Background: All pregnant women by virtue of their pregnant status face some level of maternal risk. Data suggest that around 40% of all pregnant women have some complications. Therefore, present study aims to assess effectiveness of learning package on awareness regarding danger signs of pregnancy. Method: Pre experimental research design with Quantitative approach was applied to conduct the study. A sample of 120 antenatal women selected for the study through non probability purposive sampling technique.

Results: The mean pretest knowledge score was 13.52 ± 2.62, whereas mean posttest knowledge score was 24.52 ± 3.83. The post-test mean value knowledge score among antenatal women was significantly higher than the pretest knowledge score. The mean difference was 11 The paired student “t” test value was 33.67 which was significant at p=0.05 level. The findings revealed that there was no significant association between knowledge score with selected demographic variables of the antenatal women. Conclusion: Findings of our study strongly recommend the need for conducting learning program to increase the awareness regarding danger signs of pregnancy among antenatal women.

Pregnancy is stated as creative and productive stage in the life of women. This is a physiologically significant occurrence that requires special attention from the time of conception to the postnatal period. Although pregnancy is regarded as a normal physiological process at the reproductive age, improper pregnancy care might result in the mother's and child's death.[1] The health of women during their pregnancies, deliveries, and postpartum periods is referred to as maternal health. Despite significant advancements over the previous 20 years, over 295,000 women lost their lives during pregnancy and childbirth in 2017. In addition to indirect reasons including anaemia, malaria, and heart disease, the most frequent direct causes of maternal injury and death are excessive blood loss, infection, high blood pressure, botched abortion, and obstructed labour. [2]

Due to their pregnancy, all women are at some risk to their unborn child. According to data, about 40% of pregnant women experience some kind of difficulty. 15% of expectant mothers require obstetric treatment to address issues that could endanger the mother's or the child's life.[3] Because pregnancy issues might arise anytime, every woman should be aware of the warning symptoms that appear during her pregnancy. Vaginal bleeding, a strong headache, seizures, blurred vision, a high fever, swollen hands or cheeks, and decreased foetal activity are some of these warning indicators.[4] Maternal morbidity and mortality can be prevented and reduced in large part by women's capacity to recognize warning signs of risk and seek medical attention. Inadequate awareness of obstetric warning signs during pregnancy causes

delays in seeking or receiving professional care.[5]

Haleema M. et al (2019) found that about half 54.70% pregnant women were having adequate knowledge about warning signs of pregnancy. Awareness about bleeding per vagina as warning sign was found in 67.10%, excessive vomiting in 50%, blurring vision in 23.50% and convulsion was found as warning sign of pregnancy in 20% pregnant women.[6] According to Radhika K (2019) 62% of participants had poor knowledge, 26% had average knowledge, 10% had good knowledge regarding the selected warning signs during pregnancy. Least knowledge level 37.60% was observed in the area related to anemia. Only 37.8% participants knew about bleeding per vagina, 38.29% knew about unusual swelling, 40% knew about severe vomiting, 37.8

1. To assess the pretest and posttest level of knowledge regarding warning signs of pregnancy among antenatal women.
2. To develop, implement and evaluate the effectiveness of information booklet on knowledge regarding warning signs of pregnancy among antenatal women.
3. To find out the association between pretest level of knowledge regarding warning signs of pregnancy among antenatal women with selected socio-demographic variables.

Research approach: - Quantitative approach

Research Design: - Pre experimental research design (one group pre-test post-test). Research Setting: Study was conducted at Geetanjali Hospital Udaipur, Rajasthan. Population: - Study population comprised of antenatal woman attending antenatal OPDs at Geetanjali Medical College and Hospital (GMCH) Udaipur, Rajasthan.

Sampling technique and sample: 120 antenatal women attending antenatal OPDs at Geetanjali Hospital selected through non probability purposive sampling technique.

Research Tool: The tools used for the present study had two sections.

Section I: - Socio-demographic variables included 8 items such as age, educational status, occupation, monthly income, type of family, religion, area of residence, gestational age.

Section II: - Structured knowledge questionnaire consists of 30 questions to assess the level of knowledge regarding warning signs of pregnancy. The area included were general information, bleeding per vagina, severe vomiting, unusual swelling, high fever, decreased foetal movements, pallor and rupture of membrane.

The period of data collection was 4 weeks from 03.02.2020 to 28.02.2020. Formal administrative, permission was obtained from the concerned authorities. Researchers explained the nature and purpose of the study to the antenatal women. Oral consent was obtained from the antenatal women in the study before the data collection.

