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Research Article - (2022) Volume 30, Issue 2

Women's Knowledge about Danger Signs during Pregnancy, Delivery and After Delivery: A descriptive study.
Aymen Elsous1,2*, Dina El-Oka3, Fadwa Abo-Namos3, Amna Jnead3 and Eslam Abu-Ajwaa3
1Department of Medical Sciences, Israa University-Gaza, Palestine
2Ministry of Health, Unit of Planning and Institutional Performance Development, Palestine
3Department of Nursing, Israa University-Gaza, Palestine
*Correspondence: Aymen Elsous, Department of Medical Sciences, Israa University-Gaza, Palestine, Email:

Received: 26-Jan-2022, Manuscript No. IPQPC-22-12794; Editor assigned: 28-Jan-2022, Pre QC No. IPQPC-22-12794 (QC); Reviewed: 11-Feb-2022, QC No. IPQPC-22-12794; Revised: 16-Feb-2022, Manuscript No. IPQPC-22-12794 (R); Published: 23-Feb-2022, DOI: 10.36648/1479-1072.22.30.12-16


Background: Most causes of maternal and fetal deaths are avoidable and preventable if women are aware of obstetric danger signs. This study aimed to assess women knowledge about danger signs during pregnancy, delivery and after delivery in Gaza strip, Palestine.

Materials and methods: The study design was cross-sectional clinic-based study. An interviewed based questionnaire comprises two parts: socio-demographic, Obst/Gyn information and knowledge about obstetric danger signs during pregnancy, delivery and after delivery was administered to 150 women. Moreover, perception about danger signs and source of information were identified. Women were considered to have adequate/good knowledge if they mentioned at least three danger signs.

Results: 138 women participated. Mean age was 26.3 ± 6.1 years and 76.1% were married less for than 10 years. Three quarter (73.9%) had history of at least two deliveries. Women had adequate knowledge about obstetric danger signs during pregnancy, delivery and after delivery (82.6%, 71%, and 68.1% respectively). Common danger signs reported were in order: severe vaginal bleeding, severe headache, blurred vision and convulsion. One third of women relied on more than two source of information regarding danger signs and 90.6% thought that danger sings result in death.

Conclusion: Women have adequate knowledge about obstetric danger signs; however, it is quite less after delivery. Efforts should be made to target knowledge deficit about danger signs after delivery and to reduce stress resulted from these danger signs.


Maternal Health is one of the most important aspects of health care. It refers to the health of women during pregnancy, childbirth, and the postpartum periods [1]. Pregnancy is usually a major event in family’s life. It is a time of joyful for most families as they do expect coming of new life to earth. Pregnancy is a normal physiologic processing with many physiological changes happen that requires support, explanation and reassurance to help pregnant women to adapt and overcome such bad consequences like nausea, vomiting, shortness of breath, heartburn, dizziness, edema and backache. This physiological adaptation of the body to pregnancy is named ‘minor complaints’ of pregnancy. Although these complaints are low harm, they can be extremely distressing and cause significant anxiety.

Maternal mortality measures the quality of maternal health care in healthcare institutions. Most of maternal deaths, that develop during pregnancy, childbirth or post-delivery, are avoidable and treatable; however, it remains high especially in low and very low income countries [2]. About 830 women die from pregnancy or childbirth-related complications around the world every day. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care [3].

Many factors contribute to development of maternal complications. Kazaura, Kidanto and Massawe (2006) reported that parity, maternal age, race, smoking, birth weight, gestation age, labor complication, antenatal care, previous unfavorable outcomes such as still birth, neonatal deaths, maternal morbidity and poor socio- economic conditions are the most important risk factors influence maternal mortality [4]. More than 20% of women worldwide had been reported to have high-risk pregnancy. Furthermore, 50% of them are expected to die [5]. Teenagers have two to three times higher risk for mortality compared to younger mothers, because they have no physical and mental fitness in this respect [6].

