The first crucial step in making an appropriate and prompt referral is to be aware of the risk signals of obstetric problems during pregnancy. Therefore, educating women about pregnancy danger signals is essential for safe parenthood [1].

The World Health Organisation (WHO) has estimated that 300 million women in poor countries suffer from both short- and long-term ailments as a result of issues with pregnancy. Around 529,000 mothers lose their lives to maternal causes each year, with the developing countries accounting for 99% of these deaths. Approximately 75% of mother deaths are attributed to direct obstetric complications, which include haemorrhage, sepsis, hypertensive disorders of pregnancy, obstructed and prolonged labour, and botched abortion [2,3].

If women and their families were to recognise obstetric warning signs and seek immediate medical assistance, they could significantly lower maternal morbidity and mortality. The most common pregnancy warning signs are excessive bleeding, swollen hands or cheeks, blurry vision, etc. If pregnant women were made more aware of the warning signs, it would be better to increase early detection of problems and reduce the delay in deciding to seek obstetric treatment. Therefore, women should get health information about pregnancy, including warning signs, when they visit an ANC clinic [4,5].

WHO advises that health services work with women, their families, and the larger community to provide them with appropriate and understandable information on the warning signs of pregnancy complications because any woman can experience them, as well as to make sure that everyone is aware of where to seek care in an emergency [3,4].

Despite the fact that emphasis is given by the national strategy to raise knowledge of obstetric danger signs little is known about the current level of knowledge in Himachal Pradesh. This study therefore aims to fill this gap by assessing the current status of knowledge of danger signs and symptoms during pregnancy among Antenatal mothers attending outpatient department of Civil hospital Sunni in Shimla, Himachal Pradesh.

Objectives of the Study

To evaluate the knowledge about the danger signs and symptoms during pregnancy among Antenatal mothers attending outpatient department of Civil hospital Sunni in Shimla, Himachal Pradesh.

Methodology

• Research Approach – Descriptive 

• Research Design – Hospital based cross-sectional survey design

• Setting of the study – OPD in Civil hospital Sunni in Shimla, Himachal Pradesh.

• Study duration – between January 2023- March 2023

• Study population – Antenatal Mothers came to OPD 

Sample Size

400 Antenatal Mothers assuming 50% mothers have adequate knowledge regarding danger signs and symptoms during pregnancy, 5% absolute error, 95% confidence level, and 5% non-response rate.

Sampling Technique – Convenience Sampling technique

Sampling Criteria

First five antenatal mothers who came to OPD were selected everyday till the completion of sample size after explaining the purpose of the study. Informed consent was taken from them and confidentiality of the selected participants was also maintained.

Inclusive Criteria

Antenatal mothers who were willing to participate in the study.

Exclusion Criteria

Antenatal mothers who were not willing to participate in the study

Description of Tool 

Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income, delivery pattern, ANC Checkup and many more.

Questionnaire

The questionnaire contains 20 structured knowledge related questions having three options (yes, no, don’t know). The participants have to choose right one. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as

 >80% (16-20)     = very good

60-79% (12-15)  = Good

41-59% (8-11)    = Fair

<40% (< 8)                           = poor

Validity of tool - by the experts in this field

Data collection by under the guidance of supervisors and Antenatal mothers were given 30 minutes time to complete that questionnaire and collected at the end of the prescribed time

Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage.

Present study was developed to evaluate the knowledge of danger signs and symptoms during pregnancy among Antenatal mothers attending outpatient department of Civil hospital Sunni in Shimla, Himachal Pradesh. A total of 400 antenatal Mothers came to OPD were selected after explaining the purpose of the study. Among the total mothers, maximum 201(50.25%) were having age between 26-30 years, educated up to Matric & Senior Secondary 165(41.25%), Hindu 376(94%), housewife 304(76%) and Multigravida 278 (69.5%).

In the present study 16% (64) antenatal mothers had very good knowledge (16-20 marks) towards danger signs and symptoms during pregnancy, 64 % (256) having good knowledge (12-15 marks), 19% (76) having fair knowledge (8-11 marks) and 1% (4) having poor knowledge (<8 marks).

