الفهرس 
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Abstract
Summary
There are risks and concerns associated with advanced
maternal age. All expectant women will experience
complications during their pregnancy. Such as high blood
pressure, gestational diabetes, preterm labor, miscarriage,
placental abruption, placenta previa, low-birth weight baby,
higher caesarean rate, higher chance of maternal death,
stillbirth, ectopic pregnancy and birth defects, (Fouad,
2003).
Many studies have shown the roughly 30% of
admission and about 40-50% of death of occurring in
pediatric hospitals are accounted for children with genetic
disorder or congenital malformation almost all this
problems due to about 41.3% for advanced maternal age
high risk pregnancy, (Gomaa, 2007).
Aim of the Study
The aim of the study was to evaluate the effect of
counseling program for advanced maternal age’s mothers
during antepartum period in rural areas through:
1) Assessing the needs of advanced maternal
regarding their knowledge and practices during
antepartum period.
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2) Developing and implementing the counseling
program according to their needs.
3) Evaluating the outcomes of counseling program
on mothers and fetus health.
Hypotheses:
1- Counseling program will improve advanced
maternal age knowledge and practices related to
antepartum care.
2- Counseling program will improve the mother &
fetus health.
Subjects and Methods
Research design:
A quasi experimental design was conducted for this
study.
Setting:
The study was conducted in the Maternal and Child
Health Center of El Sahal Al kably (from nine Maternal
and Child Health Centers in health administration of
Baltim).
Subjects:
The purposive sample was used in this study. The total
number of Maternal and Child Health Center of Baltim are
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181
nine centers. One center was selected randomly. The total
number of advanced maternal age newly attending to
Maternal and Child Health Center in (El Sahal Al Kably)
was 178 the previous year 2010 half of them were chosen
randomly (89 advanced maternal age mothers) according to
inclusion criteria: only advanced maternal age (from 35&
more), at 1st trimester of pregnancy and free from chronic
diseases.
Technical design:
Tools of data collection:
Two tools were used for data collection
1st tool: An interviewing questionnaire to assess:
1- Socio-demographic data
2- Advanced maternal age mothers’ knowledge and
practices related to antepartum care in rural areas.
2nd tool: Record review to collect data about antepartum
care (first, second and third trimaster):
a– Initial visit may include diagnosis of pregnancy,
determine the follow up and establishing the data base
such as
History such as family history, menstrual history,
obstetrical and gynecological history …etc..
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182
Physical examination through general examination,
local abdominal examination and local vaginal
examination, (appendix I).
b - Subsequent antenatal visits monitoring:
Mothers measurements such as blood pressure,
complete blood analysis, urine tested, weight, height,
measuring body mass index (BMI).
Danger sings height of uterine fundus above the
symphsis pubis and position, consistency, effacement and
dilation of the cervix (late in pregnancy).
Fetus such as fetal heart rate, size of fetus, amount of
amniotic fluid, fetal activity (fetal movement), presenting
part and station (late in pregnancy), (Nour, 2001),
(appendix I).
The counseling program for advanced maternal age’s
mothers prepared and implemented by researcher in rural
areas.
This program covered all aspects of counseling for
advanced maternal age’s mothers.
The assessment of advanced maternal age’s mother’s
knowledge and practices in relation to the
identification of high risk pregnancy and counseling of
advanced maternal age’s mothers were carried out
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183
through using the constructed questionnaire. The
questionnaire covered the basic knowledge &practices
in relation to counseling advanced maternal age’s
mothers.
Results:
The result of this study have shown the following
regarding High Risk Pregnancy: Counseling Program for
Advanced Maternal Age’s Mothers During Antepartum in
Rural Areas.
Minority of advanced maternal age’s mothers had a
good total knowledge about anatomy & physiology of
reproductive system, normal change & warning signs
and hygiene in preprogram it was improved to
majority in post program while, decreased to 85.7%,
89.3% and 76.2% in follow up respectively.
As regards advanced maternal age’s mothers had
minority of a good total knowledge about nutrition of
pregnancy, exercises and immunizations in
preprogram, increased to 92.9%, 72.6% and97.6% in
post program while, decreased to72.6%, 64.3% and
84.5% in follow up respectively.
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Statistical differences were found between pre& post
program and pre& follow up of program statistically
high significant in total knowledge of anatomy&
physiology of reproductive system, normal change&
warning signs, hygiene, nutrition of pregnancy,
exercises and immunizations respectively.
Regarding complete total practices as stated it was
found that 14.3%, 0.0%(no one) and 16.7%of the
sample done complete their total practices as meal
intake, physical exercise and dental care respectively
in preprogram, increased to 57.1%, 70.2% and 77.4%
in post program while, decreased to 29.8%27.4%
and57.1% in follow up respectively.
Also the results indicated that, 0.0%(no one)and 1.2%
of the sample done complete their practices as breast
care and perineum car in preprogram, improved to
65.5% and 84.5% after taking counseling program
while, decreased to 28.6% and 60.7% in follow up
respectively.
The differences between pre& post program and pre
&follow up of program statistically high significant in
total practices of meal in take, physical exercise,
prenatal care, breast care, perineum care .
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185
Conclusion
from the result of the present study it was concluded
that the knowledge and practices of mothers’ study sample
were inadequate pre-counseling program and increased
after counseling program implementation while decreased
in follow up. This was proved by the presence of statistical
significant difference between pre & post-program and pre
&follow up of program. This difference high significant in
total knowledge and total practices.
The advanced maternal age’s mothers may be more
need & continuous awareness counseling about A.M.A.’s
mothers and high risk pregnancy in order to improve
mother health and outcome pregnancy (fetus).
Based on the results of study the community health
nurses could recommend
Health counseling programs through mass media as
T.V. must be directed to advanced maternal age’s mothers
for encouraging them to counseling & seek antenatal care
for:
o Early appearance of high risk pregnancy and
complications.
o Early identification of warning signs and medical care
at proper time.
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o Improving advanced maternal age’s mothers over all
well- being, appropriate treatment and reproductive
health through the provision of prophylaxis
immunization, iron &folic supplementation ….etc. to
maintain reproductive health.
o Increase all women’s awareness about preconception
& appropriate health because preconception advice is
often neglected. Preconception care for advanced
maternal age mothers will prepare her for the role will
soon under take in pregnancy or care prior to ceasing
use of contraception.
o For new graduates and community health nurses in
such M.C.H. center a counseling program regarding
risks of advanced maternal age’s mothers, modern
program assessment, appropriate nursing counseling
& intervention as well as using the new technology in
counseling fields should be implemented.