According to table 1, majority of antenatal women 58.34% were in the age group of 21-25 years, 23.33% were in the age group of below 20 years. With regard to educational status, majority of participants 66.67% had secondary education, 23.33% had graduation and above In connection with occupation, 81.67% antenatal women were homemakers while rest 18.33 were working woman. Regarding monthly family income 43.33% were earning between 5001 to 10000 rupees monthly and 28.34% were earning between rupees 10001 to 15000 monthly. 55% antenatal women were living with nuclear family and rest 45% were living with joint family. As per religion majority of antenatal women 60% were Hindus, 26.67% were Muslims and 13.33% were Christians. 60% of antenatal women were residing in urban areas while 40% were residing in rural areas. Regarding gestational age, 63.33% of antenatal women were in 8-12 weeks of gestation while 36.67% were in 13-24 weeks of gestation age. 

Table: 1. Distribution of samples according to socio demographic variables (N=120)

Fig1. Percentage distribution of pre-test and post-test level of awareness among antenatal women

Figure 1, revealed that majority of antenatal women 76.67 % had inadequate knowledge level and 23.33% had moderately adequate knowledge level. Nobody scored adequate knowledge

level in pretest. But in posttest majority 80% of antenatal women had adequate knowledge level and 20% had moderately adequate knowledge level.

Table-2 Comparison of mean pre-test and mean post-test score of Knowledge score in antenatal women(N=120)

Table 2 shows the comparison of pre – test and post – test scores of knowledge level among samples. The mean pre – test score is 13.52 and mean post –test score is 24.52, with mean difference is 11.00, the Paired ‘t’ test value was 33.67 was greater than table value at .05 level of significance. This shows that there is significant difference between the pretest and post-test level of knowledge regarding warning signs of pregnancy among antenatal women.

Table -3 Associations between pre-test scores of knowledges regarding warning signs of pregnancy among antenatal women with demographic variables

On the basis of table 3, there was no significant association found between the pretest knowledge score regarding danger signs of pregnancy among antenatal women with demographic variables like age, educational status, occupation, monthly income, type of family, religion, area of residence and gestational age.

Our study findings revealed that majority of antenatal women 76.67 % had inadequate knowledge level and 23.33% had moderately adequate knowledge level. Nobody scored adequate knowledge level in the pretest. Our result supported by Jamaat F et al (2015)[11], their cross sectional study also revealed that 50% of women were lacking in knowledge of pregnancy danger signs. Hymavthi K et al (2013) [12] found 46.6% participants had average knowledge, 43.3% had poor knowledge regarding warning signs of pregnancy. Nithya R et al (2017) [13] found that 49.2% pregnant woman had sufficient knowledge about danger signs during pregnancy in her study. Belal Ghada et al (2017) [14] and Patel BB et al (2016) [15] also revealed approximately similar findings regarding danger signs of pregnancy.

Our study revealed in post test, majority 80% of antenatal women had adequate knowledge level and 20% had moderately adequate knowledge level. Our study findings supported by Kamble SS (2024) [16] in which there was 58% participants had moderate and 40% had good knowledge level regarding management of minor ailments and danger signs danger signs during pregnancy. Akruti Ramoliya et al (2019) [10] also revealed enhancement of the knowledge level in the post test regarding warning signs of pregnancy among primi gravid mothers. There was enhancement in knowledge level in posttest due to learning package. The mean pre – test score is 13.52 and mean post –test score is 24.52, with mean difference is 11.00, the Paired ‘t’ test value was 33.67 was greater than table value at .05

level of significance. Randhava RK. Choudhary P. (2022) [17] discovered that the mean post- test knowledge score of primigravida mothers regarding warning signs of pregnancy was

24.11 higher than the mean pre-test knowledge score of 9.9. This difference was judged to be significant. Mishre P. Singh P (2023) [18] found that there was marked difference of 6 in post-test and pre test knowledge score on danger signs of pregnancy among primigravida women. The paired ‘t’ test value at 24.8, was very highly significant indicating effectiveness of structured teaching programme. Chaturvedi D., Kumar B. (2023) [19] also found effectiveness of information pamphlet on knowledge regarding pregnancy-related problems among primigravida women. Tak HK, Chaturvedi D (2022)20 also revealed similar findings while assessing effectiveness of learning package.

Our study also revealed that there is no significant association between pre-test level of knowledge regarding danger signs of pregnancy among antenatal women with demographic variables like age, educational status, occupation, monthly income, type of family, religion, area of residence and gestational age. Our study findings supported by Rimpi Devi (2019)[21]& Mahalingam G et al (2014)22, in which demographic variables were not significantly associated with the knowledge level regarding warning signs of pregnancy. There was contradictory findings revealed by Asferie WN et al (2022) & Bintabara D. et al (2017) in which almost all demographic variables were significantly associated with the knowledge level regarding warning signs of pregnancy.

Findings of our study strongly recommend the need for conducting learning program to increase the awareness regarding danger signs of pregnancy among antenatal women. Antenatal women are the future mothers and they will also feel responsible for their health during entire pregnancy period.

The small size (120) of the sample made it difficult to draw generalization. A structured questionnaire was used for data collection which restricts the amount of information that can be obtained from the respondents, only knowledge was assessed; no attempt was made to evaluate their attitudes.

Researcher had self-financed the present study.

The current study was carried out without any conflicts of interest.