BACKGROUND:
The lack of antenatal care is a critical barrier in ensuring that every pregnancy and birth is a positive and healthy experience. Despite progress in maternal health, around 287,000 women died around the world in 2020 from preventable pregnancy and childbirth causes such as excessive bleeding, infection, high blood pressure, unsafe abortion, and obstructed delivery. This study aimed to determine the prevalence, factors and perinatal outcomes associated with unbooked maternity admissions at a provincial tertiary hospital in Gauteng Province, South Africa.

METHODS:
The study employed a retrospective case-control study design using secondary data of maternity cases between March 2023 and April 2024. Data from 152 unbooked cases, and 152 booked cases who delivered on the same day, were abstracted from hospital records using a Qualtrics data tool. Data analysis was done using STATA version 18.

RESULTS:
Between March 2023 and April 2024, the hospital recorded a total of 14 151 deliveries, of whom 638 were unbooked, with a prevalence of unbooked deliveries being 4.51%. The median maternal age was similar between booked (28 years,) and unbooked (30 years,) groups (p=.67). Booked women had significantly higher haemoglobin levels (median 12.1 g/dL vs. 10.7 g/dL, p<.001) and were less likely to be HIV-positive (38.2% vs. 61.8%, p=.028), married (OR 13.69; 95% CI: 2.42–77.47; p=.003) and employed (OR 1.94; 95% CI: 1.03–3.66; p=.040). Unbooked women experienced higher rates of maternal complications (23.7% vs. 9.2%). Neonatal outcomes were notably poorer among unbooked cases: low birth weight (38.2% vs. 9.2%, p<.001), preterm delivery (38.8% vs. 8.6%, p<.001).

CONCLUSIONS:
The study found that the unbooked admissions were at 4.5% and that many mothers were between the ages of 20 and 34, with an even distribution of booked and unbooked status across all age categories, showing that booking status was balanced regardless of age.