A comparative study of 4-hour versus 2-hour action line on who modified partograph

Abstract

Background: World health organization has promoted modified partograph with action line, 4 hour to left of alert line. While others have used various action line 2, 3, or 4 hours to initiate and guide ‘‘active management’’ decisions. Objectives of the study were to evaluate outcome of labour in terms of caesarean section rate, augmentation of labour and fetal outcome in whom labour has been managed with 4-hour vs 2-hour action line on WHO modified partograph.Methods: This was a randomized, prospective, comparative study. Primigravida, 19-28 years, with single live foetus in vertex presentation without any medical and obstetrical complications, at term pregnancy have been included in the study. Results were compared between Group A, with 100 cases, in whom labour has been managed with WHO modified Partograph with 4-hour action line and Group B, with 100 cases, in whom labour has been managed with that of 2-hour action line.Results: The present study shows that more women in 2-hour arm crossed the action line, compared with the 4-hour arm, and therefore received more interventions to augment labour. Rate of caesarean section is more in group B (11%) than in group A (9%) which is statistically nonsignificant.Conclusions: Neonatal outcome measured with APGAR score at 5 minute, has shown no significant difference in both groups. Therefore, partograph with 2-hour action line doesn’t show any superiority over that of 4-hour action line but to be associated with higher incidence of intervention. Further research is required in this field of active management.

Labor curves based on cervical dilatation over time and their accuracy and effectiveness: A systematic scoping review

“…The full texts of 435 articles were screened, leading to the exclusion of 327 articles, mainly because they were unrelated to the topic of interest or were not research articles (e.g., commentaries and posters). In total, 108 studies were included in the review (Fig 1): 73 described labor curves [4,7,14,, 26 assessed curve accuracy [2,3,7,8,31,32,81,[96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114], and 13 assessed curve effectiveness [1,15,[115][116][117][118][119][120][121][122][123][124][125]. 4 studies described both labor curves and their accuracy [7,31,32,81].…”

“…Of the 13 studies evaluating the effectiveness of labor curves, 4 were from Norway [115][116][117]124]; 2 each were from England [118,119], Australia [120,121], and India [123,125]; 1 each was from Southeast Asia (Indonesia, Malaysia, and Thailand) [1] and Nigeria [122]; and 1 was a systematic review including studies from multiple countries [15]. The studies were published in 1994-2023, with the earliest being the WHO's longitudinal randomized controlled trial (RCT) comparing partograph designs [1].…”

“…The studies were published in 1994-2023, with the earliest being the WHO's longitudinal randomized controlled trial (RCT) comparing partograph designs [1]. This study was followed by two RCTs conducted in England and published in 1998 [118] and 2006 [119], and 10 studies published between 2017 and 2023 [15,[115][116][117][120][121][122][123][124][125]. Six studies each had <1000 participants [118,[120][121][122][123]125] and 1000-10,000 participants [15,[115][116][117]119,124], and one study had 35,484 participants [1].…”

“…Most outcomes used to assess the effectiveness of labor curves were related to obstetric interventions, such as the mode of birth [1,15,115,[118][119][120][121][122][123]125], oxytocin augmentation [1,15,115,116,118,119,[121][122][123]125], and artificial rupture of membranes (ARM) [15,115,118,119,121,125]. Maternal outcomes included the duration of labor [1,15,[117][118][119][121][122][123], postpartum hemorrhage or blood transfusion as a proxy [15,115,118,119,[121][122][123], maternal satisfaction or childbirth experience [15,118,119,121,122,124], and perineal trauma …”

“…Maternal outcomes included the duration of labor [1,15,[117][118][119][121][122][123], postpartum hemorrhage or blood transfusion as a proxy [15,115,118,119,[121][122][123], maternal satisfaction or childbirth experience [15,118,119,121,122,124], and perineal trauma [15,115,120]. Perinatal outcomes included the Apgar score [15,115,[118][119][120][121][122]125] and umbilical cord pH [15,115,[118][119][120][121], in some studies as part of composite neonatal outcomes [120,121].…”