teenage pregnancy is defined as pregnancy after menarche to age of nineteen [ 13 ] . this period corresponds to a time when there is a gradual transition from childhood to adulthood with potential conflict between biological and social factors . there is also a concurrent physical , psychological , emotional , and social development [ 1 , 2 ] . among many identifiable factors contributing to the high risk of teenage pregnancies are early menarche , early onset of coital activity , early marriage , overpowering effect of the partners , inadequate parental support , single - parent factors , lack of education , poor socioeconomic background and unemployment . there is an increased sexuality among teenagers the world over [ 3 , 4 ] . in a developing country like nigeria , teenagers account for 20 percent of the total population [ 5 , 6 ] . the age at menarche has been found to be decreasing all over the world [ 1 , 2 ] . a study in nigeria in 1990 found that the median age at first intercourse was 16 years , and that by the age of 20 years ; 80 percent of females had experienced sexual intercourse [ 5 , 7 ] . thus , more than 50 percent of young women in sub - saharan africa give birth before the age of 20 years . in northern nigeria for , instance , where the culture and religion permits early marriage , the minimum legal age of marriage for females is nine years [ 5 , 9 ] . this increased sexual activity among these teenagers usually result in unplanned and often unwanted pregnancies [ 1 , 10 , 11 ] . it has been shown that 57 percent of teenage girls become pregnant within one year of sexual activity [ 10 , 11 ] . a number of reasons why these vulnerable teenagers are exposed to these ill - timed pregnancies have been mentioned [ 12 , 13 ] . perhaps , the most important predisposing factor to unplanned pregnancy among teenagers is the low level of utilization of modern contraception . in a study in lagos in 1990 , only 20 percent of sexually active teenagers had ever used any form of modern contraception . another study in the eastern part of nigeria in 1993 revealed that only 5.3 percent of sexually active teenagers had ever used modern contraceptives . the rate of default among these teenagers was equally very high even when contraceptive counseling had been offered [ 16 , 17 ] . a prospective study in benin , nigeria , found a high default rate of 43 percent among unmarried sexually active teenagers some of whom had a previous induce abortion . contraceptive use among married teenagers is equally low because of family pressure for them to become pregnant soon after marriage . pregnancy at a very young age is a high risk that can leads to a vicious cycle of medical , physical , and social problems from which the girl and her fetus can hardly escape [ 1 , 18 , 19 ] . pregnancy at this age group is therefore generally regarded as high risk pregnancy [ 20 , 21 ] . pregnancy in teenagers are often complicated by hyperemesis gravidarum , miscarriage , malaria , anaemia , preeclampsia , eclampsia , and prematurity [ 1 , 2 ] . labour and delivery may also be complicated by obstructed labour due to fetopelvic disproportion , rupture uterus , stillbirth , obstetric fistulae , prolonged labour , instrumental delivery , caesarean section , and death [ 1 , 2 ] . this trend is common in some parts of africa due to sociocultural , geographical , and financial constraints [ 1 , 2 ] . antenatal care provides an opportunity for pregnancy complications to be diagnosed early and appropriate intervention instituted . the safest mode of delivery for the mother is determined before labour or early in the course of labour as the case may be . in developed countries of america and europe and some parts of the middle east where pregnant teenagers receive adequate antenatal care , pregnancy and delivery complications are minimal [ 2 , 22 ] . it is therefore important to study perinatal outcome in the unbooked pregnant teenagers and then compare with their counterparts who had antenatal care and hospital delivery . the records of our pregnant women who delivered between 2006 and 2010 at the maternity annex of the university of calabar teaching hospital were reviewed . during the period under review ( january 1 , 2006 to december 31 , 2010 ) there were 9906 deliveries with 644 ( 6.5% ) of this accounted for by teenage mothers . the parameters for comparison included maternal age , booking status , duration of labour , mode of delivery , and perinatal