One of the main causes of maternal death is delayed medical attention, which might be linked to ignorance of obstetric warning symptoms. The first crucial step in making an appropriate and prompt referral is to be aware of the risk signals of obstetric problems during pregnancy. The results of this study have revealed information on pregnant women's awareness of obstetric risk signs in the study area, which may be used to develop effective interventions and as a foundation for additional extensive research in other regions of the nation [5,6].

Our findings suggest that the few pregnant women in Himachal Pradesh who took part in this study had little knowledge of pregnancy danger symptoms. The fact that pregnant women were unaware of the warning indications of major health issues could have a negative impact on how well-prepared they were for pregnancy difficulties. The first delay in seeking medical attention is thought to be reduced if pregnant women and their families are aware of the risk indicators of obstetric problems. Therefore, efforts should be made to raise awareness of pregnancy hazard signals.

Table 1: Socio demographic characteristics of the participants

Lack of awareness of potential problems' warning signals and their presentation suggests that many pregnant women may not be familiar with their presentation and may mistake it for a typical pregnancy symptom. By enhancing access to health information and education through the creation of community outreach projects that specifically provide information on childbearing issues, particularly danger signs for obstetric complications, the delay in seeking appropriate healthcare due to ignorance of danger signs can be reduced. Individual women and their families should receive this information to encourage their cooperation when care is required. To help women who have limited access to health facilities, the creation of community-based programmes is particularly crucial. It will also help if other community members obtain education and eventually form a support network that can assist when complications arise. The effectiveness and relevance of the health education provided at the medical facility should be thoroughly examined [5-7].

Limitations of the study 

Due to the limited sample size and cross-sectional character of the current investigation, it was challenging 

Table 2: Knowledge about the danger signs during pregnancy among pregnant mothers

Table 3: Knowledge about danger signs during pregnancy 

Maximum =20 Minimum=6

to generalize the results. Future studies should concentrate on qualitative investigations with a bigger sample size, such as focus group interviews, to uncover the obstacles to learning about pregnancy warning indicators.

In general, this study showed that still few pregnant women were unaware of the warning signs of pregnancy. The health department and other partner organizations that work in the area of reproductive health should develop appropriate strategies, including the provision of targeted health education or provide information, education, and communication to pregnant mothers, in order to increase pregnant mothers' awareness and enable early detection of serious health problems during pregnancy. Given that they all bear the possibility of developing pregnancy-related problems, all women who visit an ANC clinic should be educated on the danger signs of pregnancy.

1. Hailu, M. et al. “Knowledge about obstetric danger signs among pregnant women in Aleta Wondo District, Sidama Zone, Southern Ethiopia.” Ethiopian Journal of Health Sciences, vol. 20, no. 1, Mar. 2010, pp. 25–32.

2. Bililign, N. et al. “Knowledge of obstetric danger signs and associated factors among reproductive age women in Raya Kobo district of Ethiopia: a community based cross-sectional study.” BMC Pregnancy and Childbirth, 2017, Article ID 70.

3. Mwilike, B. et al. “Knowledge of danger signs during pregnancy and subsequent healthcare seeking actions among women in urban Tanzania: a cross-sectional study.” BMC Pregnancy and Childbirth, 2018, Article ID 4.

4. World Health Organization. Counselling for maternal and newborn health care: A handbook for building skills. Geneva, 2013. Chapter 8, “Danger signs in pregnancy.” https:// www. ncbi. nlm. nih. gov/ books/ NBK304178/. Accessed 12 Apr. 2023.

5. Pregnancy birth baby. “Warning signs during pregnancy.” https:// www. pregnancybirthbaby. org. au/ warning-signs-during-pregnancy. Accessed 13 Apr. 2023.

6. HHMA. “Warning signs in pregnancy.” https:// hhma. org/ healthadvisor/ aha – dangpreg – wha/. Accessed 14 Apr. 2023.

7. Verywell Family. “Warning signs to watch for in pregnancy.” https://www.verywellfamily.com/warning-signs-to-watch-for-in-pregnancy-2759779. Accessed 14 Apr. 2023.