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Knowledge of Antenatal Women regarding Pregnancy
Induced Hypertension
*Symborian Anita, M.Sc.(N)., M.A (Sociology)

Abstract
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

Introduction Sibai, 2012). Hypertensive disorders during pregnancy are

classified into 4 categories, as recommended by the National
Pregnancy and child birth is a normal physiological High Blood Pressure Education Program Working Group on
process with an expected and positive outcome. However, the High Blood Pressure in Pregnancy: 1) chronic hypertension,
process of carrying, labouring and delivering a baby has its 2) preeclampsia-eclampsia, 3) preeclampsia superimposed
own risks, for both the mother and the baby especially in on chronic hypertension, and 4) gestational hypertension
developing countries like India, which are well documented. (Barton, O'brien, Bergauer, Jacques, & Sibai, 2001).
Globally, preeclampsia and eclampsia account for 10 - 15 %
Globally almost all maternal deaths (99%) occur in of maternal deaths. The national incidence of Pregnancy
developing countries. More than half of these deaths occur in Induced Hypertension (PIH) is 15.2% in India and it is four
Subsaharan Africa and almost one third in South Asia. The times higher in primipara women than in multipara (Dutta,
maternal morbidity ratio in developing countries in 2016 was 2002). PIH is a life threatening condition during pregnancy
239 per 1, 00, 000 live births versus 12 per 1,00,000 live births which can cause premature delivery, intrauterine growth
in developed countries (World Health Organisation [WHO], retardation, abruptio placenta, intrauterine death and
2018). maternal mortality and morbidity.

The preeclamptic toxaemia and eclampsia is an Need for the Study

important cause of maternal deaths. The prevalence of
hypertensive disorders in pregnancy is 8-10% of all Hypertension is the most common medical condition
pregnancies in the population worldwide (Ghulmiyah & encountered in and complicates pregnancy, with significant

* Professor, Jagadguru Shankaracharya CON, Raipur Indian Journal of Continuing Nursing Education
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Knowledge of Antenatal Women regarding Pregnancy Induced Hypertension 110

implications on maternal and perinatal morbidity and Awareness regarding PIH and availability of easily
mortality (Karthikeyan & Lip, 2007). Preeclampsia places accessible and affordable health care services to all is
both mother and fetus at risk (Mammaro et al., 2009). important which shall be helpful in reducing the PIH related
Environmental factors such as exercise, infections, seasonal morbidity and mortality. Early diagnosis and treatment
variation, and socioeconomic factors have been proposed to through regular antenatal check-up is a key factor to prevent
influence pre-eclampsia risk (Trogstad, Magnus, & hypertensive disorders of pregnancy and its complications.
Stoltenberg, 2011). PIH can cause serious effects such as Therefore, it is the need of hour to test the knowledge of PIH
abruptio placentae, haematological disturbances in the in women and to educate on the management of hypertension
kidney, lungs, liver, and brain. Fetal manifestations may in pregnancy as well as maternal and child complications.
occur before, with, or in the absence of maternal
manifestations, and consist of oligohydramnios, Intrauterine Objectives
Growth Retardation (IUGR) (up to 30%), abnormal umbilical
artery doppler velocimetry, decreased fetal middle cerebral § To assess the knowledge of antenatal women regarding
artery resistance, an abnormal ductus venosus waveform, PIH
and/or stillbirth (Magee, Helewa, Moutquin, & Von § To find the association between the knowledge of
Dadelszen, 2008). In the fetus PIH can cause low birth antenatal women regarding PIH with selected socio-
weight, fetal hypoxia, intrauterine death and preterm demographic variables.
delivery. Pregnant women need to be aware of the warning
signs of PIH and seek medical help at the earliest (Dutta, Methods
2002). Early diagnosis and initiation of appropriate
intervention can significantly improve maternal survival. A cross sectional descriptive research design was used in
Nurses being the primary caregivers have immense the current study for assessment of knowledge regarding PIH
responsibility in improving the knowledge of the mother on among antenatal women. Antenatal OPD of a tertiary care
various problems associated with pregnancy. hospital in Chattisgarh was selected for the study. The target
population consisted pregnant women of age group 18-35
Preserving maternal health is one of the key component years. The sample for the present study comprised of 100
in Millennium Development Goals put forth by (WHO, pregnant women between the age of 18 to 35 years.
2011). Health maintenance is an important aspect of prenatal Convenient sampling method was used to select subjects into
care. Participation of the mother in her care ensures the the study. The structured interview questionnaire was
prompt reporting of the possible problems. Prenatal care is constructed and administered for assessing the knowledge
one of the models of primary and secondary prevention of regarding PIH among antenatal women.
disease. In order to reduce the increasing maternal mortality
rates, women with hypertensive disorders in pregnancy Instruments
should be informed of their disease and satisfactory medical
information should be provided by their health care The structured interview questionnaire had two sections.
providers. Developed countries have reduced maternal Section A consisted of socio demographic data and Section B
mortality not only by medical improvements, but also due to included the interview schedule consisting of 28 questions.
advanced general health, education, and social position of the The questionnaire was split into four parts: PIH and its
women. Making motherhood safe is essential to reduce the clinical features, risk factors, management and
maternal mortality and morbidity. This can be done by complications. Each correct answer was given a score of 1
various activities like providing quality care to the women and a wrong response was given score of 0. Content validity
during antenatal, intranatal and postnatal period, creating of tool was determined by eight experts for their opinion from
awareness regarding care during these periods. By keeping different specialties. Reliability of the tool was calculated and
this in mind, the investigator planned to assess the knowledge the reliability coefficient was 0.85.
of antenatal women regarding PIH and also to develop a
health education leaflet to improve the knowledge of After the pilot study, the data for the main study was
pregnant women. collected. Antenatal women who consented to participate

