Impact of Early and Delayed Antenatal Registration on Outcome of Pregnancy among Postnatal Mother in Selected Maternity Hospital

Ms Supriya Chinchpure

Lecturer, Sadhu Vaswani College of Nursing, 10/10-1, Koregaon Road, Pune 411001

*Corresponding Author Email: supriyachinchpure@gmail.com

ABSTRACT:

BACKGROUND: Pregnancy, labor and birth of a child are important milestones in a couple’s life. Regular medical care, knowledge of your choices, and understanding the unknown event during pregnancy can make childbirth an extremely enriching and joyful event. Antenatal care is the clinical assessment of mother and fetus during pregnancy, for the purpose of obtaining the best possible outcome for the mother and the child.

The purpose of ANC is to prevent or identify and treat conditions that may threaten the health of the fetus and the mother, and to help a woman approach pregnancy and birth as positive experience.

All pregnancies and deliveries are at risk. However, there are certain categories of pregnancies where the mother, the fetus or the neonate in state of increased jeopardy. About 20 to 30 percent pregnancies belong to this category. If we desire to improve obstetric results, this group must be identified and given extra care. Even with adequate antenatal care, this small group is responsible for 70 to 80 percent of perinatal mortality and morbidity.

Delayed access to antenatal care is linked to maternal deaths and morbidity. Social deprivation also accounts for much maternal and child ill health, which national health data showing the access and utilization of the care by groups of women who differ by ethnicity, age and socio economic status. The knowledge of pregnant women regarding antenatal care and their compliance to it is of paramount importance in preventing maternal and infant mortality rate and morbidity.

The Indian society is made of large number of socio–culturally diverse groups. Their views of antenatal care and the health care system in general, may be different. The disparity of their knowledge and practice has to be assessed for improving the delivery of such services to these groups. Research can also help us to compare the levels of knowledge and practice of Primigravida and multiparas. This helps us to assess the stress given to preventive obstetric care within the health care system as well as the dissemination of knowledge in the community. Such a study could also potentially help us find the source of knowledge of those who have it and to intensify the use propaganda through such media.

So the researcher felt a need to identify the duration when mother comes for registration which helps in assessing the risk factors to the antenatal women. This would help in identifying associated risk factors which will help to bring down the perinatal and maternal mortality rate as well as to have healthy mother with healthy baby.

OBJECTIVES:

 To assess outcome of pregnancy with early registration.

 To assess outcome of pregnancy with delayed registration.

 To assess outcome of pregnancy with selected demographic variables

 To associate early and delayed antenatal registration with maternal and fetal outcome

RESEARCH APPROACH: Quantative Evaluative approach.

RESEARCH DESIGN: Retrospective cross sectional design was adopted.

SETTING: Selected corporation hospital in Pune city

PARTICIPANTS: Postnatal mothers in the selected corporation hospitals.

METHODOLOGY: Tool consisted of Semi structured Interview and questionnaire. Data was collected from the mothers when they were in the hospital during their immediate postpartum period. Demographic data was collected during interview; records like ANC registration card, delivery notes etc were assessed to find out outcome of delivery. Tool consisted of two sections: Section I Demographic data, Section II Outcome of pregnancy (Mode of delivery, Complications during labor process, Mother condition on delivery, Baby condition on delivery) All participants fulfilling the criteria was approached, consent was taken and data was collected over 24 hours according to the patient’s transfer to postnatal ward after delivery. The average time taken to fill the questionnaire after delivery was almost 15-20 minutes.

RESULTS: Majority of mothers had done ANC registration in 2^nd trimester (42%), whereas (41%) had done ANC registration in 3^rd trimester and less percentage in 1^st trimester (17%). Majority of mothers done delayed ANC registration and they were having complications such as Anemia (40%), PPH (33.3%), PIH (11.6%), DM (8.33%), Pre Eclampsia (3.33%), Pre-term labor (1.6%) and convulsions (1.66%). Majority of mothers were alive without complications (60%), whereas less percentage alive with complications (40%). Majority of baby’s were alive with complications (60%), whereas (26%) alive without complications and less percentage death (1.4%).

In association of early registration with outcome of pregnancy the Chi Square is 5.5319, P value is 0018673 which is significant at p < 0.05. Thus explains that early registration reflects healthy (good) outcome of pregnancy.

In association of delayed registration with outcome of pregnancy the Chi Square is 23.5558, P value is 1E-06 ("E" represents "times ten raised to the power") which is significant at p < 0.05. Thus explains that delayed registration reflects unhealthy (bad) outcome of pregnancy.

