Using Alert and Action Expected Times of Delivery in Prevention of Prolonged Labor

Abstract

Background and Objective: Although globally admitted as the most valuable tool to prevent prolongation of labor, the partogram has failed to be commonly used. This is due to its alleged complexity. Based on the simplified model proposed by Debdas, the so called paperless partogram, we aimed at evaluating the ability of only using the alert and action lines to prevent prolongation of labor. Methods: This was a cross-sectional study including labor records of women delivered at King Baudouin Hospital of Kinshasa (secondary level) from 01/01 till 31/12/2013. The study was approved by the Faculty Ethical Committee. Inclusion criteria were: 1) live singleton pregnancy, 2) cephalic fetal presentation, 3) lack of uterine scar, 4) monitoring in labor ward by 4 cm of cervical dilation, and 5) delivery at term. For every record, the expected time of delivery (ETD = 6 hours after 4 cm of cervical dilation) was considered "Alert EDT" to which 4 hours were added to obtain the "Action EDT". Irrespective of other fetal and maternal features contained in the traditional partogram Alert and Action ETD were checked a posteriori on Debdas's model to derive the appropriate outcome of labor. Results: The study included 357 participants, of which 219 primiparous and 138 multiparous. Vaginal delivery took place in 91% of cases. Full cervical dilation was achieved after 8-9 hours (9.5 ± 1.8 hours for primiparous and 8.4 ± 1.7 hours for multiparous women), namely 2-3 hours following Alert ETD). This duration is close to the Action ETD. For 32 cesarean sections (9%) final decision took place within the Alert ETD. Conclusion: Using only Alert and Action ETD was found convenient to derive appropriate measures for the outcome of labor. So, the paperless partogram is a simplified method to manage the active stage of labor that could prevent prolongation of labor in our setting.

Expert perspectives on essential parameters to monitor during childbirth in low resource settings: a Delphi study in sub-Saharan Africa

“…Besides, we didn’t seek new parameters for childbirth monitoring but rather the identification of the (non)contentious ones and seek convergence. The initial round was informed by a synthesis of the existing childbirth management guidelines and literature review on partograph use [2, 7, 15, 18, 19, 21, 23, 25, 30]. A synopsis was provided to potential participants in the invitation email and in the introduction of the questionnaires.…”

“…To address usability, some researchers have suggested simpler childbirth monitoring without adverse effects on pregnancy outcomes [5, 15, 18]. Moreover, other authorities called for a revamp of the partograph citing changed physiology of labour over time [19, 20], which attracted a backlash from traditionalists and realists [21–23].…”