The influence of antenatal care on pregnancy outcome.

Analysis of medical records at the Ahmad Bello University Teaching Hospital in Zaria compared the effects of antenatal care in booked and unbooked women. 22,774 pregnancies resulted in 22,725 deliveries. Pregnancy complications were most prevalent in unbooked patients and included anemia, pregnancy-induced hypertension, malpresentation, and malposition of the fetal head. Lower incidence of cephalopelvic disproportion (CPD) occurred in booked teenage patients. Unbooked patients' operative delivery rate was 3 times greater; 6.4% of the booked patients and 18.2% of the unbooked patients had cesarean sections. Labor complications were higher among unbooked patients compared to unbooked patients. These complications include CPD (18.1%), prolonged labor (15.8%), retained placenta (12%), eclampsia (5.5%), pre- eclampsia (7.5%), and uterine rupture (2.6%). Excluding vaginal deliveries, occurrences of vesico-vaginal fistula were greater in unbooked patients. The maternal mortality rate for unbooked subjects was 24/1000 and 1/1000 for booked patients across all parity and age groups; thus, antenatal care is related to lowered maternal mortality. Furthermore, antenatal care has a positive effect on fetal outcome; perinatal mortality is 3 times less in booked patients. Higher perinatal rates are associated with home deliveries. Overall, the educated booked patients experienced reduced perinatal deaths (30/1000) and maternal mortality (2.5/1000 deliveries) compared to the uneducated unbooked patients (perinatal deaths=259/1000 and 28.9 maternal deaths/1000 deliveries); however, booking status had a greater positive influence than education as evident in a perinatal death rate of 44/1000 for uneducated booked patients compared to 169/1000 for uneducated unbooked subjects. It is suggested that traditional birth attendants be better trained and employed in the national primary health care organization.