According to International medical studies, 69% of maternal deaths in Gaza are avoidable. One of every fourth pregnant woman in Palestine is considered high-risk and requires specialized health care during pregnancy [7]. Maternal mortality ratio has dramatically increased between years. It was 30.8/100,000 live birth in 2019 compared to 19.1/100,000 live birth in 2018 with increasing rate 54.5% [8]. Most causes of deaths were pulmonary embolism (23.55) and septicemia (17.6%), whereas, 5.9% died at home.

Women awareness about obstetric danger signs, during pregnancy, childbirth and after delivery, is crucial for preventing such complications. Lack of awareness of most common danger signs and obstetric complications in pregnancy is one of the most important reasons of women failure to identify and to get facilities of health care and to reach emergency care before severe forms of obstetric complications are developed [9]. There is lack of studies investigating women awareness about obstetric danger signs in Palestine. Therefore, this study aimed to investigate knowledge of women about obstetric danger signs during pregnancy, childbirth and post-delivery in the Gaza strip, Palestine.


Study Design

This was a facility based cross-sectional design conducted between September and mid of Novemeber, 2020

Study Setting

The study was conducted at PHCs located in Gaza city and north Gaza governorates. They are 24 PHCs in which three PHCs were randomly selected. They were Al-Zaitoon, Al- Qoba, and Abo Shbak PHC.

Study Population, Sample Size And Sampling

The study population was women who attended the governmental primary health centers (PHCs) and had benefited from antenatal care services. Women should be married for at least one year preceding the study and aged from 18-45 years old. Number of beneficent women from the three mentioned clinics was 677, 468 and 505 women, respectively. Using the sample size formula for cross-sectional studies, 150 women were determined. A convenient sampling was approached and women were selected based on principle of the first comes the first one is interviewed.


An interview based questionnaire was developed after reviewing relevant literature [10-13]. The questionnaire consisted of two parts: the first part enclosed socio-demographic and pregnancy characteristics (age, duration of marriage, level of education, gravida, para,…), in addition to information related to health care facility. The second part comprised questions about knowledge about obstetric danger signs during pregnancy, childbirth and after delivery. Moreover, one question about source of information and perception about danger signs. The questionnaire showed adequate reliability measured by alpha cronbach (α=0.86), and validity (I-CVI > 0.89 and S-CVI = 0.90)

Ethical Considerations

This study was implemented to fulfill requirement of student’s graduation from department of nursing, faculty of medical sciences, Israa University – Gaza. Permission was obtained from the ministry of health to conduct the study in governmental PHC. Women were informed about study objectives and data collection was done in private room at the selected PHC. Voluntary participation and right to withdraw were ensured, and accordingly a consent was obtained. Data were collected by four well trained nursing students (4th level). The mean time for data collection was 20 minutes.

Data Analysis

Data were checked for accuracy, outliers and missing values. We used the SPSS software program version 22. Descriptive analysis was employed using the SPSS software version 21. Analysis of continuous variables (age, duration of marriage) were presented informs of mean and standard deviation, whereas, frequency and percentage were provided for categorical variables (level of education,..). Knowledge level was categorized as adequate or inadequate if they answered at least three correct danger signs.


Characteristics of Participated Women

One hundred thirty eight women participated with response rate reached 92%. Majority were between 24-32 years old (48.5%), married ≤ 10 years (76.1%), and nearly one fourth (26.8%) had university degree. Moreover, 86.2% had at least history of two pregnancies and 79% received anti-natal care (ANC) services, and 68.8% claimed they received health education (Table 1).

Table 1: Baseline Characteristics of Participated Women (n=138).

