Steroid concentrations in fluid from human ovarian antral follicles during pregnancy

1985 ◽  
Vol 107 (1) ◽  
pp. 133-136 ◽  
Author(s):  
L. Westergaard ◽  
K. P. McNatty ◽  
I. J. Christensen
Keyword(s):  
Pregnant Women ◽  
Granulosa Cells ◽  
Follicular Fluid ◽  
Ovarian Follicles ◽  
Progesterone Level ◽  
Third Trimester ◽  
Antral Follicles ◽  
Human Pregnancy ◽  
The Third ◽  
Flow Cytometric

ABSTRACT Steroid concentrations in fluid from 138 ovarian antral follicles obtained from 30 pregnant women were measured and compared with those in aspirates of 151 follicles of similar size (i.e. diameter 2–6 mm) from 61 non-pregnant women who had normal regular menstruations. The follicles were classified as healthy or atretic by flow cytometric DNA measurement of the granulosa cells contained in the follicular fluid aspirate. Nine (7%) of the follicles from pregnant women and 21 (14%) of those from non-pregnant women were healthy, and the remainder atretic (P>0·05). Androstenedione was the most abundant steroid in all follicles. Mean progesterone levels in follicular fluid from pregnant women were significantly (P<0·05) higher than in follicular fluid from non-pregnant women. In pregnant women progesterone levels were significantly (P<0·01) higher in fluid from healthy than from atretic follicles. In contrast, no significant differences in steroid concentrations were found between fluid from healthy and atretic follicles in non-pregnant women. We conclude that antral ovarian follicles may develop normally to a diameter of around 6 mm during the third trimester of human pregnancy. We also conclude that these follicles accumulate steroids in the follicular fluid in amounts which equal those found in follicles of similar size in the ovaries of non-pregnant women, but that the composition of intrafollicular steroids during pregnancy is modified towards higher concentration of progesterone. The reason for this increased intrafollicular progesterone level is unclear. J. Endocr. (1985) 107, 133–136

Activin A and follistatin are dynamically regulated during human pregnancy

1997 ◽  
Vol 152 (2) ◽  
pp. 167-174 ◽  
Author(s):  
T K Woodruff ◽  
P Sluss ◽  
E Wang ◽  
I Janssen ◽  
M S Mersol-Barg
Keyword(s):  
Pregnant Women ◽  
Binding Protein ◽  
First Trimester ◽  
Activin A ◽  
Maternal Serum ◽  
Third Trimester ◽  
Serum Samples ◽  
Biologically Relevant ◽  
Human Pregnancy ◽  
The Third

Abstract Activin A (βA–βA) and activin B (βB–βB) are related dimeric proteins that regulate numerous cellular activities. Activin activity is bioneutralized by follistatin, a specific and high-affinity binding protein. Recently, our group developed specific and sensitive enzyme-linked immunosorbent activin assays that do not detect either activin isoform when bound to follistatin, therefore, the assays are specific for biologically relevant ligands. Activin A is measurable in the serum of pregnant women (cross-sectional sample collection), while activin B is not detected in maternal serum. However, activin B is measurable in amniotic fluid and cord blood sera. The purpose of this study was to measure serum activin A, activin B, and follistatin prospectively in longitudinally collected samples during pregnancy. This study design offered observations of relative changes in serum hormone concentration with each person serving as an internal reference. Serum samples were collected bimonthly from seven pregnant women beginning within the second month of gestation, and up to, but not including, the onset of labor. Six of the seven women had normal labor and delivery. One patient required pitocin (an oxytocin agonist) for induction of labor which led to delivery. Activin A, activin B, total follistatin, free follistatin, human chorionic gonadotropin, estradiol, progesterone, FSH, and LH were measured in maternal serum samples using specific assays. Serum activin A levels increased in the final month of pregnancy in the six patients who delivered following normal labor (<0·78 ng/ml (first trimester) to 1–6 ng/ml (term)). Activin B was not detected in any serum sample (<0·78 pg/ml). Total serum follistatin (free follistatin, follistatin–activin, and follistatin–inhibin) increased 10- to 45-fold in the final month of pregnancy in four of the women undergoing normal labor (10 ng/ml (first trimester) to 100–450 ng/ml (final month)). Total follistatin was high and variable in two women throughout pregnancy. Total follistatin returned to basal serum concentration in three of the patients during the last 2 weeks of pregnancy. Free follistatin was detected throughout pregnancy (range <2–35 ng/ml). Free follistatin represented a small percentage of the total follistatin throughout the time of pregnancy and did not rise coincident with the rise in total follistatin. Serum activin A and activin B were not detected during the entire course of pregnancy in the one patient who did not have normal labor and total follistatin did not rise in the last trimester of pregnancy. Gonadotropin and steroid hormones were measured in all patients and were within normative ranges for human pregnancy (inclusive of the non-laboring patient). The results suggest that immunodetectable activin A is present in the third trimester of pregnant women who have normal onset labor. The total follistatin assay results suggest that follistatin–activin (or –inhibin) complexes are upregulated during the third trimester of pregnancy. Importantly, activin A production exceeds the binding capacity of circulating follistatin. Because binding protein free activin A is biologically active we conclude that the activin A detected in late pregnancy is biologically relevant. The findings are consistent with our hypothesis that activin A is an endocrine factor during the last trimester of human pregnancy and may be involved in normal labor. Journal of Endocrinology (1997) 152, 167–174

