1
|
Lee N, Flynn J, Gao Y, Kildea S. Comparing compliance with commencement and use of two partograph designs for women in active labour: A randomised controlled trial. Women Birth 2023; 36:e17-24. [PMID: 35400605 DOI: 10.1016/j.wombi.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/15/2022] [Accepted: 04/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Documentation and assessment of progress in labour using a partograph is recommended by the World Health Organisation to assist in the timely recognition of labour dystocia. Recent studies have tested new designs of partographs that aim to account for more variable rates of labour progress. However, other studies have suggested that poor compliance in the completion of partographs affects utility. The objective of this study was to compare two types of partographs for compliance in documentation and use for managing labour. METHODS Low-risk nulliparous women in spontaneous labour (n = 228) were randomised to either an Action Line (control) (n = 114) or Dystocia Line partograph (intervention) (n = 114). Primary outcome was compliance with instructions for commencement of the partograph following a multifaceted training strategy. Secondary outcomes included compliance with the accompanying clinical management protocol for each partograph; and labour and birth outcomes. RESULTS The compliance rate for commencing the Action line partograph was 43.2% compared to 67.0% (p = 0.02) for the Dystocia line partograph. Other than a reduction in artificial rupture of membranes in the Dystocia Line group there were no other differences in labour management or birth outcomes. The use of centralised electronic display of labour progress may be a contributing factor. CONCLUSIONS Compliance with the commencement and use of either partograph was low. There was little indication that the partograph was being utilized in the assessment and management of prolonged labour. Further studies are needed to explore the current utility of partographs in labour management and the effect of centralised monitoring of progress in high resource settings.
Collapse
|
2
|
Shazly SA, Shawki AA, Ahmed MM, Monib FA, Radwan AA, Sedik AS, Said AE, Ali SS, Abouzeid MH, Sayed EG, Nassr AA, Eltaweel NA, Hortu I, Hassan RM, Abdelbadie AS. Middle-East OBGYN graduate education (MOGGE) foundation practice guidelines: use of labor charts in management of labor. Practice guideline no. 04-O-21. J Matern Fetal Neonatal Med 2021; 35:7280-7289. [PMID: 34470117 DOI: 10.1080/14767058.2021.1946787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Since the 50 s of the last century, labor charts have been proposed and appraised as a tool to diagnose labor abnormalities and guide decision-making. The partogram, the most widely adopted form of labor charts, has been endorsed by the world health organization (WHO) since 1994. Nevertheless, recent studies and systematic reviews did not support clinical significance of application of the WHO partogram. These results have led to further studies that investigate modifications to the structure of the partogram, or more recently, to reconstruct new labor charts to improve their clinical efficacy. This guideline appraises current evidence on use of labor charts in management of labor specially in low-resource settings.
Collapse
Affiliation(s)
- Sherif A Shazly
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Abdelrahman A Shawki
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Manar M Ahmed
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Fatma A Monib
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmad A Radwan
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmed S Sedik
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Aliaa E Said
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Shimaa S Ali
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Mostafa H Abouzeid
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Esraa G Sayed
- Department of Obstetrics and Gynecology, Assiut School of Medicine, Assiut, Egypt
| | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Nashwa A Eltaweel
- Department of Obstetrics and Gynecology, University hospitals of Coventry and Warwickshire, UK
| | - Ismet Hortu
- Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Rana M Hassan
- Department of Obstetrics and Gynecology, Maternity Hospital, Alexandria, Egypt
| | - Amr S Abdelbadie
- Department of Obstetrics and Gynecology, Aswan University, Aswan, Egypt
| |
Collapse
|
3
|
