Assessment of Nurses’ Knowledge about Management of Pregnancy with Danger Signs

Background: A well-equipped obstetrics unit, proper knowledge of danger signs, and the ability to take immediate action can help prevent maternal mortality. As the nurses being the primary health care providers, their preparedness for obstetrics emergencies attains paramount importance. Objective: the study aimed to assess nurses’ knowledge about management of pregnancy with danger signs and to find out relationship between these nurses’ knowledge and their specific demographic characteristics Methodology: A descriptive study design was carried to assess nurses’ knowledge. A non-probability (purposive sample) of (50) nurses working in the emergency room, labour room, and maternity care. The questionnaire is divided into two sections: demographic characteristics of the nurses and knowledge on how to manage danger signs in pregnant women. Results: The current study shows that nurses age mean (27.62±4) years in which the highest with age group 26-30 years, most of nurses was live in urban as seen with 92% of them.most of the study sample has a nursing schools education and have 1-5 year of experience Conclusions: nurses’ knowledge about management of pregnancy with danger signs was fair level of knowledge and there is no statistically significant association with demographic characteristics.


INTRODUCTION
Pregnant women should be on the lookout for any warning signs or symptoms that could jeopardize her pregnancy. The following are some obstetric danger symptoms (ODS): loss of consciousness, nausea and vomiting, severe chronic stomach pain, vaginal bleeding, puffiness of the face, fingers, and toes, blurred vision, menstrual problems, and severe recurrent frontal headaches (Agrawal, 2015). There is a risk of unanticipated, uncontrollable complications that could result in death or injury to the mother and/or child, all of which are linked to ODS and cannot be predicted. As a mother, you have a unique opportunity to establish positive habits and parenting skills in your child during pregnancy. As a result of this breakdown in continuity of care, both mothers and their newborns are affected. Premature membrane rupture, growth restriction in the fetus, oligohydramnios, and preterm labor are all possible outcomes of ODS, as are greater rates of cesarean delivery and higher rates of preterm labor (Terefe et al., 2020).
More than 70% of all maternal deaths are due to complications such as hemorrhage, infection, improper abortion, eclampsia, and obstructed labor, among other things. In addition to these major causes of maternal death, inadequate, inaccessible, expensive, or of poor quality care are other factors in maternal mortality (El-Nagar et al 2017).
Because difficulties can emerge at any time throughout pregnancy, every woman should be aware of the warning signals. Vaginal bleeding, severe headaches, visual issues, high temperature, swollen hands/face, and diminished fetal activity are all warning symptoms. It is common for these symptoms to signify an obstetric complication that could arise during or after childbirth. This information can help determine the best decisions and get the necessary medical attention. Maternal mortality and morbidity are reduced as a result of timely and adequate healthcare seeking activities. When pregnant women attend an ANC center, they should receive health education on pregnancy outcomes, warning signs and symptoms throughout pregnancy, nutrition, and family planning, among other services (Kearns et al., 2014).

METHOD
A descriptive study design was carried to assess nurses' knowledge about danger signs during pregnancy. A non-probability (purposive sample) of (50) of nurse who emergency words, labor room and maternal words.
A questionnaire was developed by researchers through review of related literature. The questionnaire consists of two parts for data collection includes the following: Part I: consists of the nurses' demographic variables (Age, Residence, education, and experience) Part II: concerning nurses' knowledge about managing danger signs in pregnant women (vaginal bleeding and its types, high blood pressure, severe headaches and blurred vision, severe abdominal pain, rapid or difficult breathing, urgency, pain or a burning feeling when urinating, and unusual or more than usual vaginal secretions).
Reliability is refers to an extent to which a questionnaire reports the same results on repeated time measure. Briefly it refers to consistent scores over times or raters (Bolarinwa, 2015).
The data was collected after getting the official approval from hospital, the researchers collects the information from statistic units at targeted about all nurse are working in emergency words, labor room and maternal words. After collecting the information, the researchers selects the subjects that meet inclusion criteria. The data were collected after getting permission from the subjects. Through the period from 1 st august 2021 to January 4 th 2022.
The three Likert scale was used for the purpose of items' rating for the three domains follows: (1) for never, (2) for sometimes, and (3) for always. SPSS version 26.0 is used to examine the data.and excel it include: data of this study analyzed descriptive by identifying the change and the percentage, frequency, standard deviation and mean of score. Also means determining the outcome. And Inferential Statistical Tests (Pearson Correlation Coefficient and Repeated Measure ANOVA).

