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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2015  |  Volume : 12  |  Issue : 1  |  Page : 20-23

The factors affecting gestational age at booking in Lagos University Teaching Hospital, Lagos, Nigeria


Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Lagos, Nigeria

Date of Web Publication14-Jul-2015

Correspondence Address:
Dr. Omololu Adegbola
Department of Obsterics and Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, PMB 12003, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1595-9587.160762

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  Abstract 

Background: Antenatal care is an important part of safe motherhood and plays a major role in maternal and perinatal mortality and morbidity reduction. Thus early antenatal bookings contribute immensely to good pregnancy outcome. Objective: To ascertain the factors that determine gestational age at booking in Lagos University Teaching Hospital (LUTH) and how these factors affect timing of seeking antenatal care in the hospital. Materials and Methods: A cross-sectional study of 302 consenting consecutive pregnant women attending the antenatal clinic in LUTH from October 2009 to April 2010. Results: The mean age of the women was 31.5 ± 5 years (range 17-46 years) and the mean gestational age at booking was 18.9 ± 7.8 weeks (range 6-40 weeks). The majority of women, booked at 20 completed weeks or less were 185 (61.3%), while 117 (38.7%) booked after 20 completed weeks. The main reason for early booking for most patients was physician referral in 36.8%, while 27.6% perceived benefit by husband, partner or patient was the reason for early booking. The main reason for late booking was late referral from the previous hospitals where they initially booked. Conclusion: Most of the women booked early did so as a result of their doctor's referral due to complications in pregnancy. Late booking was mainly due to late referrals from other hospitals.

Keywords: Antenatal booking, early and late booking, factors responsible, gestational age, influencing factors


How to cite this article:
Adegbola O, Kuku TO. The factors affecting gestational age at booking in Lagos University Teaching Hospital, Lagos, Nigeria. J Clin Sci 2015;12:20-3

How to cite this URL:
Adegbola O, Kuku TO. The factors affecting gestational age at booking in Lagos University Teaching Hospital, Lagos, Nigeria. J Clin Sci [serial online] 2015 [cited 2020 Oct 21];12:20-3. Available from: https://www.jcsjournal.org/text.asp?2015/12/1/20/160762


  Introduction Top


The role of antenatal care in ensuring improved pregnancy outcome evidenced by safe delivery and healthy infant is no longer in doubt. [1] Its objective is to render effective and appropriate screening, preventive and treatment interventions. [2] A woman is regarded as "booked" by the World Health Organization [WHO] if she has attended at least four antenatal visits and has had tetanus toxoid, [3] thus an early antenatal booking is undoubtedly highly important in reducing maternal and perinatal mortality and morbidity.

The WHO antenatal care model for developing countries requires the first visit to be at 14 to 16 weeks, [3] while the Royal College of Obstetricians and Gynecologists [4] recommend booking in the first trimester to afford the diagnosis of early abnormalities and appropriate intervention. While it is customary for women to book early in the developed countries, it is the reverse in the developing nations. [4] The average gestational age at booking in Riyadh, Saudi Arabia was 13 weeks, [5] the mean gestational age at booking in different cities in Nigeria was 19.1 ± 7.8 weeks in Lagos, [1] 21.8 ± 7.0 weeks in Ibadan, [6] and 23.5 ± 6 weeks in Sokoto. [7]

In Lagos, there are differences in the gestational age at booking in relation to parity. While nulliparous and primiparous women booked at a mean gestational age of 18.5 ± 8.3 weeks and 18.4 ± 7.4 weeks, respectively; the grand multiparous women was 25.9 ± 8.6 weeks. [1] As a result of late antenatal booking in Lagos, this study was designed to determine factors that determine the gestational age at booking and recommend measures that may improve gestational age at booking.


  Materials and Methods Top


This was a cross-sectional descriptive study on all consenting consecutive pregnant women attending their first antenatal clinic in their current pregnancy at the Lagos University Teaching Hospital (LUTH) from October 1, 2009 to April 30, 2010. The instrument of survey was a structured questionnaire consisting of information on personal data, present pregnancy, reasons for booking at the particular gestational age, past obstetric history including pregnancy complications, past medical history, and reasons for booking. The questionnaire was self-administered by literate women while illiterate women were interviewed at the clinic. The hospital accepts all pregnant women that come to receive antenatal care irrespective of if they were referred or not. Analysis of data was done using Epi-info 2002 software. Categorical variables were compared with chi- square test and Fisher exact test as appropriate while continuous variables were compared using t-test. A P value of < 0.05 was considered as significant.


  Results Top


There were 302 women involved in the study. Their mean age was 31.5 ± 5 years (range 17-46 years). The majority of them (98%) were married and Christians (90.4%). Most of the women (55.3%) and their husbands (54.6%) had tertiary education as shown in [Table 1].
Table 1: Age, marital status, religion, and educational levels of participants and their husbands/partners


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The mean gravidity was 2.9 ± 1.6 (range 1-10), the mean number of spontaneous abortion, induced abortions, and number of children alive are all shown in [Table 2].
Table 2: Pregnancies, children, induced, and spontaneous abortions


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The mean gestational age at which pregnancy was diagnosed was 8.8 ± 5.1 weeks (range 7-36 weeks), the mean gestational age at first antenatal visit was 18.9 ± 7.8 weeks (range 6-40 weeks). The majority of women, 185 or 61.3%, booked at or before 20 th week of gestation while 117 (38.7%) booked after 20 th week gestation as shown in [Table 3].
Table 3: Pregnancy and booking details


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Most of the women, 153 (50.7%), had their pregnancy initially diagnosed using the urine beta Human Chorionic Gonadotrophin (HCG) test, while 75 (24.8%) women had the diagnosis via serum beta HCG. Pelvic ultrasound scan was used in 74 (24.5%) women as the initial mode of pregnancy diagnosis.

