Comparative feasibility of two World Health Organization partographs to predict prolonged labour: a randomized control trial

Mohini Rajoriya; Ruchi Kalra

doi:10.18203/2349-3259.ijct20193674

Authors

Mohini Rajoriya Department of Obstetrics and Gynaecology, People's College of Medical Science, Bhopal, Madhya Pradesh, India
Ruchi Kalra Department of Obstetrics and Gynaecology, People's College of Medical Science, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2349-3259.ijct20193674

Keywords:

WHO composite partograph, WHO simplified partograph, Prolonged labor, Obstructed labor, Randomized control trial, Feto maternal outcome, Labor monitoring

Abstract

Background: One of the major causes of maternal mortality is obstructed labor. Identification of abnormal labor at earliest and timely management can prevent prolonged labor and significantly reduce its sequel. Partograph is a useful tool in hands of labor care givers to monitor labor course. The study was done to compare feasibility of two WHO partographs a composite partograph including the latent phase with a simplified one without the latent phase to predict prolonged labor in randomized control trial.

Methods: A randomized controlled trial, with parallel arm design was conducted. Sample size was calculated as 404 pregnant women .They were randomly categorized in two groups, each group having 202 participants.

Results: labor had crossed the alert line in 108 (53.4%) cases monitored by composite partograph and 38(18.8%) cases monitored with simplified partograph. The calculated P value was <0.0001. The odds ratio calculate was 4.95 and 95% confidence interval was 3.16 to 7.76. Labor crossing the action line was found in 16 (7.9%) in composite partograph whereas in simplified partograph, labor had crossed the action line in 18 cases in simplified group. Calculated P value was 0.72 (>0.05). The odds ratio was 0.8793 and 95% confidence interval 0.43 to 1.77 which was not significant statistically .Most participants (70%) experienced difficulty with the composite partograph, but no participant reported difficulty while plotting the simplified partograph.

Conclusions: WHO simplified partograph was found to be as good as WHO composite partograph in identifying maternal and perinatal outcomes and was more user friendly.

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Author Biographies

Mohini Rajoriya, Department of Obstetrics and Gynaecology, People's College of Medical Science, Bhopal, Madhya Pradesh, India

Post Graduate Resident

Department Of Obstetrics &Gynecology

Ruchi Kalra, Department of Obstetrics and Gynaecology, People's College of Medical Science, Bhopal, Madhya Pradesh, India

Professor ,Obstetrics &Gynecology

MD,FICOG ,CMCL FAIMER Fellow .

References

Friedman E. Graphic analysis of labour. Am J Obstet Gynecol. 1954;68:1568-75.

Hendricks CH, Brenner WE, Krans G. Normal cervical dilatation pattern in late pregnancy and labour. AJOG. 1970;106:1065-82.

Philpott RH. Graphic records in labour. Br Med J. 1972;4:163-5 .

Studd J. Partograms and Nomograms of cervical dilatation in management of primigravid labour. Br Med J. 1972;4:451-5.

Philpott RH, Castle WM. Cervicographs in the management of labour in primigravidae. II. The action line and treatment of abnormal labour. J Obstet Gynaecol Br Commonw. 1972;79:599-602.

Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015.

World Health Organization. Maternal Health and Safe Motherhood Programme. World Health Organization partograph in management of labour. Lancet. 1994;343:1399-404.

Kwast BE, Poovan P, Vera E, Kohls E. The modified WHO partograph: do we need a latent phase? African J Mid Women's Health. 2008;2(3):143-8.

Preventing prolonged labor: A practical guide. The Partograph Part II: User's Manua Maternal Health and safe Motherhood programme. Division of family health, WHO Geneva. Focus Gend. 1994;2(2):19-28.

World Health Organization. Maternal Health and Safe Motherhood Programme (‎1994)‎. Preventing prolonged labour: a practical guide: the partograph. World Health Organization. https://apps.who.int/ iris/handle/10665/58903. Last accessed 20 June 2019.

Kenchaveeriah SM, Patil KP, Singh TG. Comparison of two WHO partographs: a one year randomized controlled trial. J Turkish-German Gynecol Assoc. 2011;12:31-4.

Sethi PS, Sharma S, Chawla I. Comparative evaluation of composite and simplified who partograms in a tertiary care centre in North India. Int J Reprod Contracept Obstet Gynecol. 2017;6(11):5003-7.

Ghanghoriya V, Patel K. Study of partogram in relation to labour outcome and significance of alert line in partogram. Int J Reprod Contracept Obstet Gynecol. 2018;7(4):1361-6.

ACOG Committee Opinion No 766. Approaches to limit intervention during labor and birth. Obstetr Gynecol. 2019:133(2);e164-e173.

Alauddin M, Bal R, De A, Mondal P, Chakraborty M. Monitoring of labor with WHO modified partogram: a study report. NJOG. 2008;3(2):8-11.

Windrim R, Seaward PG, Hodnett E, Akoury H, Kingdom J, Salenieks ME, et al. A randomized controlled trial of a bedside partogram in the active management of primiparous labour. J Obstet Gynaecol Can. 2007;29(1):27-34.

Lavender T, Cuthbert A, Smyth RMD. Effect of partograph use on outcomes for women in spontaneous labour at termand their babies. Cochrane Database of Systematic Review. 2018;8 :Art noCD005461.

Mathews JE, Rajaratnam A, George A, Mathai M. Comparison of two World Health Organization partographs. Int J Gynecol Obstetrics. 2007;96(2):147-50.

Singh S, Singh V, Thakur T, Radhika AG, Mittal P, Kashyap JA, et al. Influence of hospital policy on partograph use in tertiary care facilities in India: a cross sectional survey. Int J Reprod Contracept Obstet Gynecol. 2017;6(11):4890-4.