Prl, TSH, FSH, β-hCG and oestriol responses to repetitive (triple) LRH/TRH administration in the third trimester of human pregnancy

1984 ◽  
Vol 106 (3) ◽  
pp. 400-404 ◽  
Author(s):  
F. R. Pérez-López ◽  
J. Robert ◽  
J. Teijeiro
Keyword(s):  
Pregnant Women ◽  
Third Trimester ◽  
Single Bolus ◽  
Human Pregnancy ◽  
The Third ◽  
Β Hcg ◽  
Hormonal Levels

Abstract. The effects of repetitive administration of 50 μg of LRH and 100 μg of TRH in a single bolus at 0, 90 and 180 min on Prl, TSH, FSH, μ-hCG and oestriol were tested in 11 healthy pregnant women in their third trimester of pregnancy. Basal hormonal levels were in agreement with previous reports. The Prl and TSH peaks after each injection of LRH/TRH were similar for each hormone. No significant changes in serum FSH, β-hCG and oestriol were detected after repetitive administration of LRH/TRH. Thus, the responsiveness of lactotroph and thyrotroph cells to pulsatile stimulation with LRH/TRH is not altered during the last trimester of pregnancy, and FSH, β-hCG and oestriol levels remain constant during the period of sampling.

Features of the course and treatment of glaucoma during pregnancy

2020 ◽  
Vol 98 (3) ◽  
pp. 178-184
Author(s):  
T. V. Chernyakova ◽  
A. Yu. Brezhnev ◽  
I. R. Gazizova ◽  
A. V. Kuroyedov ◽  
A. V. Seleznev
Keyword(s):  
Pregnant Women ◽  
Laser Treatment ◽  
Progressive Disease ◽  
Clinical Course ◽  
The Other ◽  
Third Trimester ◽  
The Third ◽  
Chronic Progressive Disease ◽  
Hypotensive Therapy ◽  
Eye Pressure

In the review we have integrated all up-to-date knowledge concerning clinical course and treatment of glaucoma among pregnant women to help specialists choose a proper policy of treatment for such a complicated group of patients. Glaucoma is a chronic progressive disease. It rarely occurs among childbearing aged women. Nevertheless the probability to manage pregnant patients having glaucoma has been recently increasing. The situation is complicated by the fact that there are no recommendations on how to treat glaucoma among pregnant women. As we know, eye pressure is progressively going down from the first to the third trimester, so we often have to correct hypotensive therapy. Besides, it is necessary to take into account the effect of applied medicines on mother health and evaluate possible teratogenic complications for a fetus. The only medicine against glaucoma which belongs to category B according to FDA classification is brimonidine. Medicines of the other groups should be prescribed with care. Laser treatment or surgery may also be a relevant decision when monitoring patients who are planning pregnancy or just bearing a child. Such treatment should be also accompanied by medicines.

