantly correlated with their demographic characteristics, including employment status, occupation, and monthly income.¹⁰It is in this background and by clinical experience; the researcher is encouraged to undertake a study to design self-instructional modulewhich will be useful and informative to the antenatal mothers regarding knowledge about high risk pregnancy.

OBJECTIVES:

1. To assess the the existing knowledge regarding high risk pregnancy among antenatal mothers.

2. To develop and administer self instruction module on knowledge regarding high risk pregnancy among antenatal mothers.

3. To determine the effectiveness of self instruction module on high risk pregnancy among antenatal mothers

4. To find out the association of pre-test score of antenatal mothers with their selected socio- demographic variables.

MATERIALS AND METHOD:

Pre-experimental research designand quantitative approach was used in the present study. 63 antenatal mothers were chosen by using purposive sampling technique from PDMC Udaipur, Rajasthan.

The tools for the present study included socio-demographic variables, structured knowledge questionnaire to assess knowledge regarding high risk pregnancy. Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (chi-square, paired‘t’ test) were used to analyse the data and to test hypothesis.Kuber-Richardson (kr20) formula was used to test the reliability of the tool and tool was found to be reliable (r=0.76). Prior to tool administration all subjects were explained about the purpose, nature and outcome of study. Informed consent was taken from the participantsin the present study. 63 antenatal mothers were chosen by using purposive sampling technique from PDMC Udaipur, Rajasthan.

The tools for the present study included socio-demographic variables, structured knowledge questionnaireto assess knowledge regarding high risk pregnancy. Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (chi-square, paired‘t’ test) were used to analyse the data and to test hypothesis.Kuber-Richardson (kr20) formula was used to test the reliability of the tool and tool was found to be reliable (r=0.76). Prior to tool administration all subjects were explained about the purpose, nature and outcome of study. Informed consent was taken from the participants.

RESULTS:

The data given in Table 1 shows that according to age, majority of the respondents (36.51%) were from the age group of 22-25 years of age, equal (28.6%) were from the age group of 18-21 years and 26-30 years and the least (6.35%) were from above 30 years of age. According to education, majority of the respondents (30.1%) were secondary educated, (28.6%) were graduate and above, (22.2%) were primary educated and the least (19%) were higher secondary educated. As per area of residence, majority of the respondents (66.7%) were from urban area and (33.3%) were from rural area. According to type of family, majority of the respondents (69.8%) were from joint family and (30.2%) were from nuclear family. According to monthly income, majority of the respondents (46.03%) had monthly income between Rs 10,001- Rs 15000, (25.4%) had monthly income less than Rs 10,000, and (17.46%) had monthly income between Rs 15,001- Rs 20,000 and the least percentage (11.11%) had monthly income above Rs 20,000. In view of previous knowledge, 53.97% of respondents had previous knowledge about high risk pregnancy and (46.03%) respondents had no previous knowledge about high risk pregnancy. According to source of information, majority (38.10%) of the respondents was electronic media; equal (20.63%) for print media, friends/relatives/family members and health personnel.

Table: 1. Distribution of subjects according to socio demographic variables (n=63)

S. No.

Demographic Variables

Sample Group

Freq.

Age (in years)

18-21 years

22-25 years

26-30 years

Above 30 years

28.57%

36.51%

28.57%

6.35%

Educational status

Primary

Secondary

Higher Secondary

Graduate and above

22.22%

30.16%

19.05%

28.57%

Residence

Rural

Urban

33.33%

66.67%

Type of family

Nuclear family

Joint family

30.2%

69.8%

Monthly Income

Less than Rs. 10000/-

Rs. 10001- Rs. 15000/-

Rs. 15001- Rs. 20000/-

Above Rs. 20000/-

25.40%

46.03%

17.46%

11.11%

Previous Knowledge

Yes

53.97%

46.03%

Source of Information

Print media

Friends/Relatives/Family members

Health Professionals

Electronic media

20.63%

38.10%

Table 2 Area wise pre-test and post-test score of knowledge regarding high risk pregnancy among antenatal mothers (n=63)

Areas	Pre-Test		Post Test
Areas	Mean	SD	Mean	SD
High Risk Pregnancy	1.71	0.89	3.37	0.70
Pregnancy Induced Hypertension (PIH)	2.10	1.04	4.36	1.21
Iron Deficiency Anaemia during Pregnancy	4.48	1.49	6.94	1.40
Antepartum Haemorrhage	3.44	1.51	6.78	1.35

Table 2 depicts that in the pre test the highest knowledge (mean 4.48 and mean % 49.74%) was found in area of iron deficiency Anaemia during pregnancy with SD 1.49 and the least score was (mean 2.10 and mean % was 29.93%) in area of PIH with SD 1.04 whereas in the post test the highest knowledge (mean 3.37 and mean % was 84.13%) was found in area of high risk pregnancy with SD 0.70 and the least score was (mean 4.36 and mean % was 65.99%) in area of PIH with SD 1.21.

Table 3: Pre-test and post-test score of knowledge regarding high-risk pregnancy among antenatal mothers (n=63)

Level of knowledge regarding osteoporosis	Pre-test scores		Post test scores
Level of knowledge regarding osteoporosis	Freq.	%	Freq.	%
Poor	41	65.08%	0	0.00
Average	19	30.16%	11	17.47%
Good	03	4.76%	52	82.53%

Table 3 depictsthatin pre – test majority ofthe respondents (65.08%) had poor knowledge regarding high risk pregnancy, (30.16%) had average knowledge and only (4.76%) had good level of knowledge., whereas in post – test majority of the respondents (82.53%) had good knowledge regarding high risk pregnancy, (17.46%) had average knowledge and No respondents had poor knowledge.

