1. Most Common Factors Contributing with Risky Pregnancy in Ante-natal Clinics in Nablus in 2008 Name of students: Yusra Ahmad Osama Radwan Masouda Asayrah Yousef Mayaleh Supervised by: Dr. Adnan ASarhan -Dean of Nursing Miss:Mariam Altell Miss: Iman Al-shaweesh An-Najah National University Faculty of Nursing

2. Introduction This project about the Most Common Factors Contributing with risk pregnancy in ante-natal clinics in Nablus in 2008. Antenatal period is a very important period in women health life. The Palestinian women fight for their new babies, health care but they forget and ignore their right of health care and health promotion. Pregnancy is biologically,physiologically, and psychologically stressful,even for healthy women. For women with preexisting (pregestational) conditions such as substance abuse, diabetes, infection, and cardiac disease it may be life threatening. (Deweerd et al, 2002).

3. Methodology Purpose: The purposes of this study are: (1) To determine what are the most common factors that contributing with risky pregnancy in ante-natal clinics in Nablus in 2008. (2) To prevent and decrease the incidence of risky pregnancy in Nablus city. Study design This study is quantitative using descriptive design to describe variable relationships within the sample that affect high risky pregnancy.

4. Study question and hypotheses Study question What are the most common factors that contributing with risky pregnancy in Nablus city in 2008?. Hypotheses Hypotheses(1): The pregnant woman who had previous history of risky pregnancy,will be at increaser risk to have risky pregnancy at the present pregnancy. Hypotheses(2): Multiparty and previous caesarians are the most tow common factors that contributing with risky pregnancy in Nablus in 2008.

5. Setting of the study The study setting was done in Nablus city in Ante-natal Care clinics including governmental (Al-yasmeen &Balata Al- Balad) clinics,and UNRWA (Askar &Balata) clinics. Population of the study The target population is high risky pregnant mothers who visit Ante-natal Care clinics in Nablus city including governmental clincs (Al-yasmeen &Balata Al-Balad clinics) and UNRWA clinics (Balata &Askar clinics). The accessible population is (60) pregnant mothers who meet criteria, who actually have access to work and give approval, readiness and agreement to participate in the study and used as sample.

6. The sample The sample size is (60)pregnant mother who had risky pregnancy from four different clinics in Nablus city,who give approval to participate in the study, the sample taken was convenient sample. (15) risky pregnants were taken from each clinic, of the four clinics that is governmental (Al-yasmeen &Balata Al-Balad clinics) and UNRWA (Balata &Askar ) Care clinics in the days of our questionnaire distribution.

7. Study results

8. As we can see from the above tables, the normal range was about 28.33% while the over weight reached to 13.3%, obesity was the highest percentage which reached to 58.33%.

9. The study results indicates that there is a percent of 15% belong to moderate economic statues as represented by there monthly income of between" 1000- 2000 NIS". While the results also show that a percent of 35%, with monthly income of above" 2000 NIS". The highest percentage was for the low economic statue which represents about 50% of the study sample.

10. This table shows the more than 6 children were the highest with a percent of 58.33%, while 1-3 children holders were of a percentage of 33.33%. Moreover, the results show that holders of 4-6 children reached of a percentage of 8.33%.

11. We can see clearly from the above table that the most popular contraceptive method was of using the IUCD with a total percent of48.33% while pills came secondary with a percent of 26.67%. Needles came in the third rank with a percentage of 13.33% other contraceptive methods came in the final rank with percent of 11.67%.

12. The total of 46.67% of the study sample reported that the main person to encourage them to seek antenatal health care was themselves and this is the highest percentage. While 25.00% reported mother, husband 15.00% while the husband family played a percent of 13.33%as the main character that encourage them.

13. The percentage of risks related to medical and obstetrical history UTI

14. The percentage of Risks related to current pregnancy

15. Discussion

16. Obesity Obesity was the highest percentage which reached to 58.33%. The normal range of BMI was about 28.33% while the over weight reached to 13.3%. Obesity is referred to many factors such as: sedentary life style, diet, and it may relate to medical problems such as: hypothyroidism and psychological problems such as: binge eating disorder and night eating syndrome. The Palestinian women faced a stressful event in their life that create depression which consider the important risk factor to occurrence of obesity.