scholarly journals A systematic review and meta-analysis of prevalence of insomnia in the third trimester of pregnancy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nader Salari ◽  
Niloofar Darvishi ◽  
Behnam Khaledi-Paveh ◽  
Aliakbar Vaisi-Raygani ◽  
Rostam Jalali ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Meta Analysis ◽  
Physical And Mental Health ◽  
Third Trimester ◽  
Cross Sectional ◽  
The Third ◽  
Physical Problems ◽  
Meta Regression Analysis

Abstract Background Sleep disorders, which are among the foremost important medical care issues, are prevalent in pregnancy. The present study is a meta-analysis of the prevalence of insomnia in the third trimester of pregnancy. This study aims to systematically review the overall prevalence of insomnia in the third trimester of pregnancy through conducting a meta-analysis. Method The literature used in this meta-analysis for the topic discussed above were obtained through searching several databases, including SID, MagIran, IranDoc, Scopus, Embase, Web of Science (WoS), PubMed Science Direct and Google Scholar databases without time limitation until December 2020. Articles developed based on cross-sectional studies were included in the study. The heterogeneity of studies was investigated using the I2 index. Also, the possible effects of heterogeneity in the studied studies are investigated using meta-regression analysis. Result In 10 articles and 8798 participants aged between11–40, the overall prevalence of insomnia in the third trimester of pregnancy based on meta-analysis was 42.4% (95% CI: 32.9–52.5%). It was reported that as the sample size increases, the prevalence of insomnia in the third trimester of pregnancy increases. Conversely, as the year of research increases, the prevalence of insomnia in the third trimester of pregnancy decreases. Both of these differences were statistically significant (P < 0.05). Conclusion Insomnia was highly prevalent in the last trimester of pregnancy. Sleep disorders are neglected among pregnant women, and they are considered natural. While sleep disturbances can cause mental and physical problems in pregnant women, they can consequently cause problems for the fetus. As a result, maintaining the physical and mental health of pregnant mothers is very important. It is thus recommended that in addition to having regular visits during pregnancy, pregnant women should also be continuously monitored for sleep-related disorders.

The sFlt-1 to PlGF Ratio in Pregnant Women with Rheumatoid Arthritis: Impact of Disease Activity and Sulfasalazine Use

Rheumatology ◽  
2021 ◽  
Author(s):  
Rugina I Neuman ◽  
Hieronymus T W Smeele ◽  
A H Jan Danser ◽  
Radboud J E M Dolhain ◽  
Willy Visser
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Disease Activity ◽  
Pregnant Women ◽  
Gestational Age ◽  
Third Trimester ◽  
Low Disease Activity ◽  
The Third ◽  
Observational Prospective Cohort Study ◽  
Plgf Ratio

Abstract Objectives An elevated sFlt-1/PlGF-ratio has been validated as a significant predictor of preeclampsia, but has not been established in women with rheumatoid arthritis (RA). We explored whether the sFlt-1/PlGF-ratio could be altered due to disease activity in RA, and could be applied in this population to predict preeclampsia. Since sulfasalazine has been suggested to improve the angiogenic imbalance in preeclampsia, we also aimed to examine whether sulfasalazine could affect sFlt-1 or PlGF levels. Methods Making use of a nationwide, observational, prospective cohort study on pregnant women with RA, sFlt-1 and PlGF were measured in the third trimester. A total of 221 women, aged 21–42 years, were included, with a median gestational age of 30 + 3 weeks. Results No differences in sFlt-1 or PlGF were observed between women with high, intermediate or low disease activity (p= 0.07 and p= 0.41), whereas sFlt-1 and PlGF did not correlate with DAS28-CRP score (r=-0.01 and r=-0.05, respectively). Four (2%) women with a sFlt-1/PlGF-ratio ≤38 developed preeclampsia in comparison to three (43%) women with a ratio &gt; 38, corresponding to a negative predictive value of 98.1%. Sulfasalazine users (n = 57) did not show altered levels of sFlt-1 or PlGF in comparison to non-sulfasalazine users (n = 164, p= 0.91 and p= 0.11). Conclusion Our study shows that in pregnant women with RA, the sFlt-1/PlGF-ratio is not altered due to disease activity and a cut-off ≤38 can be used to exclude preeclampsia. Additionally, sulfasalazine use did not affect sFlt-1 or PlGF levels in this population.