outcome of the newborn . for the purpose of this study the following operational definitions were used : a booked pregnant woman is one who attends at least one antenatal clinic session by trained personnel ,   an unbooked pregnant woman is one has not attended any antenatal clinic session with a trained personnel before presentation in labour . during the period of study , 9906 women were delivered at the maternity annex of the university of calabar , 7192 ( 72.4% ) of these women were booked whereas 2714 ( 27.4% ) were unbooked . teenage mothers accounted for 644 ( 6.5% ) of women who were delivered in the hospital during the period . out of the 644 teenage mothers who were delivered during this period , 399 ( 62% ) were unbooked while 245 ( 38% ) had received antenatal care . teenage mothers accounted for 399 ( 14.7% ) of women who delivered without prior antenatal care . the yearly distribution ( table 1 ) of the teenage mothers showed that 399 were unbooked while 245 were booked . unbooked teenagers contributed significantly to the proportion of women who delivered without prior antenatal care (  = 6.360 ; p < 0.05 ) .   age distribution of the teenage pregnant girls was classified into 15 years ( the younger teenagers ) and 1617 years , 18 - 19 years ( the older teenagers ) . the mean age of unbooked teenagers was 17.4  2.8 while booked was 17.2  2.1 , and was not statistically significant ( t - value = 1.682 ; p the duration of labour among the teenage mothers showed that 90% of the unbooked teenagers had prolonged labour while only 10% of their booked counterparts had prolonged labour . the mean duration of labour among unbooked teenagers was 23.31  3.6 hours while booked teenagers was 10.85  4.2 hours . duration of labour was significantly prolonged among unbooked teenagers ( t - value = 77.1039 ; p < 0.05 ) . spontaneous vaginal delivery was significantly higher among booked teenagers 65.4 percent than in unbooked teenager 44.6 percent (  = 12.722 ; p < 0.05 ) . caesarean section was significantly higher among unbooked teenage mothers 50 percent , than in booked teenagers , 19.4 percent (  = 36.75 ; p < 0.05 ) live birth among booked teenagers was 96.0 percent and was significantly higher than in unbooked teenager 68 percent (  = 15.145 ; p < 0.05 ) . there was significant higher incidence of macerated stillbirth among unbooked teenage mothers (  = 71.226 ; p < 0.05 ) . however , early neonatal death (  = 0.512 ; p < 0.05 ) , fresh stillbirth (  = 0 ; p < 0.05 ) were not significant among booked and unbooked teenage mothers . this study has shown that the prevalence rate of teenage pregnancy in our community of 6.5 percent is relatively high . this is however in consonance with findings in other studies in sub - saharan africa which show a prevalence rate of between 612 percent [ 3 , 24 ] . found a prevalence rate of 8.3 percent among teenage mothers booking for antenatal care in university calabar teaching hospital . the prevalence rate is higher in saudi arabia , northern nigeria and other parts of the world where the religion and culture of the people permit early marriage [ 2 , 25 , 26 ] . it was noted that out of 644 teenage mothers who were delivered during the period , as many as 399 ( 62 percent ) had no prior antenatal care . teenage mothers also contributed significantly , 14.7 percent to the proportion of women who were delivered in the hospital without any prior antenatal care . this is perhaps the trend in other areas like ilorin , where most teenage mothers are single [ 2 , 27 ] . on the contrary , most married teenagers and some in stable relationships have antenatal care prior to delivery [ 2 , 28 ] this is because this group of mothers usually have spousal and parental support and approval of the pregnancy [ 2 , 9 , 29 ] . there was no significant reduction in the proportion of unbooked teenagers during the period of study , 2006 to 2010 . the proportion of unbooked teenagers were in the majority for the five years under study . this apparently suggested that the teenagers were not sensitized to the need for antenatal care during the period of study . most of the women in our community erroneously believe that pregnancy is a natural process which requires no interference . majority of the teenage mothers as older teenagers than who have been found to have better obstetric outcome [ 1 , 24 , 30 ] . in the study , younger teenagers aged 15 years and below accounted for only 8.0 percent of the