In association of early and delayed antenatal registration with maternal outcome the Chi Square is 18.541, P value is 1.7E-05 ("E" represents "times ten raised to the power"). The result is significant at p < 0.05. Suggest that there is an significant association of early and delayed antenatal registration with maternal outcome.

In association of early and delayed antenatal registration with fetal outcome the Chi Square is 40.1053, P value is 0. Result is significant at p < 0.05. Thus it means that there is an significant association of early and delayed antenatal registration with fetal outcome.

CONCLUSION: To conclude with the help of above findings this study provides us with evidence that early ANC registration have less complication in the outcome of pregnancy than the delayed registration. Thus importance should be given be given to delayed registration of cases, with identification of risk factors or complications and prompt treatment is necessary. Preconceptional counseling is an important aspect which must be emphasized as she is the future mother who needs to prepare herself for pregnancy to ensure a safe motherhood.

KEY WORDS: Impact, antenatal registration, early antenatal registration, delayed antenatal registration, outcome of delivery.

INTRODUCTION:

Pregnancy calls for quality antenatal care, as she needs to take care of the growing baby throughout those nine months when the baby is in the womb and bring him/her safely into this world. The responsibility of the mother of taking care of her baby does not stop here but they still turn to their mother’s advice, support and help in time of adversities.

The need of care doubles as the mother has to take care of her own self as well as the growing tiny soul inside the womb.

Pregnancy complications and child birth related are the major cause of death among women in their reproductive ages. Around 5, 29,000 women died each year from maternal causes: and for every woman who dies approximately 20 more suffer from injuries, infections and disabilities during pregnancy or child birth.²According to Thaddeus and Maine, delay can occur at three different levels; 1) Delay in decision to seek care, 2) delay in reaching the appropriate facility and, 3) delay in receiving adequate care in the facility. The reasons for the first delay may be late recognition of the problem, fear of the hospital or the costs or lack of an available decision maker. The second delay is usually caused by difficulty in transport and the third delay is often due to difficulty in getting blood supplies, equipment and operation theatre. Low socio economic, status of women, illiteracy is the main factors responsible for delays in receiving care during delivery.

As many low to middle income countries strive to achieve targets of reduced maternal, neonatal and infant mortality set by the millennium development goal, health system innovation which can accelerate progress are being carefully examined. Among these are technologies and systems which aim to strengthen frontline health workers and health systems within which they work, by enabling the registration of pregnancy, birth and outcome. Quality of health care delivered is one of the factors which determine the outcome of pregnancy. The estimation of quality of services helps as to have an understanding of mother and child health issue and possible avenues of intervention. Delayed access to antenatal care is linked to maternal deaths and morbidity. Social deprivation also accounts for much maternal and child ill health, which national health data showing the access and utilization of the care by groups of women who differ by ethnicity, age and socio economic status. The knowledge of pregnant women regarding antenatal care and their compliance to it is of paramount importance in preventing maternal and infant mortality rate and morbidity.

C. S. Metgud, M. Katti, D. Mallapur and A. S. Wantamutte (2009) conducted a study of Utilization Patterns of Antenatal care among Pregnant women, all women (n=130) village in Tanzania who were pregnant at the start of the study and who became pregnant during the study. Most of the pregnant women (92.31%) were registered for antenatal care, but only 30.00% of them were registered in the 1st trimester of pregnancy. As regards to TT immunisation70.77% of the pregnant women as received two doses or one booster dose iron and follicle acid supplementation was taken by 59.68% of the pregnant women. Nearly 39.52% of the pregnant women were provided with full antenatal care. The main antenatal care provided for the pregnant women was doctor (64.52%). The study shows early and wide spread of the antenatal care, but it also reveals that the antenatal visits of occur late in pregnancy. ³

Adekanle, DA and Isawumi, AI (2008) conducted a cross sectional study using interviewer – administered questionnaire to 345 willing participants at a booking clinic in a tertiary health facility in Nigeria. Using Mean gestational age at booking was 20.3±6.2 weeks. Prevalence of late entry to antenatal care was 82.6%. Maternal education and age remained significant factors influencing late booking. Late booking is still a major problem in this part of the world. Public enlightenment, health education coupled with women empowerment would be helpful in reducing the problem⁴

E P Ndidi and I G Oseremen (2011) conducted study on reasons given by pregnant women for late initiation of antenatal care in the Niger Delta, Nigeria. The majority of respondents were aged 20–39 years (97.1%), quarters were primigravida and 25 % of the women belonged to the upper socioeconomic class. Seventy three point six percent booked in the second trimester and 26.4% in the third trimester. Of the women who had given birth before, 80% had booked late in at least one previous pregnancy. More than three-fifth of the women (65.6%) booked late due to ignorance or misconceptions of the purpose of, and right time to commence antenatal care. The findings of this study suggest that most women book late because of a belief that there are no advantages in booking for antenatal care in the first three months of pregnancy. This seems to be because antenatal care is viewed primarily as curative rather than preventive in the study population. Research is needed to determine the best approaches for health education programmers to correct the misconceptions about antenatal care. ⁵