scholarly journals Health anxiety and related factors among pregnant women during the COVID-19 pandemic: a cross-sectional study from Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Najmieh Saadati ◽  
Poorandokht Afshari ◽  
Hatam Boostani ◽  
Maryam Beheshtinasab ◽  
Parvin Abedi ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Health Care Providers ◽  
Health Anxiety ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Sectional Study ◽  
Third Trimester ◽  
Related Factors ◽  
Cross Sectional ◽  
The Third

Abstract Background The COVID-19 pandemic has affected many countries around the world and Iran was no exception. The aim of this study was to evaluate health anxiety of Iranian pregnant women during the COVID-19 pandemic. Methods In this cross-sectional study, 300 pregnant women in different trimesters (n = 100 in each trimester) were recruited. A demographic questionnaire and the Health Anxiety Questionnaire were used to collect data. Scores of < 27, 27–34 and more than 35 were defined as low, moderate and high health anxiety, respectively. Due to nationwide restrictions, data were collected through social media groups. Chi-square tests, ANOVA and multiple linear regression were used to analyze the data. Results Mean (SD) total anxiety scores were 22.3 ± 9.5, 24.6 ± 9.3 and 25.4 ± 10.6 in the first, second and third trimesters of pregnancy, respectively. 9, 13 and 21% of women had severe anxiety in the first, second and third trimesters of pregnancy, respectively. Women in the third trimester had significantly higher health anxiety scores than those in the first trimester (p = 0.045). Conclusion At the time of the COVID-19 pandemic, women in the second and third trimesters of pregnancy were more worried about consequences of disease, but total health anxiety scores were significantly higher among women in the third trimester of pregnancy. Health care providers should pay more attention to the mental health of pregnant women in times of crises such as the COVID-19 pandemic.

EFFECT OF ZINK TABLETS INTERVENTION IN ZINC DEFICIENCY OF TRIMESTER III PREGNANT WOMEN TOWARD WEIGHT AND BODY LENGTH OF NEWBORN

2021 ◽  
Vol 10 (2) ◽  
pp. 304-312
Author(s):  
Nurfadillah S ◽  
Wardihan Sinrang ◽  
Suryani As'ad ◽  
Muh. Nasrum Massi ◽  
Mardiana Ahmad ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnant Women ◽  
Zinc Deficiency ◽  
Birth Length ◽  
World Health ◽  
Third Trimester ◽  
Average Value ◽  
The Third ◽  
A Value ◽  
Zinc Levels

Background: According to 2018 World Health Organization (WHO) data globally, an estimated 17.3% of the population has inadequate zinc intake, with estimates ranging from 5.7% in Oceania to 7.6% in Europe, 9.6% in America and the Caribbean, highest in Africa (23.9%) and Asia (19.6%). Zinc is important for the function of a number of enzymes and growth hormones during pregnancy. In pregnant women, the relative zinc concentration decreases up to 35% due to the influence of hormonal changes and the transport of nutrients from mother to baby. Objectives: The purpose of this study was to identify the effect of giving zinc tablets to pregnant women with zinc deficiency in the third trimester on body weight and length of babies born at the Makassar City Health Center. Methods: This type of research is True Experimental with a pretest-posttest design with a control group. The sample in this study was 62 samples of third trimester pregnant women, and the sampling technique used was purposive sampling. Measurement of zinc levels in third trimester pregnant women using the Elisa reader kit at the Research Laboratory of the Hasanuddin University Teaching Hospital. The research instruments were in the form of a research explanation sheet, respondent's consent sheet, respondent's checklist sheet, and the mother's zinc tablet consumption control sheet for 14 days. Results: Judging from the average value of newborns in pregnant women who did not have zinc deficiency, the average value of birth weight in pregnant women with zinc deficiency was 15.70 g/dL and 18.95 g/dL. zinc deficiency with a value (p < 0.05), while pregnant women with zinc deficiency have an average birth length of 10.00 g/dL and mothers who do not have a deficiency of 19.87 g/dL with a value (p < 0.05). So, it can be concluded that giving zinc tablets to pregnant women in the third trimester has an effect on Birth Weight (BBL) and Birth Length (PBL). Conclusion: Giving zinc tablets has an effect on increasing zinc levels in third trimester zinc deficiency pregnant women and increasing birth weight and length of the baby.  

