Pregnant Women's Knowledge about Bleeding and The Adherence to Antenatal Visits

Physiological and psychological changes during pregnancy can run normally if the mother is able to adapt to these changes. If there is a failure to adapt or there are other factors that affect the health of the mother during pregnancy, complications will arise. One of the abnormal complications during pregnancy is bleeding. To determine the relationship between the knowledge of pregnant women in the third trimester of signs of bleeding during pregnancy with compliance with antenatal visits at the Cipayung District Health Center, East Jakarta. Using a quantitative study with a cross sectional approach to 30 third trimester pregnant women with a purposive sampling technique. Data analysis using Chi-Square. The study was conducted in October-November 2020. The research instrument used a questionnaire made by the researcher about signs of bleeding during pregnancy. The results showed that the characteristics of the respondents were mostly aged 20-35 years (93.3%), primigravida (56.7%), secondary education (60%), less knowledgeable (60%), and obedient to antenatal visits (76.7%). The results of the bivariate analysis obtained p-value=1,000. There is no significant relationship between the knowledge of pregnant women in the third trimester of signs of bleeding during pregnancy and compliance with antenatal visits at the Cipayung District Health Center, East Jakarta. With this research, it is hoped that health workers, especially nursing staff, can provide information on the importance of adherence to antenatal visits to prevent risks for pregnant women, especially related to bleeding.

According to WHO, pregnancy checks are carried out at least four times, namely one visit in the first trimester, one visit in the second trimester, and two visits in the third trimester (Tyastuti and Wahyuningsih, 2016) .
Based on the magnitude of the problem and the explanation above, researchers are interested in conducting research on the relationship between third trimester pregnant women's knowledge of signs of bleeding during pregnancy and compliance with antenatal visits.

METHOD
Quantitative research method to obtain an overview of the relationship between the two variables using a cross sectional approach on 30 third trimester pregnant women who made antenatal visits at the Cipayung District Health Center, East Jakarta in September-November 2020.
Using primary data through data collection using a questionnaire to measure knowledge about signs -signs of bleeding during pregnancy, totaling 15 questions in the form of a Google form created by the researcher himself with measuring results using the cut off point method good and poor knowledge.The questionnaire has been tested for validity and reliability on 34 pregnant women who live in DKI Jakarta.
Based on the results of the validity test, there were 8 questionnaires that were invalid, and these questionnaires had been revised and used in research.In the reliability test, the questionnaire was declared reliable with a Cronbach's alpha value = 0.640 > 0.600.The questionnaire is given in the form of a link to respondents via the WhatsApp chat application .
Primary data was also used to measure

RESULTS AND DISCUSSION
The normality test shows that the data is not  Another reason that allows mothers aged 20-35 to be more obedient in making visits is that in pregnancies aged more than 35 years, the quality of the female reproductive organs begins to decline.On Adlina (2020) said that women who reach the age of 35 years and over will have their fertility level slowly decrease, as time and age go by, the number of egg cells will decrease and their quality will also decrease.In line with research conducted by Erlina (2013) , the research showed that there was no significant relationship between knowledge and antenatal visits.And in research conducted by Wahyutri (2015) , it was also found that there was no relationship between knowledge and utilization of ANC services.However, this research is not in line with research conducted by Yanti and Ayu (2016) , Hasanah (2017) , and (Lestari (2018)) where in these three studies it was stated that knowledge is related to or can influence compliance with antenatal visits.
compliance with antenatal visits by respondents sending photos of the KIA book on the antenatal visit page to researchers via the WhatsApp chat application .Bivariate analysis used Chi-Square to see the relationship between respondent characteristics and third trimester pregnant women's knowledge about signs of bleeding during pregnancy and compliance with antenatal visits.The research was conducted in September-November 2020 at the Cipayung District Health Center, East Jakarta.This research has received ethical approval with number KEPK-PKKJ3/S.114/XI/2020from the Jakarta III Health Research Ethics Committee.
adhere to antenatal visits are dominated by those aged 20-35 years, primigravidas or mothers with their first pregnancy, and those with secondary education (junior high school and high school).The results of statistical tests showed that there was no relationship between age (p-value = 0.418), gravida (p-value = 1.000), and education (p-value = 0.193) with compliance with antenatal visits for pregnant women in the third trimester at the Cipayung District Health Center, Jakarta.East.Age characteristics that are not related to compliance with antenatal visits could be because the age of 20-35 years is the ideal age for the mother and fetus, so that in this age range women feel ready to get pregnant and carry out antenatal visits in accordance with existing regulations.In line with research conducted by Fitriani (2019) , it was said that pregnant women of productive age (20-35 years) were more compliant in attending antenatal visits.In research conducted by Yanti and Ayu (2016) , the study also stated that the highest number of pregnant women who had antenatal visits were aged 20 -35 years.Mothers aged less than 20 years or more than 35 years have a high risk to themselves and their pregnancy, so it is rare for mothers of that age to become pregnant and have antenatal visits.According to Affandi et al. (2014) , 20-35 years of age is the age that has the lowest risk for the mother and fetus.At the age of less than 20 years, female reproductive organs are not yet fully mature.According to Karjatin (2016) , teenage mothers are at high risk of contracting sexually transmitted diseases and HIV, and are at high risk of high blood pressure problems during pregnancy.Babies born to teenage mothers are also at high risk of premature birth or low birth weight babies.In Diananda's research journal , (2018) , it is said that at the age of < 20 years or can be called late adolescence, in this phase teenagers are often unrealistic, still looking for their identity, and are convinced that they are attractive to the opposite sex.In research conducted by Putro (2017) , it was said that the psychological characteristics of teenagers are that they are easily influenced and emotions usually increase.
Based on the theory of knowledge according to AnikLestari (2011)  in Herlina and Lutfi (2019) , knowledge is obtained from direct experience or other people.And according to Herlina and Lutfi (2019) , knowledge is the result of sensing an object, which is mostly obtained through the eyes and ears to shape a person's actions.The absence of a relationship between knowledge and compliance with antenatal visits may be due to the majority of respondents being pregnant women who have primigravida characteristics or mothers with first pregnancies and mothers with secondary education.Mothers with first pregnancies and secondary education may have less experience than mothers who have higher education, have previously been pregnant, and have had previous antenatal visits.In theory, it is also stated that knowledge is gained from experience, in the third trimester who had antenatal visits were aged 20-35 years, primigravidas or mothers with their first pregnancy, and had secondary education.Respondent characteristics including age, gravida, and education as well as knowledge of pregnant women in the third trimester about signs of bleeding during pregnancy have no relationship with the level of compliance with antenatal visits with a significance value of p>0.05.SUGGESTION The recommendation for future researchers is to carry out further studies regarding the behavior of pregnant women which is used to analyze pregnant women's knowledge about the signs of bleeding during pregnancy.Meanwhile, health workers, especially nurses, are expected to provide education about the importance of complying with antenatal visits in order to prevent risks for pregnant women, especially those related to bleeding.ACKNOWLEDGMENT The researcher would like to express his gratitude to the respondents who were willing to participate in this research, the Cipayung District Health Center, East Jakarta, who gave permission to conduct the research and provided the data needed by the researcher, as well as the supervisors and examiners who guided the researcher while conducting this research.

Table 1 .
Characteristics of Third Trimester Pregnant Women Respondents, Knowledge of Signs of Bleeding and Compliance with Antenatal Visits

Table 3 .
Relationship between Pregnant Women's Knowledge about Signs of Bleeding during Pregnancy and Compliance with Antenatal Visits