Monitoring of labor with WHO modified partogram – A study report

Abstract

Introduction: Partogram represents labor events. World Health Organisation (WHO) had produced a partogram in the last decade and subsequently modified it to make it easier to use. The present study was conducted to note the effectiveness of the WHO modified partogram. Methods: Altogether 430 primigravida women, at term, having single live fetus in vertex presentation, were included for the study. The women were randomly subdivided into three groups: Group A (180 women) - monitoring of labor done by WHO modified partogram; Group B (150 women)- monitoring of labor done by WHO original partogram and 100 women in Group C (control), the labor would be monitored clinically. The results were noted in each group regarding the length of labor, vaginal delivery, cesarean sections, augmentation of labor etc. The results of Group A were compared with Group B and Group C. Result: The comparison of the results of the Group A and Group B did not reveal any statistically significant difference. The comparison of the results of the Group A and Group C observed that significantly less number of women in Group A (4.44%) was in labor for more than 12 hours than in Group C (18%). The number of vaginal delivery was more and cesarean section was less in Group A than Group C (p < 0.05). More number of women required augmentation of labor in Group C (p<0.001). Conclusion: WHO modified partogram, which is easier to use, gives almost the same effects as the WHO original partogram but significantly better results than clinical monitoring. DOI: http://dx.doi.org/10.3126/njog.v3i2.10824 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 8-11

Implication of the Two WHO Partographs, (Composite and Simplified) Regarding Maternal and Neonatal Outcome

“…Pvalue <0.05, it agrees with study at Belgaum-India (Kenchaveeriah et al, 2011), and study done at Calcutta (Alauddin et al, 2008). Of the laboring women randomized to the composite Partograph, 22.1% underwent cesarean section, in those with simplified group cesarean section was performed in 7.6% , p value <0.001 which was statically significant.…”

“…Of the laboring women randomized to the composite Partograph, 22.1% underwent cesarean section, in those with simplified group cesarean section was performed in 7.6% , p value <0.001 which was statically significant. Similar to study at Belgaum-India (Kenchaveeriah et al, 2011) and study from Calcutta had similar results (Alauddin et al, 2008). Published literature from Dublin-Ireland highlights 5.4 % of laboring women undergoing cesarean section in composite Partograph group (Impey and Lawrence, 2000).…”

“…While study at MedanIndonesia showed that obstructed labor occurred in 11 case when simplified Partograph was used (Fahdy and Chongsuvivatwong, 2005). Postpartum hemorrhage defined as blood loss of more than 500 ml after vaginal delivery and more than 1000 after cesarean section, there was no significant difference this is similar to study from Belgaum-India (Kenchaveeriah et al, 2011) and study at Calcutta (Alauddin et al, 2008). There was no similarity with result from study at Liverpool, where they had observed blood loss > 500 ml in 93 laboring women (Lavender et al, 1998).…”

“…This is in concordance with study at Belgaum-India, (Kenchaveeriah et al, 2011), and Vellore (Javed et al, 2007). While lower rates of augmentation observed in study done at Calcutta (Alauddin et al, 2008). The large WHO multicenter trial in south East Asia had augmentation in 10.6% of cases where composite Partograph was used (WHO, 1994).…”

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

“…11 A study done by Alauddin et al had 149 (82.7%) of cases who delivered vaginally in the simplified group and 71 (71%) in the composite group (p value 0.05, significant). 15 Windrim et al evaluate the effect of partogram use on the cesarean section and obstetric intervention rates conducted a randomized controlled trial of use of the partogram in 1932 primiparous women with uncomplicated pregnancies at term. 16 There was no significant difference between the groups in rates of cesarean section (partogram 24%, standard notes 25%), rates of other interventions, amniotomy, oxytocin use, or the mean cervical dilatation in labor.…”