A Comparative Analysis of Cesarean Section Prevalence and Associated Feto-Maternal Outcomes between Booked and Unbooked Patients at the Ekiti State University Teaching Hospital: A 5-Year Retrospective Study

Abstract

Background: Antenatal care (ANC) booking status is a vital indicator of maternal healthcare engagement and is widely considered to significantly influence delivery outcomes. In low-resource settings like Nigeria, understanding how booking status influences cesarean section (CS) rates and associated feto-maternal morbidity and mortality is essential for designing effective public health strategies and hospital-level interventions.
Objective: This study aimed to compare the prevalence of cesarean section and associated fetomaternal outcomes between booked and unbooked patients who had childbirth at the Ekiti State University Teaching Hospital (EKSUTH) over a five-year period.
Methods: For this research, a retrospective analysis of 5,650 delivery records from April 2020 to March 2025 was conducted. Patients were classified as "booked" if they had at least two scheduled ANC visits at EKSUTH or "unbooked" if they had no prior ANC at EKSUTH. Data extracted included the mode of delivery (Spontaneous vaginal delivery or Cesarean section), maternal outcomes (Primary Postpartum Hemorrhage and mortality), and neonatal outcomes (APGAR scores and stillbirths). Statistical analyses included independent-samples t-tests and chi-square tests; p-values < 0.05 were considered significant.
Results: The overall prevalence of CS was 47.36% (2,676/5,650). Unbooked patients had a slightly higher CS rate (46.50%) than their booked counterparts (45.85%). Maternal mortality (p=0.802) and the incidence of Primary PPH (p=0.602) did not significantly differ statistically across both groups. On the other hand, unbooked patients had considerably poorer neonatal outcomes. The mean APGAR scores at one minute (6.19 ± 2.46 vs. 7.30 ± 1.33, p<0.0001) and five minutes (7.67 ± 2.77 vs. 8.83 ± 1.33, p<0.0001), for their newborns were considerably lower. Similarly, the group also had a significantly higher stillbirth rate (9.53% vs. 1.32%, p<0.0001).
Conclusion: While the CS rate at EKSUTH is high overall and slightly elevated among unbooked patients, the most critical finding is the severe disparity in neonatal outcomes. The most significant finding is the stark difference in neonatal outcomes, despite the high overall CS incidence at EKSUTH and a somewhat higher rate among unbooked patients. Poorer immediate newborn viability and much greater risks of stillbirth are closely linked to a lack of organized antenatal care. These results highlight the critical role of early and frequent antenatal booking as a key strategy for increasing neonatal survival, and the urgent need for focused initiatives to close this care gap.