Effect of complete adherence to antenatal care guideline during first visit on maternal and neonatal complications during the intrapartum and postpartum periods: a prospective cohort study in Northwest Ethiopia

OBJECTIVES: To examine the relationship between complete of providers’ adherence to antenatal care (ANC) guideline during first visit and maternal and neonatal complications during intrapartum and postpartum periods. DESIGN: Prospective cohort study. SETTING: Gondar town public health facilities in Northwest, Ethiopia. PARTICIPANTS: A total of 832 pregnant women with gestational age <28 weeks who came for first ANC visit were enrolled and followed up to the first 6 hours of the postpartum periods. EXPOSURE: Providers’ adherence to ANC guideline during first visit was the exposure variable. An 18-point checklist was used to record the level of providers’ adherence. Clients who received care from providers who adhered completely to the guideline constituted the ‘exposed group’, and those who did not receive such care constituted the ‘unexposed group’. MAIN OUTCOMES: Maternal and neonatal complications occurred during the intrapartum and postpartum periods. DATA ANALYSIS: Negative binomial regression model was used to analyse the data. The adjusted incidence risk ratio (AIRR) with 95% CI was reported in the final model. RESULTS: A total of 782 pregnant women were followed up and included in the final analysis (254 in the exposed group and 528 non-exposed). Complete adherence to the guidelines during first visit reduced the risk of neonatal complications (AIRR 0.56; 95% CI 0.39 to 0.79). However, complete adherence to the guidelines was not found to have a statistically significant effect on maternal complications (AIRR 0.84; 95% CI 0.67 to 1.05) during the intrapartum and the postpartum periods. CONCLUSIONS: The group that received care from providers who completely adhered to the ANC guidelines during the first antenatal visit showed significantly improved neonatal outcomes. However, it did not show a significant improvement in maternal outcomes. Hence, focusing on safe motherhood programmes like training that gears provider’s conformity to ANC guideline is quite crucial to improve neonatal outcomes.