A realist review of the partograph: when and how does it work for labour monitoring?

Abstract

BackgroundThe 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.MethodsThis 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.ResultsThe 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.ConclusionsThis 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.

Cervical dilatation over time is a poor predictor of severe adverse birth outcomes: a diagnostic accuracy study

“…Although most healthcare providers working in maternity settings know about the partograph, it is frequently used retrospectively for recording purposes instead of providing prospective support for clinical decision making. Possible reasons for these shortcomings include difficulties in its use and interpretation 26, 27. Our findings suggest that the poor predictive performance of the partograph – and the consequent effect in supporting effective decision making – could contribute to the lack of interest in using the tool prospectively.…”

“…Possible reasons for these shortcomings include difficulties in its use and interpretation. 26,27 Our findings suggest that the poor predictive performance of the partographand the consequent effect in supporting effective decision makingcould contribute to the lack of interest in using the tool prospectively.…”

Partogram and its relevance in modern obstetrics

“…The evidence of its effectiveness is inconclusive, a Cochrane review suggested that overall use of the partograph did not significantly impact on a number of specified outcome. 17 Authors also, by our observation are doubtful of its effective use and application. The partogram was based on Friedman's labour curve, which has a doubtful validity today.…”

Recording Data Labour With Documentation Midwifery Based On Word Electric Browser (WEB)

“…Some of the things that affect the low recording in partographs are the level of knowledge of midwives about partographs which is not very influential in monitoring labor, recording documents and reporting partographs, making clinical decisions and planning future actions. During this time reporting and documentation by midwives was based on recording in partographs on paper, however, based on several studies said that there were still many midwives who did not complete the data in the partograph well and systematically, therefore a recording system, faster reporting and documentation of partographs in a computer and web-based data storage to facilitate the work of midwives in storing and re-accessing current and past labor history so as to prevent the accumulation of partograph files (Baillie, Chadwick, Mann, & Brooke-Read, 2013;Kitila, Gmariam, Molla, & Nemera, 2014;Asibong et al, 2014;Anita, 2016;Andrianto, 2017;Balikuddembe, Tumwesigye, Wakholi, & Tylleskär, 2017;Bedwell, Levin, Pett, & Lavender,…”