Perinatal Mortality in Booked and Unbooked Pregnancies: An Analytical Cross-Sectional Study

Perinatal Mortality in Booked and Unbooked Pregnancies

Abstract

Perinatal mortality remains a major public health challenge in developing countries, where inadequate antenatal care contributes significantly to preventable fetal and early neonatal deaths. Objectives: To compare perinatal mortality between booked and unbooked women presenting to a tertiary care hospital and to identify factors associated with adverse perinatal outcomes. Methods: This analytical cross-sectional study was conducted at Imran Idrees Teaching Hospital, Sialkot, from January to August 2025 after ethical approval (MRC/IRB/24043). A total of 310 women with singleton pregnancies beyond 28 weeks of gestation were enrolled through non-probability consecutive sampling and categorized as booked or unbooked based on antenatal care status. Data were analyzed using SPSS version 25. Quantitative variables were expressed as Mean ± SD, and qualitative variables as n (%). Chi-square test was used for comparison. A p-value ≤0.050 was considered statistically significant. Results: Out of 310 participants, 158 (51.0%) were booked, and 152 (49.0%) were unbooked. Overall perinatal mortality was 30 (9.7%). Mortality was significantly higher among unbooked women compared to booked women [24 (15.8%) vs 6 (3.8%); p=0.001]. Birth asphyxia (5.2%) and neonatal sepsis (3.9%) were the leading causes. Maternal age, parity, previous caesarean section, and mode of delivery were not significantly associated with perinatal mortality (p>0.050). Conclusions: Perinatal mortality was significantly higher among unbooked women. Strengthening antenatal booking services may reduce preventable perinatal deaths.