Antenatal care booking during pregnancy and its effect on maternal and fetal outcomes

Abstract

Aim: to evaluate the antenatal care booking during pregnancy and its effects on maternal and fetal outcomes. (in pre-eclamptic patients) Methods: This study was conducted to evaluate the importance of antenatal care booking on pre-eclampsia risk factors and its effect on maternal and fetal outcomes. It was carried on 150 pregnant women diagnosed with pre-eclampsia attending the Department of Obstetrics and Gynaecology. The included women were interviewed and Number of antenatal care visits was recorded. Blood pressure control, cardiotocography (CTG), ultrasonographic and Doppler evaluations and administration of methyldopa were also reported. INTRODUCTION AND RATIONALE Hypertension is a frequently encountered complication of pregnancy. It may predate a pregnancy or develop during the antenatal, intrapartum or post-partum course. In some cases it is associated with proteinuria, and this usually indicates a multi-system disease known as pre-eclampsia. Pre-eclampsia is a major cause of maternal and fetal mortality and morbidity. Its incidence ranges from 2-10%, depending on the population studied and definitions of pre-eclampsia. The National Institute for Clinical Excellence (NICE) guidelines on antenatal care has reduced the number of antenatal visits recommended for healthy woman at low risk. 2 As the randomized controlled trials on which this recommendation was based were never powered to identify important outcomes such as mortality, and as the failure to identify and act on known risk factors at booking contributes to deaths from pre-eclampsia, it is important to define risk at the beginning of pregnancy. The importance of antenatal care booking of risk factors for early onset pre-eclampsia has been greatly underestimated. Many risk factors that can be assessed at antenatal care booking including history (age, parity, previous pre-eclampsia, family history of pre-eclampsia, multiple pregnancy, and pre-existing medical conditions as; insulin dependent diabetes (IDDM), chronic hypertension, renal disease, autoimmune disease and antiphospholipid syndrome) and physical examination (body mass index (BMI), blood pressure, and proteinuria). This prospective study was carried out to reach an overall estimate for the importance of antenatal care booking of the risk of pre-eclampsia. This provides an evidence base from which healthcare professionals can assess each pregnant woman's risk of pre-eclampsia at her booking visit and tailor her antenatal care according to need. Methods: This study was conducted to evaluate the importance of antenatal care booking on pre-eclampsia risk factors and its effect on maternal and fetal outcomes. It was carried on 150 pregnant women diagnosed with pre-eclampsia attending the Department of Obstetrics and Gynaecology. The included women were interviewed and Number of antenatal care visits was recorded. Blood pressure control, cardiotocography (CTG), ultrasonographic and Doppler evaluations and administration of methyldopa were also reported. Results: There were significantly higher incidence rate and higher risk of postpartum hemorrhage, eclampsia and ICU admission among women with inadequate booking visits than among women with adequate booking visits. Overall, there was 12-folds higher risk of bad maternal outcome among women with inadequate booking visits than among women with adequate booking visits (P<0.0001). There were also significantly higher incidence rate and higher risk of bad fetal and neonatal mortality among women with inadequate booking visits than among women with adequate booking visits. Overall, there was 53-folds higher risk of bad fetal outcome among women with inadequate booking visits than among women with adequate booking visits (P<0.0001). Conclusions: The antenatal care booking visits during pregnancy have significant effects of on maternal and fetal outcomes among pre-eclamptic patients