Table 4 depicts that, mean pre – test score is 11.73 and mean post –test score is 21.70, the Paired ‘t’ test value was 26.86 when compared to table value (2.02) is high. The enhancement of overall knowledge was 9.97 (33.23%). Statistical analysis showed that there was significant difference between Pre test knowledge score and Post test knowledge score and‘t’ calculated value was more than tabulated value; hence H1 There will be significant difference between pre-test and post-test knowledge scores regarding high risk pregnancy among antenatal mothers was accepted.

Table 4: Comparison of mean pre-test and mean post-test score of Knowledge in control group (n=63)

Component

Observation

Mean

Mean %

Mean Difference (%)

Paired ‘t’ value

Knowledge score

Pre-test

11.73

39.10%

3.06

9.97

(33.23%)

26.86

Post-test

21.70

72.33%

3.08

Chi-square test was calculated to find out the association between pre-test score of knowledge score with demographic variables. Study result found that there was significant association between the pre-test knowledge score and educational status, type of family, previous knowledge and source of information regarding high risk pregnancy and rest demographic variables had no significant association found between the pre-test knowledge score like age, area of residence and monthly income.

DISCUSSION:

Findings of our study revealed the highest knowledge (mean 4.48 and mean % 49.74%) was found in area of iron deficiency Anaemia during pregnancy and the least score was (mean 2.10 and mean % was 29.93%) in area of PIH whereas in the post test the highest knowledge (mean 3.37 and mean % was 84.13%) was found in area of high risk pregnancy and the least score was (mean 4.36 and mean % was 65.99%) in area of PIH. Our findings supported by a study conducted by Haleema, M. et al (2019)¹¹ found that more about half of the study participants had knowledge regarding anaemia (51.20%) as danger signs of pregnancy. Anita S (2018)¹² also revealed in her study that about 14% of pregnant women had good knowledge, 55% had average knowledge, and 31% had poor knowledge regarding PIH.

In pre – test majority of the respondents (65.08%) had poor knowledge, (30.16%) had average knowledge and only (4.76%) had good level of knowledge regarding high risk pregnancy. Our findings supported by a study conducted by Shinde S et al (2022)¹³, in which they revealed that majority of participants, 36(60%) had average knowledge, followed by 13(21.7%) who had bad knowledge and just 11(18.3%) who had strong knowledge about high risk status of pregnancy. Nitya R et al (2017)¹⁴ also revealed that among 382 pregnant woman 49.2%, 27.2% and 21.2% had sufficient knowledge about danger signs during pregnancy, labor, and childbirth respectively. Monica Nancy Lal et al (2020)¹⁵, P VadivukkarasiRamanadin et al (2019)¹⁶ and Sinmayee Kumari Devi et al (2015)¹⁷ also revealed similar findings in pre test while assessing knowledge regarding identification of high risk pregnancies among Auxiliary Nurse Midwives and health care workers. Usha Rani. R (2019)¹⁸ and Thomas AM (2017)¹⁹ also revealed that there weremore participants with poor knowledge level in pre testregardingHigh-Risk Conditions during pregnancy. While Damor A and Mehta S (2021)²⁰revealed contradictory findings, in which participants had good knowledge, attitude and practices regarding high-risk pregnancy which indicate good penetration of IEC programme regarding the same.

In post – test majority of the respondents (82.53%) had good knowledge regarding high risk pregnancy, (17.46%) had average knowledge. The effectiveness of the self instructional module was tested by using paired ‘t’ test. mean pre – test score is 11.73 and mean post –test score is 21.70, the Paired ‘t’ test value was 26.86 when compared to table value (2.02) is high. The enhancement of overall knowledge was 9.97 (33.23%). Statistical analysis showed that there was significant difference between Pre test knowledge score and Post test knowledge score and ‘t’ calculated value was more than tabulated value. It seems that self instructional module makes significant difference between pretest and posttest scores of knowledge. Our study findings supported by Savita (2021)²¹, she revealed that, the mean post-test knowledge scores were higher than their mean pretest knowledge scores and the planned teaching programme on high risk signs of pregnancy of prenatal mothers was found to be effective in improving the knowledge of antenatal mothers. Our study findings supported by Mishra P, Singh P (2023)²², Dhanlakshmi J (2015)²³, in which they found that educational intervention was effective in increasing knowledge of antenatal mothers regarding high risk pregnancy. Reshmi P et al (2015)²⁴ and Indra V. (2016)²⁵ found effectiveness of teaching program on knowledge about high risk pregnancyand Selected Aspects of Safe Motherhood. Vyas K et al (2023)²⁶, Dwivedi J et al (2022)²⁷ and Smitha K.R et al (2015)²⁸ also found effectiveness of educational interventions in their respective research studies.

Our study found that there was significant association between the pre-test knowledge score and educational status, type of family, previous knowledge and source of information regarding high risk pregnancy. Vishwas A., Chaturvedi D. et al (2022)²⁹ also revealed that there was significant association between knowledge score with selected demographic variables of the pregnant mothers like Age, education, Nutritional habits and source of information regarding IDA. While Kumar A et al (2022)³⁰ revealed a contradictory finding that age, type of family, socio-economic status, and education status of husbands did not have any association with obstetric danger signs in their study.

CONCLUSION:

Study acknowledged that the most of the antenatal mothers had below average knowledge score regarding high risk pregnancy which was increased after educational intervention, thus the study suggests the need for regular continue education programs for antenatal mothersfor better pregnancy outcome.

SOURCE OF FUNDING:

Researcher had self-financed the present study.

CONFLICT OF INTEREST:

There was no conflict of interest involved while conducting the present study.

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Received on 18.03.2023 Modified on 22.05.2023

Int. J. of Advances in Nur. Management. 2023; 11(4):245-249.

DOI: 10.52711/2454-2652.2023.00055