Litwin LE, Maly C, Khamis AR, Hiner C, Zoungrana J, Mohamed K, Drake M, Machaku M, Njozi M, Muhsin SA, Kulindwa YK, Gomez PP. Use of an electronic Partograph: feasibility and acceptability study in Zanzibar, Tanzania. BMC Pregnancy Childbirth 2018; 18:147. [PMID: 29743032 PMCID: PMC5944152 DOI: 10.1186/s12884-018-1760-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 04/22/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The ePartogram is a tablet-based application developed to improve care for women in labor by addressing documented challenges in partograph use. The application is designed to provide real-time decision support, improve data entry, and increase access to information for appropriate labor management. This study's primary objective was to evaluate the feasibility and acceptability of ePartogram use in resource-constrained clinical settings. METHODS The ePartogram was introduced at three facilities in Zanzibar, Tanzania. Following 3 days of training, skilled birth attendants (SBAs) were observed for 2 weeks using the ePartogram to monitor laboring women. During each observed shift, data collectors used a structured observation form to document SBA comfort, confidence, and ability to use the ePartogram. Results were analyzed by shift. Short interviews, conducted with SBAs (n = 82) after each of their first five ePartogram-monitored labors, detected differences over time. After the observation period, in-depth interviews were conducted (n = 15). A thematic analysis of interview transcripts was completed. RESULTS Observations of 23 SBAs using the ePartogram to monitor 103 women over 84 shifts showed that the majority of SBAs (87-91%) completed each of four fundamental ePartogram tasks-registering a client, entering first and subsequent measurements, and navigating between screens-with ease or increasing ease on their first shift; this increased to 100% by the fifth shift. Nearly all SBAs (93%) demonstrated confidence and all SBAs demonstrated comfort in using the ePartogram by the fifth shift. SBAs expressed positive impressions of the ePartogram and found it efficient and easy to use, beginning with first client use. SBAs noted the helpfulness of auditory reminders (indicating that measurements were due) and visual alerts (signaling abnormal measurements). SBAs expressed confidence in their ability to interpret and act on these reminders and alerts. CONCLUSIONS It is feasible and acceptable for SBAs to use the ePartogram to support labor management and care. With structured training and support during initial use, SBAs quickly became competent and confident in ePartogram use. Qualitative findings revealed that SBAs felt the ePartogram improved timeliness of care and supported decision-making. These findings point to the ePartogram's potential to improve quality of care in resource-constrained labor and delivery settings.
Collapse
Affiliation(s)
| | - Christina Maly
- Jhpiego, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore, MD 21231 USA
| | - Asma Ramadan Khamis
- Jhpiego, an affiliate of Johns Hopkins University, Plot 72, Block 45B, Victoria Area, New Bagamoyo Rd, PO Box 9170, Dar es Salaam, Tanzania
| | - Cyndi Hiner
- Jhpiego, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore, MD 21231 USA
| | - Jérémie Zoungrana
- Jhpiego, an affiliate of Johns Hopkins University, Plot 72, Block 45B, Victoria Area, New Bagamoyo Rd, PO Box 9170, Dar es Salaam, Tanzania
| | - Khadija Mohamed
- Ministry of Health Zanzibar, Box 236, Stone Town, Zanzibar Tanzania
| | - Mary Drake
- Jhpiego, an affiliate of Johns Hopkins University, Plot 72, Block 45B, Victoria Area, New Bagamoyo Rd, PO Box 9170, Dar es Salaam, Tanzania
| | - Michael Machaku
- Jhpiego, an affiliate of Johns Hopkins University, Plot 72, Block 45B, Victoria Area, New Bagamoyo Rd, PO Box 9170, Dar es Salaam, Tanzania
| | - Mustafa Njozi
- Jhpiego, an affiliate of Johns Hopkins University, Plot 72, Block 45B, Victoria Area, New Bagamoyo Rd, PO Box 9170, Dar es Salaam, Tanzania
| | | | - Yusuph K. Kulindwa
- Jhpiego, an affiliate of Johns Hopkins University, Plot 72, Block 45B, Victoria Area, New Bagamoyo Rd, PO Box 9170, Dar es Salaam, Tanzania
| | - Patricia P. Gomez
- Jhpiego, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore, MD 21231 USA
| |
Collapse
|
4
|
Dalal AR, Purandare AC. The Partograph in Childbirth: An Absolute Essentiality or a Mere Exercise? J Obstet Gynaecol India 2018; 68:3-14. [PMID: 29391669 DOI: 10.1007/s13224-017-1051-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022] Open
Abstract
WHO has recommended use of the partograph, a low-tech paper form that has been hailed as an effective tool for the early detection of maternal and fetal complications during childbirth. Yet despite decades of training and investment, implementation rates and capacity to correctly use the partograph remain low in resource-limited settings. Nevertheless, competent use of the partograph, especially using newer technologies, can save maternal and fetal lives by ensuring that labor is closely monitored and that life-threatening complications such as obstructed labor are identified and treated. To address the challenges for using partograph among health workers, health-care systems must establish an environment that supports its correct use. Health-care staff should be updated by providing training and asking them about the difficulties faced at their health center. Then only the real potential of this wonderful tool will be maximally utilized.
