Objective: • To compare fetomaternal outcome of pregnancy in booked versus unbooked patients. • To study the effectiveness of hospital based antenatal monitoring and care. Material and method: This was a prospective analytical study carried out at tertiary health centre, Surat from July 2017 to February 2018. This study was carried out to assess and compare the impact of fetal and obstetrical outcome in booked and unbooked mothers. Booked patients were those who had at least three antenatal care visits while unbooked patients encompassed those who had no antenatal care throughout the index pregnancy or those who had less than three antenatal visits in the current pregnancy. Result: Total 1000 patients were recruited in study out of which 500 were booked mothers while 500 were unbooked mothers. It was observed that maximum booked and unbooked mothers belonged to the age group of 26-35 years. Besides having a lower education level (48.6% primary education), the majority of unbooked mothers belonged to lower socio economic class (46.2%) as compared to booked mothers (30%) [p value <0.001]. It was observed that unbooked mothers (56.8%) belonged to rural area as compared to booked mothers (27.2 %) [p value <0.001]. It was observed that there was an increased prevalence of anemia, antepartum haemorrhage, obstructed labour, preeclampsia, eclampsia, postdatism, preterm labour, liquor abnormalities, medical conditions in unbooked mothers as compared to booked mothers. Maternal and perinatal morbidity and mortality rate was found to be significantly higher in unbooked group as compared to booked group. Conclusion: The pregnancy outcomes in booked mothers are far more successful in unbooked mothers. Thus it can be concluded that provision of antenatal care improved the maternal morbidity and prevented maternal mortality.