Indian Journal of Continuing Nursing Education

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Knowledge of Antenatal Women regarding Pregnancy Induced Hypertension 111

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 14%
interview 3 to 5 minutes were utilized to provide information Good
regarding PIH and the educational pamphlets were 55% Average
distributed. 31%
Poor

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
Figure 1. Knowledge of Antenatal Women regarding
knowledge and socio demographic variables.
Pregnancy Induced Hypertension

Results
hypertension. In the area of clinical features mean knowledge
With regards to the socio-demographic variables, 61% of score percentage was 32.3% and the mean knowledge score
pregnant women were in the age group of 24-29 years, 22% percentage was 29% for being aware of complications. The
were between 18-23 years and 17% were between 30-35 lowest mean knowledge score percentage was 19.4% in the
years old. In relation to education 59% were graduates and area of risk factors of PIH.
above, 32% had high school education, 6% were educated up
to middle school education, 2% had primary school education Question wise analysis of knowledge of antenatal
and only 1% were illiterate. Majority of the women (93%) women regarding PIH was assessed. Majority (53%) of
were house wife and 7% were employed. Fifty five percent of pregnant women knew about normal blood pressure and only
women expressed that they had monthly family income of 30% knew the meaning of PIH. In relation to risk factors of
Rs. 5000 - 10,000, 25% were in the monthly income category PIH, majority (34%) of pregnant women answered that
of 10,000 - 15,000, 15% of them had a monthly family hypertension before pregnancy is a risk factor of PIH and only
income of below 5000 and only 5% had monthly income of 10% knew that twin pregnancy can also be a risk factor of
15,000 and above. History of hypertension was evident in PIH. In relation to management of PIH , majority (73%) had
33% of the mother's families. PIH was present in family knowledge about regular blood pressure monitoring.
members in 43% of women. Among the subjects 51% were Regarding complications of PIH, 34% knew about fetal
primigravida and 49% were multigravida. complication such as intrauterine distress and 24% knew
about antepartum haemorrhage and seizures as maternal
The first objective was to assess the knowledge of complications of PIH.
antenatal women regarding PIH. Analysis of overall
knowledge scores regarding PIH depicted that 55% of The second objective was to find the association between
pregnant women had average knowledge regarding PIH, 31% the knowledge of antenatal women regarding PIH with
had poor knowledge, 14% had good knowledge selected socio-demographic variables.
(see Figure 1). The mean knowledge score was 9.89 ± 3.98
out of the total score of 28. This indicates that pregnant Analysis of association between knowledge of antenatal
women had poor knowledge regarding PIH. Similar results of women regarding PIH with socio demographic variables
poor awareness was also seen in 76.2% of pregnant women in revealed that there is a significant association between
an Iranian study (Ganjali, Sepehri, Amjadi, Bagheri, & knowledge and education (c2=27.54, p< 0.05), occupation
Davoodi, 2017). (c2=11.61, p< 0.05), family history of hypertension
(c2=6.32, p < 0.05), family history of pregnancy induced
Sub-scale analysis of knowledge regarding PIH was
hypertension (c2=12.52, p < 0.05) and parity ( c2=9.65, p <
assessed. In the area of management of PIH, mean knowledge
0.05). There was no significant association between
score percentage was 50.3% whereas the mean knowledge
knowledge with age and monthly income.
score percentage was 41.5% with regards to the meaning of