The reasons for early and late booking are highlighted in [Table 4]. The main reason for early booking was physician's referral in 36.8% while that of late booking (39.3%) was late referral from the previous hospitals where they initially booked. [Table 5] shows the relationship of gestational age at booking to the level of education of the women and their husbands/partners. The husbands' or partners' education level was significant in influencing the gestational age at booking, while the women's education level was not.
Table 4: Reasons for booking


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Table 5: Relationship between educational status and gestational age at booking


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  Discussion Top


The gestational age at booking is important for optimal antenatal care. Early bookings enhance effective management, ensure appropriate screening as well as give room for adequate and timely preventive and treatment intervention during the antenatal period. The mean gestational age at first antenatal visit in this study is 18.9 ± 7.8 weeks. This value is similar to 19.1 ± 7.8 found in an earlier study at LUTH [1] but earlier than 21.8 ± 7.0 weeks reported at Ibadan. [6] This trend in late booking is a departure from the first trimester early booking advocated by WHO.

Parity is a key factor in determining the gestational age at booking. [1] It has been shown that primiparous and nulliparous women book early while multiparous women book late. [6],[7] This study shows a similar pattern. Though most of the patients and their partners/husbands were educated, this study shows that the level of education of the husbands/partners have a greater influence on the gestational age at booking than the women themselves. The higher the educational level of the husband, the earlier the gestational age at booking. This may be due to the fact that the husband is a dominant factor in decision making in the African home setting.

The majority of the early bookers (36.8%) were referred based on the pre-existing medical conditions and early complications in index pregnancy noticed by referring doctors. This is not surprising as LUTH is a tertiary care center and as such it is expected that complicated cases should be referred here. Other conditions responsible for early booking among that group were husband or patient's perceived benefits (27.6%), occurrence of complication in previous pregnancies (15.7%), and complication in index pregnancy (11.4%). These are all pointers to the fact that most women do not see any reason in booking early except when complication arises.

The most common reason for booking late was that majority of the patients had booked in another hospital (39.3%). Most of these patients were referred late from the initial hospitals where they booked because of development of late complications in the index pregnancy, as well as the fact that these hospitals do not have facilities for the care of pregnant women with medical complications in pregnancy.


  Conclusion Top


This study shows that the gestational age at booking is highly influenced by level of education of the spouse, the presence of pre-existing medical condition and complications in pregnancy. The role of the doctor who takes care of the patient at the initial hospital before referral determines strongly the gestational age at booking. Thus the need to provide adequate health education to women and their spouses on the importance of early booking cannot be overemphasized. Husbands and partners play an important role in determining the gestational age at booking. Health workers need training and retraining on early recognition of complications in pregnancies. This will enhance prompt treatment and referral of pregnant women to referral centers. There should also be adequate, accessible and affordable health facilities with skilled manpower for safe delivery all around the nation. This would go a long way in reducing the maternal and perinatal morbidity and mortality associated with late booking.

Source of funding

No financial support exists.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Adegbola O. Gestational age at antenatal booking in Lagos University Teaching Hospital (LUTH). Nig Q J Hosp Med 2009;19:162-4.  Back to cited text no. 1
    
2.
Carroli G, Villar J, Piaggio G, Khan-Neelofur D, Gülmezoglu M, Mugford M, et al.; WHO Antenatal Care Trial Research Group. WHO Systematic review of randomized controlled trials of routine antenatal care. Lancet 2001;357:1565-70.  Back to cited text no. 2
    
3.
Villar J, Ba′aqeel H, Piaggio G, Lumbiagnanon P, Miguel Belizan J, Fornat U. et al.; WHO Antenatal Care Trial Research Group. WHO antenatal care randomized trial for the evaluation of a new model of routine antenatal care. Lancet 2001;357:1551-64.  Back to cited text no. 3
    
4.
Royal College of Obstetricians and Gynaecologists (RCOG). (2008). Antenatal care: Routine care for the healthy pregnant women. Available from: http://www.rcog.org.uk/print/womens-health/clinical-guidance/antenatal-care-routine- care-healthy-pregnant-women. [Last accessed on 2014 Jun 10].  Back to cited text no. 4
    
5.
al-Shammari SA, Khoja T, Jarallah JS. The pattern of antenatal visits with emphasis on gestational age at booking in Riyadh Health Centres. J R Soc Health 1994;114:62-6.  Back to cited text no. 5
    
6.
Okunlola MA, Ayinde OA, Owonikoko KM, Omigbodun OA. Factors influencing gestational age at antenatal booking at the University College Hospital, Ibadan, Nigeria. J Obstet Gynaecol 2006;26:195-7.  Back to cited text no. 6
    
7.
Ekele BA, Audu LR. Gestational age at antenatal clinic booking in Sokoto, northern Nigeria. Afr J Med Med Sci 1998;27:161-3.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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