Burden of Unplanned Antenatal Visits in a Tertiary Hospital in Nigeria: Making a Case for an Improved Referral System

Non-urgent unplanned visits are frequently observed in pregnancy. However, there are no studies from Nigeria exploring its burden. A cross-sectional cohort survey of 1,182 women at the only state-owned teaching hospital in Ado - Ekiti was conducted to address this need. One-quarter of the population studied had unplanned antenatal visits during the period of care. Only about one in four of the reasons for the unplanned visits were ‘direct’ pregnancy-related complaints, while the largest proportion of the women, 227 (73.5%), visited on account of infectious morbidities, followed by gastrointestinal disorders, 63 (20.4%). Mothers who were skilled workers were significantly more likely to have unplanned antenatal visits compared with their unemployed counterparts (45.3% versus 20.7%, p = 0.013). Unplanned visits were significantly more in women who had reduced fetal movements (9.4% versus 0.9%, p < 0.0001); significantly more women who had out-of-schedule prenatal visits were admitted for care (37.9% versus 0.2%, p < 0.0001), and had induction of labour (20.1% versus 10.3%, p < 0.0001) when compared with those who had no unplanned visits. Reduced maternal perception of fetal movements (odds ratio: 7.57; 95% C. I. 3.07 - 18.70, p < 0.0001), prenatal admission (odds ratio: 241.81; 95% C. I. 59.02 - 990.75, p < 0.0001), and induction of labour (odds ratio: 1.90; 95% C. I. 1.24 - 2.93, p = 0.003) were found to be independently associated with unplanned antenatal visits