RESULTS
The current study's findings were analysed using statistical methods, and the data were organised and interpreted. These findings are based on the replies of a sample of participants to a questionnaire.   9, 12, 13, 14, 16, 17, 18, 20, 21, 23, 24, and 25, poor level is seen among items 1, 2, 3, 5, 7, 8, 15, and 19. During post-test 1 and 2, the nurses demonstrate a high level of knowledge, as seen by high mean scores across the board. As can be seen from the data in this table, nurses were found to have a fair level of knowledge (36.56±2.771) prior to the test, but their knowledge improved to a good level in post-tests 1 and 2 (90 percent and 82%, respectively), as can be seen from the mean scores and standard deviations (post 1= 45.98±2.470, post 2= 45.20±3.188). Table 1 shows the results of a demographic study on nurses. The biggest percentage of nurses (MSD=27.624) are between the ages of 26 and 30. According to Beydag (2011), the bulk of the nurse midwives in his study (60.4 percent) were between the ages of 20 and 30 years old, which is in line with this conclusion. Nursing midwives are reported to have an average age of between (25-29) years, while the World Health Organization stated that the average age of nurses' midwives is between (25-29) years in places where competent care is given by the WHO. Nurse work on wards is less stressful than employment in emergency rooms for a variety of reasons, including the fact that there are more nurses in wards than emergency rooms at the majority of critical care hospitals, there are also more nurses in wards (WHO, 2006).

DISCUSSION
Abdalmajed (2018) study stated: 35.7% had a diploma (64.3%), and nearly half (47.6%) of participants had less than ten years of experience in their age range (20-30 years. A fair degree of knowledge (36.562.771) was demonstrated by nurses in 84 percent of instances, as shown in Table (3), in regards to managing pregnancies with danger signs.
Pre-test results showed that nurse-midwives had a low to fair grasp of danger signs, whereas posttest results showed that they had a fair to good comprehension (Kadhim & Ali, 2020). The general level of nurses' understanding of danger signs was found to be adequate by (Abdalmajed, 2018).
Before the intervention, the nurses, according to El Sharkawy et al., (2020) had a reasonable understanding of the nature of an obstetrical emergency, which was corroborated by the current study's findings.
Researchers believe that a decline in the number of nurses who are knowledgeable about danger signs can be attributed to several factors, including a lack of participation in researchrelated training programs by most of the nurses studied and a secondary nursing education for the majority of those nurses. Table (2) shows the mean scores for items assessing nurses' knowledge of treating pregnancy with danger symptoms; the results suggest that nurses have a low level of knowledge on several items (Nurses' knowledge of vaginal bleeding and its types). These findings back with Emam and Saber (2018) claim that maternity nurses' overall understanding of vaginal bleeding was lacking before the educational intervention was implemented.
El-Refaaey et al. (2020) confirmed the findings by stating that in the pre-test, most staff nurses lacked acceptable knowledge and only one-third had moderate understanding regarding the causes and management of vaginal bleeding.
According to the mean scores in table 2, there was a decent degree of knowledge among items (Nurses' understanding of high blood pressure) as well. According to Emam and Saber (2018) findings, nurses' awareness of hypertension during pregnancy was incomplete.

CONCLUSIONS
The current study found that nurses had a decent degree of knowledge about managing pregnancy with danger signals, and that there was no statistically significant relationship between nurses' knowledge of danger signs and demographic variables.

ETHICAL CONSIDERATIONS COMPLIANCE WITH ETHICAL GUIDELINES
The research ethics committee of the Baghdad University's College of Nursing approved this study. Management of hospital granted written authorization. In addition, all participant provided signed informed consent.

FUNDING
The researchers bear all the costs of the study and there is no support from a specific party.

Asala
Riyadhd Mohammed: review and editing. Methodology ; writing -review and editing; writing -original draft; writing -review and editing.

DISCLOSURE STATEMENT:
No conflicts of interference are rest declared by the authors. educational hospital on the early diagnosis of cervix cancer. Asian Pacific Journal of Cancer Prevention, 12 (2)