17. Economic statues The study results also indicates that there is a percent of 15% belong to moderate economic statues as represented by there monthly income of between 1000-2000 NIS. While the results also show that a percent of 35% with monthly income of above 2000 NIS. The highest percentage was for the low economic statues which represent about 50% of the study sample, with significant the P.value (0.02).

18. Number of deliveries The distribution of the study sample according to the variable of number of deliveries. The percent of number of deliveries more than 6 children was 58.3%. Which indicate that, the increase of multiparty, will increase the incidence for high risk pregnancy. Also multiparty has many complications, which include: premature labor, premature delivery, pregnancy-induced hypertension, toxemia, gestational diabetes, and vaginal- uterine hemorrhage. (Elster et al, 2000).

19. IUCD The percent of women that use IUCD is 48.3%.So the use of IUCD increase the incidence of high risk pregnancy and IUCD complications, which include infection of the uterus (pelvic infection), Internal damage to the uterus, Uterine perforation.

20. Encouragement to seek antenatal health care Although all the study participants are Muslims and have good support from their relatives, families, and friends. But the total of 46.67% of the study sample reported that the main person to encourage them to seek antenatal health care was themselves and this is the highest percentage. While 25.00% reported mother, husband 15.00% while the husband family played a percent of 13.33% as the main character that encourage them. We must focus to increase education for pregnant women them selves.

21. Problems related to previous pregnancy: The main risk factors of women of previous pregnancy and high risky pregnancy were found that UTI, previous cesarean, and previous toxemia were the most common factors. The percentages were respectively 56.7%, 51.7%, and 36.7%.

22. Previous pregnancy UTI 56.7%, Previous toxemia 36.7%. Previous cesarean 51.7%

23. Also when making comparison between UN and governmental clinics,the main risk factors of women of previous pregnancy and high risky pregnancy were found that UTI, previous caesarean, and previous toxemia in both types of clinics. A percent of 28.3% of the study sample have UTI in both types of clinics. While a percent of 31.0% of women who visit governmental clinics had previous caesarean. And large numbers of the women who visit UN clinics have previous toxaemia with a percent of 1.36%.

24. Problems related to current pregnancy Psychological problems, UTI, Anemia, and hypertension, are the most common factors which associated with current pregnancy and high risky pregnancy. The results were respectively: 63.3%, 56.7%, and 20.0 %.

25. Current pregnancy Psychological Problems 63.3%, Hypertension 20% Anemia 20% UTI 56.7%

26. There are many reasons that make the level of Psychological problems the highest one. The first reason is the rise of the hormones level that releases during pregnancy period. This rise affects the nervous system of the pregnant woman. The second one is symptoms and tiredness that are accompanied with the pregnancy period. Some of these symptoms are: nausea, vomiting, headache, and back pain. Other reason is associated with the stressful life that the Palestinian women face in their daily life including: financial, political, cultural, and social. Psychological problems

27. Anemia Anemia is the third risk factors of women of current pregnancy and high risky pregnancy. Anemia is referring to many reasons such as: poor nutritional status, rarely and not frequent iron intake during pregnancy period.

28. Recommendations 1.To emphasize in application of UNFPA guidelines &protocols for Obstetric and Newborn Care. 2.To encourage nurses and midwifery’s to increase teaching and education for pregnant woman in specific and women in all stages of their life. 3. To focus in different screening methods as: nutritional,blood, and mental. 4.To focus on women them self to increase their knowledge regard their health status.

29. Recommendation for Further Studies: Several studies should be done to focus on: 1. The relationship between psychological problems and having risky pregnancy. 2. The relationship between urinary tract infection (UTI) and pre- term labor. 3. The relationship between maternal smoking and pre-term labor. 4. The relationship between anemia and high risk pregnancy.