Mortality outcomes between pregnant women booked for antenatal care and unbooked pregnant women

BACKGROUND:
Perinatal fetal mortality and maternal mortality remains relatively high in Saudi Arabia. Antenatal care aims to improve outcomes; however, evidence to demonstrate its impact on outcomes in Saudi Arabia is lacking.


OBJECTIVES:
Investigate whether booking status for antenatal care impacted outcomes for pregnant women and identify outcomes that predicted booking status.


DESIGN:
Retrospective observational cohort study.


SETTINGS:
Tertiary care center


PATIENTS AND METHODS:
All Saudi women admitted to the labor or delivery units between January 2011 and December 2019 were included. Outcomes were compared between booked and unbooked women, and logistic regression was used to identify outcomes that predicted booking status, adjusted for age.


MAIN OUTCOME MEASURES:
Booked/unbooked status and perinatal mortality of Saudi women.


SAMPLE SIZE:
10 781 women; 9546 (88.5%) booked, (11.1%) 1192 unbooked.


RESULTS:

Unbooked mothers had higher incidences of meconium-stained liquor (
P
=.040), ruptured uterus (
P
=.017), and blood loss >1000 mL during cesarean deliveries (
P
=.003), but a lower episiotomy rate (
P
<.001). Perinatal fetal mortality and maternal mortality were equivalent between the two groups. Episiotomy, higher birth weight, higher mother age, perinatal death, delivery mode, onset of labor, and use of analgesics were all independent predictors of the mother being booked when adjusted for all outcomes and age.



CONCLUSIONS:
The rate of perinatal and maternal mortality in this cohort was relatively low and equivalent between booked and un-booked mothers, contrary to our expectations. More analysis of the socioeconomic data may explain this striking result.


LIMITATIONS:
Retrospective chart-review with incomplete data retrieval that affected the completeness of data retrieved. The results of the multivariate analysis cannot be used to infer causality because the study is observational.