Outcomes in Unbooked Pregnancies Managed in a Tertiary Hospital in Nnewi, Nigeria
Abstract:
Background: Non-utilization of antenatal care continued to be the leading cause of maternal death among women of reproductive age arising from complications of pregnancy and childbirth. However, in view of the prevailing maternal and perinatal mortality situation in Nigeria, it is imperative to periodically determine and appraise the relationship between the antenatal status of mothers and their respective maternal and fetal outcomes.
Objectives: This was to compare the socio-demographical characteristics, obstetrics complications and fetal outcomes in unbooked and booked pregnancies.
Methods: This retrospective cross-sectional comparative study involved the case files of the unbooked and booked pregnant women who delivered singleton, in labor ward or referred after delivery at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria, between January 1st, 2020 and June 30th, 2020. The information obtained from the case files were socio-demographic data such as the age and parity including the maternal and perinatal outcomes. The data obtained were compared with the booked using statistical package SPSS version 26. The significant independent risk factors and correlates, for maternal complications and poor perinatal outcome were identified using binary logistic regression to control for the confounding variables.
Results: The total number of deliveries within the period under review was 434, out of which 152 were unbooked; hence the prevalence of unbooked cases was 35.0%. Of these 434 deliveries, only 341 case notes were retrieved from the record department. A greater proportion of the teenage patients (<20years) were unbooked as compared with those in the age of 20-34years and ≥ 35years (75% vs. 35% and 32% respectively; P=0.220) although not statistically significant. There was a significant proportion of grandmultiparous women who were unbooked compared with the nulliparous and the multiparous (50% vs. 41.1% and 29.5% respectively; P-value 0.025). The most frequent maternal complications observed were severe pre-eclampsia/eclampsia (39.7%) and obstetric hemorrhage (24.6%). The chance of the unbooked patients developing maternal complication was noted to be about 5 times that of the booked patients.
Conclusion: This study reappraises the significance of appropriate antenatal care and delivery towards reducing maternal and perinatal mortality in Nigeria. Booking should also be made more women friendly and women that are unable to afford the cost of antenatal care could be treated as indigent and offered free services where necessary. A further study will be needed in this group of women to determine any physical, economic and cultural barriers to antenatal care, which this retrospective case control study was unable to elucidate.