MENGURANGI KECEMASAN PADA MASA KEHAMILAN TM III DENGAN METODE ACCUPRESSURE DEPRESSION POINTS

2021 ◽  
Vol 13 (02) ◽  
pp. 172
Author(s):  
Dyah Ayu Wulandari ◽  
Meika Jaya Rockhmana ◽  
Adelina Cahyaningrum
Keyword(s):  
Sleep Quality ◽  
Pregnant Women ◽  
Psychological Adaptation ◽  
The Body ◽  
Wilcoxon Test ◽  
P Value ◽  
Third Trimester ◽  
Purposive Sampling ◽  
The Third

ABSTRAKAdaptasi fisik dan psikis kehamilan trimester III secara fisiologis dapat menimbulkan kecemasan ibu hamil. Adanya kecemasan pada ibu hamil trimester III dapat menyebabkan komplikasi ibu dan janin saat kehamilan, persalinan bahkan nifas. Terapi acupressure merupakan natural terapi dengan cara menekan acupoint  untuk merelaksasi tubuh, melancarkan sirkulasi darah serta memberikan rasa tenang dan nyaman. Acupoint KID 27 dan CV 17 adalah titik yang berhubungan dengan kecemasan, agitasi, penyimpangan kelenjar tiroid, keseimbangan tubuh dan pusat jantung. Penekanan pada titik ini menyeimbangkan kadar hormon tiroid dan mengatasi gangguan kecemasan. Tujuan penelitian mengetahui pengaruh acupressure depression points terhadap kecemasan ibu hamil trimester III. Metode: Jenis penelitian kuantitatif dengan metode penelitian pre-experimental One Group Pretest-Posttest Design. Penelitian dilakukan Bulan Februari-Agustus 2021. Populasi penelitian ibu hamil trimester III yang melakukan ANC bulan Juni 2021 dengan keluhan kecemasan. Sampel penelitian 22 ibu hamil trimester III dengan teknik purposive sampling. Instrumen penelitian menggunakan kuesioner PRAQ-R2. Analisa data univariat dan bivariat (Uji Wilcoxon) Hasil: Hasil analisa statistik dengan uji Wilcoxon diperoleh nilai P-value 0,000 pada tingkat kecemasan. Kesimpulan: Acupressure depression points berpengaruh terhadap tingkat kecemasan ibu hamil trimester III di Semarang.Kata kunci: kecemasan, ibu hamil trimester IIIREDUCE ANXIETY IN PREGNANT MOTHER TRIMESTER III WITH ACCUPRESSURE DEPRESSION POINTS METHODABSTRACTPhysical and psychological adaptation of the third trimester of pregnancy can physiologically cause anxiety for pregnant women. The existence of anxiety in third trimester pregnant women can affect the quality of sleep which causes maternal and fetal complications during pregnancy, delivery and even postpartum. Acupressure therapy is a natural therapy by pressing the acupoints to relax the body, improve blood circulation and provide a sense of calm and comfort. Acupoints KID 27 and CV 17 are points associated with anxiety, agitation, thyroid disorders, body balance and heart centers. Emphasis on this point balances thyroid hormone levels and treats anxiety disorders thereby improving sleep quality. Objective: to determine the effect of acupressure depression points on the level of anxiety and sleep quality of pregnant women in the third trimester. Methods: This type of research is quantitative with pre-experimental research method One Group Pretest-Posttest Design. The study was conducted in February-August 2021. The study population was pregnant women in the third trimester who performed ANC in June 2021 with complaints of anxiety. The study sample was 22 pregnant women in the third trimester with purposive sampling technique. The research instrument used the PRAQ-R2. Analysis of univariate and bivariate data (Wilcoxon test) Results: The results of statistical analysis using the Wilcoxon test obtained a P-value of 0.000 on anxiety levels. Conclusion: Acupressure depression points have an effect on the level of anxiety of pregnant women in the third trimester at Semarang.Keyword: Anxiety, Pregnant Women In The Third Trimester