Collapse
|
5
|
Iwao Y, Tsuru S, Omori M, Inoue M. The Study of Nursing NAVI. Stud Health Technol Inform 2018; 250:91-92. [PMID: 29857394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We have examined the nurses' thinking process in their professional judgment and action in the Partogram of 170 labors by 17 Midwifery students in 2 years.
Collapse
Affiliation(s)
- Y Iwao
- Yokohama Soei University, Yokohama, Japan
| | - S Tsuru
- University of Tokyo, Tokyo, Japan
| | - M Omori
- Saitama Medical University, Saitama, Japan
| | - M Inoue
- Yamaguchi Prefectural University, Japan
| |
Collapse
|
6
|
Gunnarsson B, Skogvoll E, Jónsdóttir IH, Røislien J, Smárason AK. On predicting time to completion for the first stage of spontaneous labor at term in multiparous women. BMC Pregnancy Childbirth 2017; 17:183. [PMID: 28606063 PMCID: PMC5469060 DOI: 10.1186/s12884-017-1345-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background Labor that progresses faster than anticipated may lead to unplanned out-of-hospital births. With the aim to improve planning of transportation to birthing institutions, this study investigated predictors of time to completion for the first stage of labor conditional on cervical opening (conditional time) in multiparous women at term. Methods We performed a retrospective analysis of partograms for women in Robson’s group 3 who delivered at one hospital from 2003 to 2013. A generalized additive mixed model was fitted, accounting for possible non-linear relationships between the predictor variables and outcome, e.g. the time from each cervical measurement to full dilation, using multiple measurements for each woman. The following predictors were included: cervical dilation (cm), parity (1, 2, or ≥3 previous vaginal births), oxytocin infusion (no/yes), epidural (no/yes), maternal age (years), maternal height (cm), body mass index (BMI, kg/m2), birthweight (kg), spontaneous rupture of membranes (no/yes). A modified regression model with gestational age (days) instead of birthweight was used to predict conditional time to full cervical dilation for combinations of the most relevant predictors. Results A total of 1753 partograms were included in the analysis. The strongest predictors were birthweight, epidural and oxytocin use, and spontaneous rupture of membranes, along with cervical measurements. For birthweight, there was an almost 40% increase in time to full cervical dilation for each 1-kg increment. Conditional time was on average 23% longer in cases with epidural use and 53% longer in cases requiring oxytocin augmentation. Spontaneous rupture of the membranes shortened conditional time by 31%. Maternal age was not associated with the outcome, while increasing BMI and parity modestly reduced conditional time. Conclusions Higher parity, lower fetal weight (gestational age), and spontaneous rupture of the membranes are associated with more rapid labor. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1345-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Björn Gunnarsson
- Department of Research, Norwegian Air Ambulance Foundation, Holterveien 24, 1448, Drøbak, Norway.