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Knowledge of Antenatal Women regarding Pregnancy Induced Hypertension 112

In a similar study conducted in Iran results showed Ganjali, M., Sepehri, Z., Amjadi, N., Bagheri, S., & Davoodi,
educational level and job had an impact on awareness of M. (2017). Knowledge, attitude and functioning
pregnant women (p < .05), while their awareness was not toward pregnancy induced hypertension in pregnant
associated with pregnancy, parity, age at pregnancy, history women referred to health centers in Zabol, 2014. Indian
of abortion, age group and source of information. Also, age Journal of Forensic Medicine & Toxicology, 11(2).
group, job, educational level, and source of information for Ghulmiyyah, L., & Sibai, B. (2012). Maternal mortality from
pregnant women was associated with their attitude (p < .05), preeclampsia/eclampsia. Seminars in Perinatology,
while no relationship was observed between attitude and 36(1), 56-59.
parity, age at pregnancy and history of abortion (Ganjali et
al., 2017). Karthikeyan, V. J., & Lip, G. H. (2007). Hypertension in
pregnancy: Pathophysiology and management
Women with PIH were at higher risk of adverse strategies. Current Pharmaceutical Design, 13(25),
pregnancy outcomes than those without. Poor knowledge of 2567-2579.
management of PIH and inadequate resources are a threat to Magee, L. A., Helewa, M., Moutquin, J. M., & Von
the proper management of PIH (Muti, Tshimanga, Notion, Dadelszen, P., (2008). Diagnosis, evaluation, and
Bangure, & Chonzi, 2015). management of the hypertensive disorders of
pregnancy. Journal of Obstetrics and Gynaecology
Conclusion Canada, 30(3) Supplement 1, S1-48.
Mammaro, A., Carrara, S., Cavaliere, A., Ermito, S.,
The study emphasises the importance of an education Dinatale, A., Pappalardo, E. M., ... & Pedata, R. (2009).
programme on PIH to the public especially pregnant women Hypertensive disorders of pregnancy. Journal of
to enable a reduction in complications of PIH. As an outcome Prenatal Medicine, 3(1), 1.
of this study a leaflet was prepared with the major
Muti, M., Tshimanga, M., Notion, G. T., Bangure, D., &
subheadings as causes, signs and symptoms, and
Chonzi, P. (2015). Prevalence of pregnancy induced
management of PIH. Nurses play not only the curative but
hypertension and pregnancy outcomes among women
also the preventive, promotive, and rehabilitative role.
seeking maternity services in Harare, Zimbabwe. BMC
Nurses working in obstetric departments can educate and
Cardiovascular Disorders. doi:10.1186/s12872-015-
provide information regarding PIH mainly the risk factors of
0110-5
PIH to antenatal women and their families, thus reducing
maternal mortality and morbidity rate. Trogstad, L., Magnus, P., & Stoltenberg, C. (2011). Pre-
eclampsia: Risk factors and causal models. Best
Conflicts of Interest: The author has declared no conflicts of Practice & Research Clinical Obstetrics &
interest. Gynaecology, 25(3), 329-342.
World health Organisation. (2011). Millenium development
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Indian Journal of Continuing Nursing Education

Vol. 19, No. (1), January - June 2018