Abstract
Objective: To assess the effect of antenatal care utilization on pregnancy outcomes in women undergoing emergency cesarean section. Method: This was a retrospective study conducted from January to December 2017. Women who underwent emergency cesarean section were included. Booking status was ascertained from previous antenatal slips. Primary outcome measure was pregnancy outcome, assessed by maternal and fetal parameters. Stay in hospital greater than 4 days and maternal death were maternal outcomes, whereas neonatal ICU admission and death were fetal outcomes. Results: During the study period, 419 women were delivered by Emergency cesarean section and were included. Of these 419 women, 300 (71.6%) were unbooked. Post cesarean, 284 (67.8%) women stayed for four or more days in the hospital and 16 (3.8%) women died. After cesarean 87 (20.8%) babies were shifted to neonatal ICU, whereas 91 (21.7%) of the delivered babies died. However, the maternal outcomes (stay of 4 days and above, p˂0.001 and maternal death, p=0.045) were significantly worse in unbooked women. Moreover the fetal outcomes were also poor in the unbooked population (NICU admission, p=0.004 and death p=0.010) as compared to booked women. Conclusion: Suboptimal antenatal care utilization continues to be an area of concern in Pakistan. Women may need an emergency delivery any time by cesarean section; all efforts must be made to ensure antenatal care is optimized so that high risk women and those with medical comorbidities do not suffer a suboptimal outcome. A policy that ensures attendance and utilization of antenatal care by all pregnant women is the need of the hour.
Highlights
Antenatal care provides an excellent opportunity to assess the health of pregnant women and their unborn fetuses before childbirth
The complications are higher for patients who receive less than optimal prenatal care
Facility delivery reduces intrapartum complications, but the effect of suboptimal antenatal care remains evident in situations where the parturient requires cesarean delivery [4]
Summary
Antenatal care provides an excellent opportunity to assess the health of pregnant women and their unborn fetuses before childbirth. It is utilized for screening congenital abnormalities, dating the pregnancy accurately, and triaging women with risk factors like medical disorders who may need special arrangements during pregnancy and labor [1]. Cesarean section is a major abdominal surgery performed when a vaginal birth is considered dangerous for mother, baby, or both In modern obstetrics, it holds a special place and has rendered childbirth in tricky life-threatening situations safer [2]. It holds a special place and has rendered childbirth in tricky life-threatening situations safer [2] As it is major surgery it is not devoid of complications. Women from low and middle-income countries are more likely to underutilize
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