| | - Eirik Skogvoll
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Jo Røislien
- Department of Health Studies, University of Stavanger, Stavanger, Norway.,Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Alexander Kr Smárason
- Department of Obstetrics and Gynecology, Akureyri Hospital, Akureyri, Iceland.,Institute of Health Science Research, University of Akureyri, Akureyri, Iceland
| |
Collapse
|
7
|
Bedwell C, Levin K, Pett C, Lavender DT. A realist review of the partograph: when and how does it work for labour monitoring? BMC Pregnancy Childbirth 2017; 17:31. [PMID: 28086823 PMCID: PMC5237234 DOI: 10.1186/s12884-016-1213-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 12/29/2016] [Indexed: 11/29/2022] Open
Abstract
Background The partograph (or partogram) is recommended by the World Health Organisation (WHO), for monitoring labour wellbeing and progress. Concerns about limitations in the way the partograph is used in the clinical context and the potential impact on its effectiveness have led to this realist systematic review of partograph use. Methods This review aimed to answer two key questions, 1) What is it about the partograph that works (or does not work); for whom does it work; and in what circumstances? 2) What are the essential inputs required for the partograph to work? A comprehensive search strategy encompassed key databases; including papers of varying methodologies. Papers were selected for inclusion if the focus of the paper was the partograph and related to context, mechanism or outcome. Ninety five papers were included for data synthesis. Two authors completed data extraction and synthesis. Results The evidence synthesis relates the evidence to identified theories of health worker acceptability, health system support, effective referral systems, human resources and health worker competence, highlighting barriers and facilitators. Conclusions This first comprehensive realist synthesis of the partograph, provides the international community of maternity clinicians with a picture of potential issues and solutions related to successful labour recording and management, which is also translatable to other monitoring approaches.
Collapse
Affiliation(s)
- Carol Bedwell
- School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Karen Levin
- Monitoring and Evaluation, Fistula Care Plus project, EngenderHealth, 440 9th Avenue, New York, NY, 10001, USA
| | - Celia Pett
- Fistula Care Plus project, EngenderHealth, 440 9th Ave, 12th floor, New York, NY, 10001, USA
| | - Dame Tina Lavender
- School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| |
Collapse
|
8
|
Kc A, Wrammert J, Clark RB, Ewald U, Målqvist M. Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: a case-referent study in Nepal. BMC Pregnancy Childbirth 2016; 16:233. [PMID: 27542350 PMCID: PMC4991085 DOI: 10.1186/s12884-016-1034-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 08/15/2016] [Indexed: 11/16/2022] Open
Abstract
Background Newborns are at the greatest risk for dying during the intrapartum period, including labor and delivery, and the first day of life. Fetal heart rate monitoring (FHRM) and partogram use to track labor progress are evidence-based techniques that can help to identify maternal and fetal risk factors so that these can be addressed early. The objective of this study was to assess health worker adherence to protocols for FHRM and partogram use during the intrapartum period, and to assess the association between adherence and intrapartum stillbirth in a tertiary hospital of Nepal. Methods A case-referent study was conducted over a 15-month period. Cases included all intrapartum stillbirths, while 20 % of women with live births were randomly selected on admission to make up the referent population. The frequency of FHRM and the use of partogram were measured and their association to intrapartum stillbirth was assessed using logistic regression analysis. Results During the study period, 4,476 women with live births were enrolled as referents and 136 with intrapartum stillbirths as cases. FHRM every 30 min was only completed in one-fourth of the deliveries, and labor progress was monitored using a partogram in just over half. With decreasing frequency of FHRM, there was an increased risk of intrapartum stillbirth; FHRM at intervals of more than 30 min resulted in a four-fold risk increase for intrapartum stillbirth (aOR 4.17, 95 % CI 2.0–8.7), and the likelihood of intrapartum stillbirth increased seven times if FHRM was performed less than every hour or not at all (aOR 7.38, 95 % CI 3.5–15.4). Additionally, there was a three-fold increased risk of intrapartum stillbirth if the partogram was not used (aOR 3.31, 95 % CI 2.0–5.4). Conclusion The adherence to FHRM and partogram use was inadequate for monitoring intrapartum progress in a tertiary hospital of Nepal. There was an increased risk of intrapartum stillbirth when fetal heart rate was inadequately monitored and when the progress of labor was not monitored using a partogram. Further exploration is required in order to determine and understand the barriers to adherence; and further, to develop tools, techniques and interventions to prevent intrapartum stillbirth. Clinical trial registration ISRCTN97846009.