M. A. Okunlola (2006) conducted a study with an aim of improved outcome of pregnancy for mother and fetus, early booking (first antenatal visit), prior to 14 weeks' gestation is usually recommended. A survey of information on personal data, index pregnancy, reasons for booking at a particular gestational age, past obstetric history and medical history of 205 pregnant women attending the antenatal booking clinic at the University College Hospital, Ibadan, Nigeria was carried out using a structured questionnaire. The mean gestational age at booking was 21.82 (±7.0) weeks. Only 29 patients (14.1%) booked before 14 weeks. The reasons given for early booking among them were the perceived benefits of such practice (41.4%), physician's recommendation (34.5%) and occurrence of complication(s) in previous pregnancy (24.1%). Illness in the index pregnancy and nulliparity were the only factors found to significantly favour early booking. The need to educate women of the reproductive age group, who are potential mothers, on the benefits of early booking was recommended.⁶

Adekanle DA, Isawumi (2008) conducted a study conducted on late antenatal care booking and its predictors among pregnant women in south western Nigeria. Mean gestational age at booking was 20.3±6.2 weeks. Prevalence of late entry to antenatal care was 82.6%. Maternal education and age remained significant factors influencing late booking. Four hundred and eighty questionnaires were administered, four hundred and seventy (97.9%). Mean age of the respondents was 28 ± 4.6 years (17 - 41). Eighty four (18.5%) booked within 13 weeks of gestation while majority, 370(81.5%) booked after 13 weeks. Mean gestational age at booking was 20.3 ± 6.2 weeks. Three hundred ninety three (83.6%) were in monogamous union and sixty four (14.0%) were polygamous. Three hundred and eighty-eight (82.6%) were carrying singleton fetus, 22(4.7%) multiple pregnancies and 60(12.8%) were unsure.Majority, 324(69.3%) of the respondents were aged 25 - 34 years and were mostly Yoruba of ethnic group, 443(92.5%). Most, 215(46.2%) had secondary education while majority, 207(44.6%) were self-employed. ⁷

Geeta Pardeshi, Sonali Salvi, (2014) conducted study regarding timing of registration for antenatal care among pregnant women delivering in a tertiary care hospital: A total of 370 women who had been admitted in the postpartum ward after delivery were included in the sample. A total of 230(62%) women reported the ANC registration in the first trimester while 120 (38%) reported the first visit in the second trimester and 15 women in the third trimester. A total of five women reported that they had never visited any health facility for antenatal care. The wife’s education and husband’s education were significantly associated with the time of first contact with health care services. A woman reporting that their husband consumed alcohol was 1.73 times more likely to report a late contact with the health care services when pregnant. Residence, type of family, BPL status, age, parity and duration of marriage were not related to the time of first contact of the pregnant women with health care services.⁸

Rahman S, Nessa F, Rahman S, Alir, Ali HA conducted a study was conducted in rural Bangladesh to identify the health and social effects of pregnancy in married women 13-23 years of age were studied among a population of 175,000. In major causes of death in the younger group were obstructed labour and toxemia. The major causes of death of infants born to the younger mothers was birth injury. Perinatal death rate was 66.4/1000. All deliveries occurred at home and 89% of births were attended by relatives neighbours or an untrained birth attendant. The study result shows that an educational programme on the importance of antenatal care, child care and identification and referral of high risk group is urgently needed. Furthermore, a broad community approach to inform and educate husbands and mother-in-law about the importance of antenatal care in reducing risks to mothers and their infants is also needed.⁹

PROBLEM STATEMENT:

A study to assess the impact of early or delayed antenatal registration on outcome of pregnancy among postnatal mother in selected maternity hospital.

OBJECTIVES:

 To assess outcome of pregnancy with early registration.

 To assess outcome of pregnancy with delayed registration.

 To assess outcome of pregnancy with selected demographic variables

ASSUMPTIONS:

The study assumes that:

 Early antenatal registration has effect on outcome of pregnancy

 Delayed antenatal registration has effect on outcome of pregnancy

HYPOTHESIS:

H0: There is no significant effect of early and delayed antenatal registration on outcome of pregnancy.

H1: There is no significant effect of early and delayed antenatal registration with selected demographic variables.

