COMPARISON OF MATERNAL AND FETAL OUTCOMES BETWEEN BOOKED AND UNBOOKED PREGNANT WOMEN DELIVERING AT A TERTIARY CARE HOSPITAL: A COMPARATIVE CROSS-SECTIONAL STUDY

Abstract

Background: Adequate antenatal care is essential for early identification and management of pregnancy-related complications. However, unbooked pregnancies remain common in developing countries and are associated with poor maternal and neonatal outcomes. This study compared maternal and fetal outcomes between booked and unbooked pregnant women delivering at a tertiary care hospital.

Methods: This hospital-based comparative cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, POF Hospital, Wah Cantt, from January 2025 to January 2026. A total of 500 pregnant women (250 booked and 250 unbooked) with singleton pregnancies of ≥28 weeks' gestation were enrolled using consecutive sampling. Maternal demographic characteristics, obstetric variables, maternal complications, and neonatal outcomes were recorded using a structured proforma. Data were analyzed using IBM SPSS Statistics version 26. Continuous variables were compared using the independent-samples t-test, categorical variables using the Chi-square test, and binary logistic regression was performed to identify independent predictors of adverse outcomes. A p-value <0.05 was considered statistically significant.

Results: Unbooked women had significantly lower mean hemoglobin levels at admission than booked women (p<0.001). Postpartum hemorrhage (11.2% vs. 4.0%; p=0.003) and ICU admission (5.6% vs. 1.2%; p=0.006) were significantly more frequent among unbooked women. Neonates born to unbooked mothers had higher rates of low birth weight (32.8% vs. 15.2%; p<0.001), NICU admission (24.4% vs. 9.6%; p<0.001), birth asphyxia, and stillbirth. Logistic regression demonstrated that unbooked pregnancy was independently associated with increased odds of postpartum hemorrhage, ICU admission, low birth weight, and NICU admission.

Conclusion: Unbooked pregnancy is associated with significantly poorer maternal and neonatal outcomes compared with booked pregnancy. Strengthening antenatal care services, promoting early pregnancy registration, and improving access to quality maternal healthcare may substantially reduce preventable maternal and neonatal morbidity.