Variables n (%)
Age (M±SD: 26.3 ± 6.1) <24 yrs 52 (37.7)
24-32 yrs 67 (48.5)
≥ 33 yrs 19 (13.8)
Duration of marriage (M ± SD: 8 ± 6.4) ≤ 10 yrs 105(6.1)
≥ 10 yrs 33 (23.9)
Working status Yes 2 (1.4)
No 136 (98.6)
Education level Primary 12 (8.7)
Up to secondary 89 (64.5)
>University 37 (26.8)
Living status with family 46 (33.3)
Alone 92 (66.7)
Have you received information about maternity danger signs? Yes 95 (68.8)
No 43 (31.2)
Pregnancy times Once 19 (13.8)
Multi 119 (86.2)
Delivery times None 7 (5.1)
Once 29 (21.0)
Multi 102 (73.9)
Received ANC services? Yes 109 (79.0)
No 29 (21.0)
Previous health problem Yes 79 (57.2)
No 59 (42.8)
Distance from health center (M±SD: 16.7 ± 10.9) ≤ 15 min 84 (60.9)
>15 min 54 (39.1)
Do you think obstetric danger signs lead to death Yes 125 (90.6)
No 13 (9.4)

Knowledge About Obstetric Danger Signs During Pregnancy

Majority of women have adequate / good knowledge (114/138, 82.6%) compares to 24/138 (17.4%) have poor knowledge. Common danger signs reported are vaginal bleeding (71.4%), severe abdominal pain (71.4%) and severe headache (69.6%) (Table 2).

Table 2: Common Danger Signs during Pregnancy among Participant (n=138).

  Yes n (%) No n (%)
Vaginal bleeding 85(71.4) 34(28.6)
Severe headache 71(69.6) 48(30.4)
Blurred vision 57(47.9) 62(52.1)
Convulsion 31(26) 88(74)
Face & peripheral edema 60(50.4) 59(49.6)
High fever 67(56.3) 52(43.7)
Difficulty in breathing 51(42.8) 68(57.2)
Loss of conscious 42(35.3) 77(64.7)
Severe abdominal pain 85(71.4) 34(28.6)
Lower rapid fuels movement 35(29.4) 84(70.6)
Rupture of membrane without labor signs 43(36.1) 76(63.9)

Knowledge About Danger Signs During Delivery

Most of participated women (98/138, 71%) have good / adequate knowledge about danger signs during delivery. In return, 29% (40/138) have poor knowledge. Common danger signs reported are severe vaginal bleeding (87.1%), prolong labor >12 hrs (63.2%) and high grade fever (60.7%) (Table 3).

Table 3: Common Danger Signs reported during delivery (n=138).

  Yes n (%) No n(%)
Sever Vaginal Bleeding 102(87.1) 15(12.9)
Severe Headache 48(41) 69(59)
Convulsion 39(33.3) 78(66.7)
High Grade Fever 71(60.7) 46(39.3)
Loss of Consciousness 48(41) 69(59)
Prolong labor (>12h) 74(63.2) 43(36.8)
Placenta is not out (after 30 min from delivery) 51(43.6) 66(56.4)

Knowledge About Danger Signs After Delivery

Almost two thirds (94/138, 68.1%) have adequate knowledge about danger signs after delivery. Whereas, 31.9% (44/138) shows to have poor knowledge. Common danger signs reported are severe vaginal bleeding (96.6%) and high grade fever (77.1%) (Table 4).

Table 4: Common Danger Signs reported after delivery (n=138).

  Yes n (%) No n(%)
Severe Vaginal Bleeding 114(96.6) 4(3.4)
Severe Headache 47(40) 71(60)
Blurred Vision 39(33) 79(67)
Convulsions 24(20.3) 94(79.7)
Face & Hands Edema 31(26.3) 87(73.7)
High Grade Fever 91(77.1) 27(22.9)
Loss of Consciousness 43(36.4) 75(63.6)
Difficulty in Breathing 30(25.4) 88(74.6)
Bad Odor of Vaginal Secretion 48(40.7) 70(59.3)

Source of Information

Participated women relies on various sources for information regarding pregnancy and delivery. One third (32%) received information about danger signs from at least three sources (self-reading, education from health center and family especially mother and mother in law). Self-reading (15.9%) was the most source of information.

Perception About Danger Signs

Majority (125/138, 90%) believes that death would occur with obstetric danger signs, whereas, 13/138 (9.4%) do not.


Women health remains at the top priority of any health sector strategy and the challenge is keeping maternal mortality at low level. Reproductive health is mainly about maternal health and mortality. Many maternal deaths are preventable giving women are aware and knowledgeable about obstetric danger signs that could threaten their lives. Indeed, if women have lack of information and are not aware about obstetric danger signs during pregnancy, childbirth and postpartum they would delay the decision to seek healthcare when needed.