LIMITATIONS OF THE STUDY:

The limitations of the study are:

 The present study was limited to 150 mothers.

 Data was collected only from one hospital.

 Only registered subjects were included in the study.

EHICAL ASPECT:

^{ The study proposal has been sanctioned
by the ethical committee of the Sadhu}Vaswani College of Nursing.

^{ Permission was obtained from the
concerned authority of the selected hospitals,}Pune.

^{ Informed consent has been taken from
the participants.}

RESEARCH APPROACH

In order to achieve the objectives of study, Quantative Evaluative approach is used.

RESEARCH DESIGN

The design adopted in this study was retrospective cross sectional

THE SETTING

The study was conducted in selected corporation hospital^.

THE POPULATION

The population in the present study comprised of all the postnatal mothers in the selected hospitals.

THE SAMPLE

The sample of present study consider of the postnatal mother who have done early and delayed antenatal registration in selected hospitals.

SAMPLING TECHNIQUE

In this study hospitals all over Pune listed down then the hospital which was feasible and convenient was taken for the study.

SAMPLING SIZE

Total number of postnatal mother which done early and delayed antenatal registration selected for the study was150.

INCLUSION CRITERIA:

1. Pregnant women above 19 yrs. of age.

2. Registered pregnant mothers.

3. Mothers willing to participate

EXCLUSION CRITERIA:

1. Pregnant mothers who have not registered in the same hospital.

DEVELOPMENT AND DESCRIPTION OF THE TOOL

The data gathering tool was constructed by the investigator in the light of the literature reviewed and her experience in the clinical field to ensure the adequacy and validity of the content.

The tool consisted of semi structured Interview and Questionnaire which had 2 sections

Section I Demographic data

Section II Outcome of pregnancy

 Mode of delivery

 Complications during labor process

 Mother condition on delivery

 Baby condition on delivery

PROCEDURE OF DATA COLLECTION

A formal permission was obtained from the medical directors and the various other related authorities of the selected hospitals. The study was conducted from 10^thFebruary 2015 to 28^thFebruary 2015. The investigators approach the study subjects, explained to them the purpose of the study and obtained the consent after assuring the subject about the confidentiality of the data. Data was collected over 24 hours, according to the admission of the patients. The average time taken to fill the questionnaire was almost 1015 minutes. The data was collected from 150 samples that were found to fit into the criteria.

PLAN FOR DATA ANALYSIS

The data analysis was planned to include descriptive and inferential analysis. Descriptive analysis would be used for analysis of the demographic data and section II. Inferential statistics would be used to associate the early and delayed antenatal registration with outcome of pregnancy.

MAJOR FINDINGS OF THE STUDY

Findings of section 1

Section 1 consist of demographic data which included age, education, occupation, religion, age of marriage, parity, social class and ANC registration the major findings revealed are as follows-

Majority (76%) of mother belongs to age group of 20-29 yrs. (18%) belongs to >30 yrs. And less percentage in the age group of <19 yrs.

Majority (84%) mothers have taken education up to SSC, (9%) mothers have taken education up to HSC and less percentage is graduates (7%).

Majority (97%) mothers were house wife, (2%) were doing service and less percentage is self-employed (1%).

Majority of mothers belongs to Hindu religion (79%), were as (20%) mothers belongs to Muslim and less percentage are other religion (1%).

Majority of mothers were married at the age group of 18-25 (96.7%), whereas (2.7%) mothers married at the age group of 26-32 and less percentage women’s married at the age group of above 32 (0.6%).

Majority of mothers were Primipara (39%), whereas (39%) were Multipara and less percentage were grand Multipara (22%).

Majority of mothers belongs to low class (88.7%), whereas (68.7%) mothers belongs to middle class and less percentage were in high class (2.6%).

Majority of mothers done ANC registration on 2^nd trimester (42%), whereas (41%) done ANC registration on 3^rd trimester and less percentage on 1^st trimester (17%).

In percentage Wise Reason Distribution For Early Registration 44% mothers had done early registration due to Sickness, whereas 40% mothers done early registration due to parental advice and 16% mothers done early registration by Friends advice.

In percentage wise reason distribution for late registration 36% mothers done late registration due to not being sick, where as 27%mothers done late registration due to lack of knowledge, 25% mothers done late registration due to lack of transport, 4% mothers done late registration due to uncooperative attitude, 4% mothers done late registration due to medical problems in early pregnancy, 3% mothers done late registration due to booked elsewhere, and1% mothers done late registration due to unknown pregnancy.

Findings of section 2

Majority of mothers undergone vaginal delivery (51%), whereas (43%) undergone LSCS and less percentage on instrumental delivery (6%).