unbooked group . younger teenagers have however been traditionally classified as those 16 years and below while older teenagers are 17 to 19 years of age . for the purpose of this study , younger teenagers were those aged 15 years and below while older teenagers were 16 years to 19 years of age . majority , 90.0 percent of the booked teenage mothers were delivered within 12 hours from onset of labour . on the contrary , only 10.0 percent of the unbooked teenagers were delivered within this time limit . for the purpose of this study , prolonged labour was defined as delivery of the fetus achieved more than 12 hours from onset of active phase of labour with cervical dilatation of 4  cm . majority of those who delivered more than 24 hours from onset of labour presented with prolonged obstructed labour . most of those who delivered between 12 and 24 hours from onset of labour were allowed some more time in labour based on reassuring fetal well being , progress in labour and continued surveillance in labour . half of the unbooked teenager had emergency caesarean section for various reasons whereas only 19.4 percent of booked teenage mothers required this operation . unbooked teenagers accounted for 44.6 percent of teenage mothers who had spontaneous vaginal delivery whereas as many as 65.4 percent of the booked teenage mothers delivered spontaneously . macerated stillbirth was 29.0 percent among unbooked teenage mothers apparently from prolonged obstructed labour while 3.0 percent ended in early neonatal death from prematurity or complications of prolonged obstructed labour . generally , booked teenagers have a better perinatal outcome than their unbooked counterpart even when subjected to the same delivery conditions [ 12 , 31 , 32 ] . this is because adequate antenatal care influences labour and delivery favourably [ 31 , 32 ] . the high incidence of operative delivery for teenage mothers is due to fetopelvic disproportion which result from incomplete pelvic growth and development [ 33 , 34 ] . teenage mothers are also said to be likely to die as a result of complications of pregnancy and delivery . no mortality was however recorded in this study among the teenage mothers probably because delivery was in hospital with adequate measures put in place to forestall such catastrophe . in conclusion , the prevalence rate of teenage pregnancy in our community is relatively high . these often render them vulnerable to various risks and hazards both to the mother and fetus . antenatal care has been found to improve the obstetric outcome in these young women .   to reverse this trend , promotion of moral , and sex education at home , in schools , and at places of worship . contraceptive awareness campaigns coupled with affordable and accessible family planning services for teenagers are advocated . emergency obstetric care should be available and accessible for management of complications of teenage pregnancy . there is need for a prospective study of the obstetric performance of teenage mothers in community and possible comparison of the pregnancy outcome between the younger and older teenagers .
background . teenage pregnancy being a high risk condition 
 requires skilled attention for good outcome . objectives . to determine the influence of antenatal care on perinatal outcome in teenage pregnancies in calabar . materials and methods . 
 a review of patient records in calabar was conducted between 1st january , 2006 and 31st december , 2010 , to determine perinatal outcome in teenage pregnancy . 
 results . 
 teenage pregnancy accounted for 644 ( 6.5% ) of the total deliveries with 245 ( 38.0% ) booked while 399 ( 62.0% ) were unbooked . 
 teenage mothers contributed significantly to the proportion of women who were delivered without prior antenatal care ( 2 = 6.360 ; p < 0.05 ) . 
 the mean duration of labour in booked teenagers was 10.85  4.2 hours , while unbooked teenagers was 23.31  3.6 hours ( t - value = 77.1039 ; p < 0.05 ) . 
 there was statistically more caesarean sections among unbooked teenage pregnancies than booked ( 2 = 36.75 ; p < 0.05 ) . 
 stillbirth was statistically significant ( 2 = 27.096 ; p < 0.05 ) among unbooked teenagers than booked . 
 however , early neonatal death was not significantly different between booked and unbooked teenage pregnancies(2 = 0.512 ; p < 0.05 ) . 
 conclusion . 
 unbooked teenage pregnancies were significantly associated with increased operative intervention and poor perinatal outcome .