Exploration of Information Needs for 3rd Trimester Pregnant Women with Severe Preeclampsia at Banyumas Hospital

Background: Preeclampsia is a munciton characterized by high blood pressure during pregnancy, with symploms such as body weling, especially in the face and hands, a sudden increase in blood pressure, and high protein levels in the une, several rise factors can increase the Molhood of developing preeclampsia/eclampsia at an individual level including a history of chronic hypertension, obesity, and severe anemia. Liteacy of the pregnant women can influence their behavior toward preventing severe preeclampsis Providing information is expected to enhance knowledge and reduce anxiety among pregnant woment. Methods: This study aims to explore the information needs of tri-mester pregnant women with severe preeclampsia at Banyumas Hospital. This qualitative exploratory study used interview methods. The subjects were 10 pregnant women with severe preeclampsia at Banyumas Hospital, selected through purposive sampling. The data analysis involved qualitative techniques, including data reduction prosentation, and conclusion. Results: The research results show that most informants (8 women) are adults (aged 26-45). Their educational level is primarily high school (SMA), with 8 individuals Moat are housewives (fi individuals), and 9 have more than one child or are mutparous. Conclutions: Overall, all informants require information to support their pregnancy up to the delivery process, such as education on understanding severe preeclampsia, managing atuty and fear of preeclampsia risks, and being aware of matomal health.


INTRODUCTION
Reducing maternal mortality is still a priority health problem in the world.In the 2015-2030 Sustainable Development Goals (SDGs), the maternal mortality rate is one of the targets in third place in the health sector in Indonesia [1].The SDGs target reducing the ratio of Maternal Mortality Rate (MMR) to less than 70 per 100,000 live births by 2030.The ratio of maternal mortality rates in developing countries is very high, it is estimated that 415 maternal deaths per 100,000 live births and is 40 times higher than the mortality rate in Europe.Globally, in 2017 it was estimated that the maternal mortality ratio was 211 deaths per 100,000 live births [2].
Maternal mortality in Indonesia is still quite high, this incident is caused by disturbances during pregnancy or during childbirth.Some of the causes of maternal death include hypertensive disorders 33.07%, ISSN: 2808-1021 Proceedings homepage: https://conferenceproceedings.ump.ac.id/index.php/pshms/issue/view/30 2 obstetric bleeding 27.03%, non-obstetric complications 15.7%, obstetric complications 12.04%, infections 6.06% and other causes 4.81%.[3] Awareness of the occurrence of severe preeclampsia, of course, starts within the mother/prospective mother which cannot be separated from the mother's level of knowledge about the dangers of severe preeclampsia which creates attitudes, and results in the practice of mothers to take preventive measures for severe preeclampsia.With the provision of information is expected to increase knowledge in pregnant women.Knowledge of pregnant women can influence the behavior of preventing severe preeclampsia.Previous research conducted by [4] suggested that pregnant women's knowledge regarding the prevention of severe preeclampsia is still lacking, this is caused by several factors such as the age of pregnant women who are classified as young adults so they do not know about prevention of severe preeclampsia, the second factor that influences knowledge is the education of pregnant women where in this study the average education of pregnant women is secondary education where there is still a lack of knowledge of pregnant women regarding preeclampsia and another factor is that pregnant women have never received information regarding the prevention of severe preeclampsia.In addition, according to [5], providing information to pregnant women can reduce the level of maternal anxiety so that signs of preeclampsia symptoms are known as early as possible so that deaths from severe preeclampsia can be reduced.
Providing insufficient information to pregnant women regarding preeclampsia needs more attention.Most pregnant women in society are not aware of the signs of severe preeclampsia such as swelling of the legs, headaches, weight gain.These signs are considered as normal problems experienced by pregnant women, if left unchecked the impact is fatal which can result in death of the fetus or endanger the health of the mother.A remote environment far from health facilities makes many pregnant women less aware of the importance of prenatal care or called ANC (Antenatal care).Another thing that exists in Banyumas Hospital is the lack of health workers providing information to pregnant women due to the fast examination period and the large number of patients.Pregnant women need to get information about preeclampsia, with this information it is hoped that pregnant women can take the right prevention and attitude so that there is a decrease in mortality.Facts about the delivery process during pregnancy can cause various complications for pregnant women who are about to go into labor so that pregnant women need information about delivery when carrying out ANC (Antenatal care) examinations.
Provision of appropriate information can reduce the emergence of psychosocial factors such as ignorance about pregnancy in pregnant women which can cause complications during pregnancy and even death.The task of health workers as counselors is very important in providing information such as matters relating to health and health services needed by pregnant women.Pregnant women also need to be given education about proper behavior during pregnancy [6].According to research conducted by [7] there is an effect of providing information in the form of health education on knowledge about preeclampsia in pregnant women.According to her, the provision of information in the form of health education and counseling related to pregnancy with severe preeclampsia can build a mother's psychological condition and is expected to help the mother from the start of her pregnancy to organize her feelings, thoughts, strength to accept, maintain her pregnancy so that she can give birth smoothly.
Banyumas Hospital is one of the regional general hospitals which is a referral center for the Banyumas area and its surroundings.The Banyumas Hospital also has a special polyclinic for pregnant women which provides services in the form of providing information, counseling, health education and other health checks.The results of a preliminary study at Banyumas Hospital based on medical record data obtained data on the number of patients with severe preeclampsia from January to September 2022 in total 208 patients.
Based on the background above, the purpose of this research is to explore the information needs of third trimester pregnant women with severe preeclampsia at Banyumas Hospital.