Majority of mothers had done delayed ANC registration and they were having complications such as Anemia (40%), PPH (33.3%), PIH (11.6%), DM (8.33%), PRE ECLAMPSIA (3.33%), Pre-term labor (1.6%) and convulsions (1.66%).

Majority of mothers were alive without complications (60%), whereas less percentage alive with complications (40%).

Majority of baby’s were alive with complications (60%), whereas (26%) alive without complications and less percentage death (1.4%).

Early Antenatal Registration

	Alive without complications	Alive with complications	Row Total
Mother	26	0	26
Baby	21	5	26
Column Total	47	5	52

In association of early registration with outcome of pregnancy the Chi Square is 5.5319, P value is 0018673which is significant at p < 0.05. Thus explains that early registration reflects healthy (good) outcome of pregnancy.

Delayed Antenatal Registration

	Alive without complications	Alive with complications	Row Total
Mother	32	29	61
Baby	7	54	61
Column Total	39	83	122

Association of Maternal outcome with early and late registration

	Alive without complications	Alive with complications	Row Total
Early registration	26	0	26
Late registration	32	29	61
Column Total	58	29	87

Association of Fetal outcome with early and late registration

	Alive without complications	Alive with complications	Row Total
Early registration	21	5	26
Late registration	7	54	61
Column Total	28	59	87

CONCLUSION:

To conclude with the help of above findings this study provides us with evidence that early ANC registration have less complication in the outcome of pregnancy than the delayed registration. There is significant association of early and delayed antenatal registration with fetal outcome and maternal outcome.

Thus importance should be given be given to delayed registration of cases, with identification of risk factors or complications and prompt treatment is necessary. Preconceptional counseling is an important aspect which must be emphasized as she is the future mother who needs to prepare herself for pregnancy to ensure a safe motherhood.

All the assumptions of this study were proved, that early and delayed ANC registration has effect on outcome of pregnancy.

RECOMMENDATIONS:

Based on the findings of the study the investigator wants to recommend further studies-

● It is suggested that the study may be replicated using larger population of mothers

● It is suggested that the study may be replicated using only Primipara as the sample and findings may be observed.

● This study may be done in different hospitals as our study was done in only one hospital.

● A comparative study among the hospital set up i.e. government and private setup can be done.

● A prospective study would be much more useful rather than retrospective.

● A comparative study with early and delayed ANC registration at different trimester can be done.

● A comparative study with registered and unregistered cases can be done.

● A comparative study at different gestational week of delivery can be done, to assess the changes in the outcome of pregnancy.

There are few important things which need to be recommended besides doing further research which includes:

● The study recommends mass media campaign and appropriate advertisement for registration of cases and importance of regular attendance in ANC clinic.

● Encouraging community involvement and empowerment in maternal and perinatal issues.

● Participation with empathetic prevention and promotion Programme, which should include more active movement of private sectors.

REFERENCES:

1. Dutta DC. Text book of obstetrics including Perinatology and contraception.6^th edition, Calcutta: New central book agency; 2004, pp 631.

2. WHO, Antenatal care is the care of the mother during pregnancy; 2008.

3. Geeta Pardeshi, Sonali Salvi. Timing of Registration for antenatal care among pregnant women. British Journal of obstetrics and Gynecology.2012.pp 67.

4. Adekanle, DA and Isawami, AI. Maternal education and age remained significant factors influencing late booking. West Indian medical journal, 2008[cited 2010 January] ;56.

5. M.A Okunlola .Improved outcome of pregnancy for mother and fetus, Journal of pregnancy ,2006 [cited 2010 January ].pp 138.

6. EP Ndidi and IG Osermen. The women book late because of the belief that no advantages in booking for antenatal care in first month .journal of maternal and childhealth.2011.pp 5

7. Adekanle, D.A. Isawami, AI. Maternal education and age remained significant factors influencing late booking. West Indian medical journal, 2008[cited 2010 January] ;49.

8. C.S. Metgud, S.M Katti, M.D. Mallapur and A.S. Watamutta, a utilization pattern of antenatal care among pregnant women. Asian pacific Journal of Tropical Medicine, vol.3, issues 7, 2009, pp 560.

9. Rahman S, Nessa F, Rahman S, Alir, Ali HA, Bangladesh Medical Research Council, Azimpur, Reproductive health of adolescents in Bangladesh, PMID : 2571535 (PUBMED)

Received on 02.06.2015 Modified on 26.06.2015

Int. J. Nur. Edu. and Research 3(3):July-Sept., 2015; Page 310-316

DOI: 10.5958/2454-2660.2015.00013.7