Antenatal Care Utilization and Pregnancy Outcome in Women Undergoing Emergency Cesarean Section

Abstract

Objective: To assess the effect of antenatal care utilization on pregnancy outcomes in women undergoing emergency cesarean section. Methods: This was a retrospective comparative cohort conducted from January to December 2017 at the Department of Obstetrics and Gynaecology, Abbasi Shaheed Hospital, Karachi.. Women who underwent emergency cesarean section were included. Booking status was ascertained from previous antenatal slips. The primary outcome measure was pregnancy outcome, assessed by maternal and fetal parameters. Stay in the hospital for more 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 the Emergency cesarean section and were included. Out 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 section, 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

Keywords

• antenatal care
• cesarean section
• pregnancy outcomes.