RESEARCH METHOD
This research was a qualitative exploratory with in-depth interview method.Sample used was pregnant women with severe preeclampsia at the Banyumas Hospital, totaling 10 informants with purposive sampling method.The inclusion of sample criteria in this study were pregnant women who had just been diagnosed with severe preeclampsia at the Banyumas Hospital and the exclusion criteria were pregnant women in labor, pregnant women with speech disorders / unable to speak or refused to become informants.The analysis was qualitative data analysis, which consists of three activity processes, namely data reduction, data presentation and drawing conclusions.The instruments used were interviews and documentation.

ISSN: 2808-1021
Proceedings homepage: https://conferenceproceedings.ump.ac.id/index.php/pshms/issue/view/303 The questions asked in the interview was 10 questions and were grouped according to the group of informants.The interview process is carried out at the Banyumas Hospital and if the required data is not yet met, then the researchers did a follow-up interview.The research time until the presentation of the results was carried out by the researchers from May to July 2023.The researchers carried out this research based on recommendations from the Health Research Ethics Committee at Banyumas Hospital number: 240/KEPK-RSUDBMS/IV/2023.Based on table 4.1, can be seen that almost all of the informants were in the adult age range of 26-45 years as many as 8 people with the highest education level being High school graduate as many as 8 people.The employment status of most of the informants was not working/housewives (IRT) as many as 6 people.Most of the informants had more than 1 child or multiparas of 9 people.According to data obtained in table 4.2, most informants do not understand the signs, symptoms and dangers of preeclampsia.Lack of understanding results in concerns about the condition of pregnancy and the labor process.

DISCUSSION
Informants in this study were third trimester pregnant women who experienced preeclampsia at Banyumas Hospital, totaling 10 people.Based on table 4.1 it stated that the highest number of informants is the adult age range (26-45 years) of 8 informants.The results of this study are in line with previous research by Dewi (2018), concerning "factors related to the incidence of preeclampsia at Dr M. Yunus Bengkulu Hospital", where in a study conducted on 96 informants, it was found that most of the informants were in the age group 25-35 years as many as 73 informants 76.8%.According to him, pregnant women aged 20-35 years are the ideal age for an adult woman to undergo a pregnancy.With this, it is hoped that these women can have a good picture of knowledge about preeclampsia as an effort to prevent and manage the risk of preeclampsia during pregnancy.
The majority of informants in this study had a high school/equivalent education level of 8 people.The results of this study are in line with previous research by Karlina (2020), regarding "the level of knowledge of pregnant women about preeclampsia at Puskesmas II South Denpasar", where in a study conducted on 96 informants, it was found that most of the informants had high school education as many as 42 informants 43.8%.Education level is highly correlated with one's knowledge.Someone will tend to have better knowledge along with the higher level of education.People who have higher education will more easily accept the information provided so that it will affect changes in attitudes in their daily lives.Mothers who have a higher level of education have maturity.In addition, mothers who are more mature are better able to manage their fear of matters related to pregnancy and childbirth and try to find information about what is needed in pregnancy Emha, Hapsari, & Lismediati (2017) Most of the mothers in this study had the status of working as housewives (IRT) as many as 6 people and the remaining 4 people working in private companies.", where in a study conducted on 39 informants, it was found that most of the informants worked as housewives as many as 32 informants 82.1%.This research is supported by Astuti (2015) which shows that the variable mother's work is the majority in both groups, namely 90% in the case group and 80% in the control group occurs in mothers who do not work but in her research the p ISSN: 2808-1021 Proceedings homepage: https://conferenceproceedings.ump.ac.id/index.php/pshms/issue/view/305 value was 0.166 which stated that there was no significant relationship between employment status and the incidence of preeclampsia.
In the parity category, most of the informants in this study had more than one child / multiparas of 9 people.This is in line with previous research conducted by Fatmawati (2017), concerning "the effect of maternal health status on the degree of preeclampsia/eclampsia in Gresik Regency", where in a study conducted on 77 informants, it was found that the majority had multiparous children, 44 informants 57.1 %.According to Winkjosastro (2012) the multiparity of the endometrial environment around the implantation site is imperfect and not ready to accept the products of conception, so that the provision of nutrition and oxygenation to the products of conception is imperfect and results in the growth of the products of conception being disrupted so that it can increase the risk of preeclampsia.

CONCLUSION AND RECOMMENDATION
Based on the description of the results and discussion in the previous chapter, it can be concluded that the majority of informants used in this study were aged between 26-45 years, namely 8 people with the educational level of most of them being high school graduates.The employment status of most of the informants is not working/housewife (IRT) as many as 6 people.Most of the informants had more than 1 child or were multipara, totaling 9 people.
Third trimester pregnant women with severe preeclampsia at Banyumas Hospital realize that they need information to support their pregnancy and delivery, including education regarding the meaning of severe preeclampsia, symptoms, dangers and treatment.Apart from the impact it can have on mothers regarding feelings of fear and anxiety, the involvement of health workers such as doctors, nurses and midwives is very necessary because they can provide information related to pregnancy.Fulfilling information needs can increase health awareness and be better prepared to face pregnancy, so that mothers avoid feelings of anxiety and things that can make mothers afraid of the condition of the mother and fetus.
The results of this research hopefully can be used as additional input and resources for future researchers, especially regarding third trimester pregnant women with severe preeclampsia.Researchers also suggest to use more varied number of variables and larger number of samples for further research.

Table 2 .
Themes, categories and coding related to the information needs of pregnant women with severe preeclampsia Proceedings homepage: https://conferenceproceedings.ump.ac.id/index.php/pshms/issue/view/30