Trends in Heart Rate and Heart Rate Variability during Pregnancy and Three Months Postpartum: Continuous Monitoring in a Free-Living Context (Preprint)

2021 ◽  
Author(s):  
Fatemeh Sarhaddi ◽  
Iman Azimi ◽  
Anna Axelin ◽  
Hannakaisa Niela-Vilen ◽  
Pasi Liljeberg ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Pregnant Women ◽  
Time Domain ◽  
Second Trimester ◽  
Third Trimester ◽  
Non Invasive ◽  
The Third ◽  
Invasive Method ◽  
Frequency Power

BACKGROUND Heart rate variability (HRV) is a non-invasive method reflecting autonomic nervous system (ANS) regulations. Altered HRV is associated with adverse mental or physical health complications. ANS also has a central role in physiological adaption during pregnancy causing normal changes in HRV. OBJECTIVE Assessing trends in heart rate (HR) and HRV parameters as a non-invasive method for remote maternal health monitoring during pregnancy and three months postpartum. METHODS Fifty-eight pregnant women were monitored using an Internet-of-Things (IoT)-based remote monitoring system during pregnancy and 3-months postpartum. Pregnant women were asked to continuously wear Gear sport smartwatch to monitor their HR and HRV. In addition, a cross-platform mobile application was utilized for collecting pregnancy-related information. The trends of HR and HRV parameters were extracted using reliable data. We also analyzed the trends of normalized HRV parameters based on HR to remove the effect of HR changes on HRV trends. Finally, we exploited hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters. RESULTS HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P<.01). Time-domain HRV parameters, average normal interbeat intervals (AVNN), standard deviation of normal interbeat intervals (SDNN), root mean square of the successive difference of normal interbeat intervals (RMSSD), normalized SDNN (nSDNN), and normalized RMSSD (nRMSSD) decreased significantly during the second trimester (P<.001) then increased significantly during the third trimester (P<.01). Some of the frequency domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF (nHF) decreased significantly during the second trimester (P<.01), and HF increased significantly during the third trimester (P<.01). In the postpartum period, nRMSSD decreased (P<.05), and the LF to HF ratio (LF/HF) increased significantly (P<.01). CONCLUSIONS Our study showed that HR increased and HRV parameters decreased as the pregnancy proceeded, and the values returned to normal after the delivery. Moreover, our results show that HR started to decrease while time-domain HRV parameters and HF started to increase during the third trimester. Our results also demonstrate the possibility of continuous HRV monitoring in everyday life settings.

Tingkat Kecemasan Ibu Hamil Trimester III dalam Menghadapi Persalinan

2021 ◽  
Vol 3 (1) ◽  
pp. 18-24
Author(s):  
Nilda Yulita Siregar ◽  
Cici Fitrayanti Kias ◽  
Nurfatimah Nurfatimah ◽  
Fransisca Noya ◽  
Lisda Widianti Longgupa ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Preterm Labor ◽  
Community Health Center ◽  
Sampling Technique ◽  
Descriptive Study ◽  
Age Group ◽  
Third Trimester ◽  
Pregnancy And Childbirth ◽  
The Third ◽  
Fear And Anxiety

Introduction: Fear and anxiety during pregnancy and childbirth can cause problems such as preterm labor and low birth weight. Purpose: The purpose of this study was to determine the level of anxiety of third-trimester pregnant women in dealing with labor. Methods: This type of research is a descriptive study and analyzed with frequency distribution. The population was all pregnant women in the third trimester who were in the working area of ​​the Mapane Community Health Center with a total of 37 people. The sampling technique used total sampling. The results showed that only 8.1% of pregnant women experienced mild anxiety, while 91.9% did not experience anxiety. pregnant women who experience mild anxiety are 20% in the risk age group, 20% with diploma education, 11.5% in mothers who do not work, 60% in primigravidas, and 15.8% in mothers who do not get support from their husbands. Anxiety occurs mostly in primigravida because it is the first experience of pregnancy. It suggested for village midwives providing information about pregnancy and childbirth, especially for primigravida mothers, and involving their husbands in posyandu activities for pregnant women.

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