title: Maternal and perinatal outcome among the booked and unbooked pregnancies from catchments area of BP Koirala Institute of Health Sciences, Nepal.
abstract: OBJECTIVE
  To examine the differences in maternal and perinatal outcome among booked and unbooked pregnant women and their perception for underutilization of services targeted for them.
  
  
  METHODS
  Two thousand two hundred and twenty eight pregnant women, booked and unbooked, attending emergency obstetrics care during Jan.-Dec. 2005, were included in the study; Investigators followed cases till discharge.
  
  
  RESULTS
  Tendency for mothers to be booked was found to be significantly associated with age. Booked and unbooked mothers differed by distance to the hospital and parity. There was difference between the periods of gestation at which they presented to the hospital among both the groups (p<0.0001). Nearly eighty percent (81.4%) of unbooked mothers did not know the period of gestation. Most of these women conceived during lactational or depo provera-induced amenorrhea. The maternal mortality rate for unbooked mothers was 16 out of 1056 and none among the booked. Perinatal mortality is 3 times less in booked mothers. Higher perinatal mortalities are associated with unbooked mothers and had a higher proportion of maternal intensive care unit admissions and perinatal deaths compared with the booked group. Focus group discussion revealed that the reasons for underutilizations of services are; Distance, cost, disempowerment of women and attitudes of hospital personnel.
  
  
  CONCLUSIONS
  The opportunities to enhance utilizations are based on distance, cost and client friendly environment of hospital personnel. It has been observed, building teaching hospitals alone, will not have much impact to maternal and perinatal outcome, unless peripheral health institutions are equipped with facilities and service provisions.
authors.affiliation: Department of Obstetrics & Gynecology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: H P
authors.initials: HP
authors.lastname: Pokharel
authors.forename: G J
authors.initials: GJ
authors.lastname: Lama
authors.forename: B
authors.initials: B
authors.lastname: Banerjee
authors.forename: L S
authors.initials: LS
authors.lastname: Paudel
authors.forename: P K
authors.initials: PK
authors.lastname: Pokharel
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D002391:Catchment Area, Health; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D009390:Nepal; D011209:Power, Psychological; D011247:Pregnancy; D011256:Pregnancy Outcome; D014933:Women's Rights