This study aimed to evaluate women knowledge about obstetric danger signs during pregnancy, childbirth and postpartum. Women belief that changes and complications associated with pregnancy are normal physiological responses of the body to pregnancy. Such belief would definitely results in low utilization of medical services, threaten women’ life, occurrence of irreversible complications and eventually death and rising of maternal mortality ratio.

Our findings revealed that women have adequate / good knowledge regarding danger signs during pregnancy, childbirth and postpartum. Our finding is much higher better than findings from Africa including Ethiopia, Tanzania and Somali state region of Ethiopia and Egypt and Asia including Jordan [14-18]. Differences could be attributed to many points: firstly, adequate knowledge was considered if women know at least three danger signs, whereas, other studies considered at least two danger signs. Secondly, high coverage and utilization of antenatal care services in which majority of women in the Gaza strip, Palestine have average of four times follow up during their pregnancies. Existence of health education programs at certain health facilities was also an assist. However, women revealed that the first source of information was self-learning and utilization of internet website. This is quite danger, unless provided by health facilities, because many internet sites content no valid information and may provide fake information. Therefore, there is a need to strengthen health education programs for women at reproductive age and enclose it as main point in the reproductive health strategy.

Vaginal bleeding was the most reported danger sign during pregnancy, childbirth and post-partum. This is consistent with findings from many countries worldwide [15,19-21]. High level of awareness could be attributed to many factors including literacy of participated women in which 90% have at least finished high secondary school education. Moreover, utilization of antenatal care and presence of education program at health facilities and easy access to internet. Furthermore, contribution of mother and/or mother in law in highlighting alarms from complications of pregnancy. Many studies have explained a link between antenatal care visits and facility delivery in which it is interpreted by increased obstetric awareness [22,23].

We found that 90% of women perceived danger signs result in death. This fear was found to be substantially high among women experienced childbirth [24]. As a source of speculation, many factors might contributed to this fear; more than half of the study sample had previous health problem related to pregnancy which increase their sensitivity to any problem rise from pregnancy. We think that fear-based messages around obstetric danger signs might help women with high fear and anxiety level, however, should be well prepared. Women should be communicated with an accurate description about danger signs that help them to determine signs in an emergency. Moreover, focus of the fear-based programs should focus on awareness and identifying danger signs as early as possible, and provide reassurance that healthcare workers are in place to help women. Thus, women feel safe, comfortable and trusts with the healthcare system even if sever complications happen.

This study has limitations: firstly, the cross-sectional design and its limitation for plausible cause effect link between independent and dependent variables. Secondly, Association between independent variables and knowledge to danger signs was not formulated. Factors associated with good / adequate knowledge were not studied.


In conclusion, women awareness about obstetric danger signs is substantially high and vaginal bleeding is the most frequent mentioned sign in the phase of pregnancy, childbirth and postpartum. Much focus should be given to health education programs at healthcare facilities especially to women after delivery. Perception about danger signs could be enhanced if information and communication, provided to women at reproductive age, is focused obstetric danger signs which in turn will help proper utilization of medical services when needed. Proper counseling giving to pregnant women to minimize fear associated with pregnancy complications within a strategy to improve reproductive health and reduce maternal mortality would be necessary.

Availability of Data

Data are available with corresponding author up on request.


The authors are grateful to women whom agreed to participate in the study and make it real.

Conflict of Interest

The authors declare that they have no competing of interest.

Authors Contributions

AE was responsible for study design. DE, FA, AJ and EA did data collection and data analysis. AE interpreted the data. DE, FA, AJ and EA equally wrote the first draft. AE did revise the first draft and made appropriate amendments. All authors agreed on the manuscript.


Citation: Elsous A (2022) Womenâ??s Knowledge about Danger Signs during Pregnancy, Delivery and After Delivery: A descriptive study. Qual Prim Care. 30.41795.

Copyright: © Elsous A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.