Abstract
OBJECTIVE:
To Compare the frequency of adverse maternal and fetal outcomes in women assigned to the high risk category to those with a low risk pregnancy in the tertiary care settings.

SETTING:
Unit II MCH Centre, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, a Tertiary Care Teaching Hospital.

METHODS:
All women delivered in labour ward MCH Centre, unit II, from 1st February 2003 to 30th April 2003 were included. Women booked for care were assigned to Low Risk or High Risk groups during the antenatal period using a standard checklist in antenatal clinic. All the non-booked women were categorized as High Risk. Main outcome measures were Operative Delivery Rate, Neonatal Morbidity and Mortality of the two groups. Secondary outcome measures were Intra partum Complications and Preterm Births.

RESULTS:
Out of enrolled 500 women, 357 (71%) were High Risk and 143 (29%) were Low Risk. 164 (33%) women were non- booked and included among high risk group. In high risk group, LSCS rate was 30 % while there were 23 perinatal deaths. Of these 23 perinatal deaths, 18 (78%) were in non- booked women. The neonatal morbidity was 4% vs 2% in low risk group. Intrapartum complications were 21% for high risk and 12% for low risk. 16 % of high risk women delivered preterm compared to only 5% in low risk.

CONCLUSION
As expected, women categorized as high risk had a higher incidence of adverse outcomes. However booked high risk women have quite good perinatal outcomes approaching the low risk with of course higher operative delivery rate while major perinatal bad outcomes are in non booked.

Key words: High Risk pregnancy, perinatal mortality, outcomes