Collapse
Affiliation(s)
- Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden. .,United Nation's Children's Fund, Nepal Country Office, UN House, Pulchowk, Nepal.
| | - Johan Wrammert
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | | | - Uwe Ewald
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
9
|
Ragusa A, Gizzo S, Noventa M, Ferrazzi E, Deiana S, Svelato A. Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term. Arch Gynecol Obstet 2016; 294:753-61. [PMID: 26924640 DOI: 10.1007/s00404-016-4046-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 02/09/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. METHODS Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention. RESULTS Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p < 0.0005). The rate of amniotomy decreased from 41.7 % in the SM group to 7.4 % in the CM group (p < 0.0005). The percentage of newborns with 5-min Apgar score <7 and/or umbilical cord arterial pH ≤ 7.00 decreased from 2.3 % in SM cohort to 0.5 % in CM cohort (p = ns). The average length of labor did not differ between the two groups of patients (264 vs 277 min; p = ns). CONCLUSION Comprehensive management of dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.
Collapse
Affiliation(s)
- Antonio Ragusa
- Dipartimento Materno Infantile, U.O.C. di Ginecologia e Ostetricia, Massa Carrara Hospital, Via Enrico Mattei 21, 54100, Massa Carrara, Italy.
| | - Salvatore Gizzo
- Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Marco Noventa
- Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Enrico Ferrazzi
- Department of Woman, Mother and Newborn, School of Medicine, Ospedale "V. Buzzi", Milan, Italy
| | - Sara Deiana
- Department of Obstetrics and Gynaecology, San Giovanni di Dio General Hospital, University of Cagliari, Cagliari, Italy
| | - Alessandro Svelato
- Department of Obstetrics and Gynaecology, Carlo Poma General Hospital, Mantua, Italy
| |
Collapse
|
10
|
Lakshmidevi M, Malini KV, Shetty VH. Partographic analysis of spontaneous labour at term in primigravida. J Obstet Gynaecol India 2012; 62:635-40. [PMID: 24293839 PMCID: PMC3575902 DOI: 10.1007/s13224-012-0208-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/26/2012] [Indexed: 11/26/2022] Open
Abstract
PURPOSE OF THE STUDY To study the use of partogram in the analysis of spontaneous labour at term in primigravida with cephalic presentation. METHODOLOGY Partographic analysis of labour was done in 200 primigravidae. Partographic variables are plotted, and the study population was divided into three groups. Group I: Cervix dilatation and descent curve falling to the left of alert line; Group II: Cervix dilatation and descent curve falling to the right of alert line; and Group III: Cervix dilatation and descent curve falling to the right of action line. Maternal and neonatal outcomes were studied in each of three groups. RESULTS Amongst the 200 primigravid labours analysed, 133 (66.5 %) belonged to group I, 40 (20.0 %) belonged to group II and 27 (13.5 %) belonged to group III. Mean durations of active phases of labour were 4.1 h, 6.9 h and 9.6 h, in groups I, II and III, respectively. In group I, 130 women (97.7 %) delivered vaginally, 3 (2.3 %) underwent LSCS. In group II, 29 (72.5 %) delivered vaginally, 4 (10 %) delivered instrumentally and 7 (17.5 %) underwent LSCS, and in group III, 5 (18.5 %) delivered vaginally, 7 (25.9 %) delivered instrumentally and 15 (55.5 %) delivered by LSCS. CONCLUSION Mean duration of active phase of labour increased as the partographic curve fell to the right of alert and action line. Increased rates of instrumental deliveries, LSCS, babies with lower APGAR score at 5 min, and NICU admissions were observed in group III compared with groups I and II.
Collapse
Affiliation(s)
- Muralidhar Lakshmidevi
- />Department of OBS & GYN, Vydehi Institute of Medical, Sciences and Research Institute, EPIP Area White Field, Bangalore, Karnataka 560066 India
| | - K. V. Malini
- />Department of OBS & GYN, Bangalore Medical College and Research Institute, Sri Krishnarajendra Road, City Market, Bangalore, Karnataka 560002 India
| | - Vishma H. Shetty
- />Department of OBS & GYN, Vydehi Institute of Medical, Sciences and Research Institute, EPIP Area White Field, Bangalore, Karnataka 560066 India
- />Department of OBS & GYN, Bangalore Medical College and Research Institute, Sri Krishnarajendra Road, City Market, Bangalore, Karnataka 560002 India
| |
Collapse
|