WHO next‐generation partograph: revolutionary steps towards individualised labour care?

Maaløe, Nanna; Roosmalen, Jos van; Dmello, Brenda Sequeira; Kwast, Barbara E.; Akker, Thomas van den; Housseine, Natasha; Kujabi, Monica Lauridsen; Meguid, Tarek; Kidanto, Hussein

doi:10.1111/1471-0528.16914

Cited by 7 publications

(10 citation statements)

References 13 publications

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“…The ndings from this study, that LCG has no different maternal and newborn outcome when compared with composite partograph, replicates the commentary published by Maaløe, et all, which concluded that, introduction of the LCG is not a key step in reducing the adverse events during the intrapartum care (15).…”

Section: Discussionsupporting

confidence: 88%

Labour outcomes among low-risk women using WHO next-generation partograph versus WHO composite partograph: A quasi-experimental study

Sospeter

Al‐beity

Kidanto³

et al. 2023

Preprint

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Background: Partogram is an important tool in the management of labor and delivery. Its correct use, has been shown to decrease maternal and newborn adverse events including deaths. In Tanzania, composite partograph is used as a standard of care. Recently, the World Health Organization (WHO) released Labour Care Guide (LCG), a next generation partograph which emphases on woman centered care. This study aimed to compare maternal and newborn outcomes among low-risk pregnant women who were monitored by using WHO LCG versus those who were monitored by using composite partograph. Methodology: This Quasi Experimental Study on LCG, was conducted at Mnazi Mmoja and Vijibweni hospitals in Dar es salaam, Tanzania. The following outcomes were compared as depicted in the WHO quality of care framework: mode of delivery, Post-Partum Hemorrhage, labour augmentation, duration of labor, maternal death, APGAR, admission to Neonatal Intensive Care Unit and perinatal death. Statistical analysis was done by using Statistical Package for Social Sciences. Stepwise logistic regression was done to identify factors associated with dichotomous outcomes. Adjusted Odds Ratio, and 95% confidence interval were used to present the results. P value <0.05 was considered significant. Results: A total of 482 women were enrolled; 241 in the intervention and 241 in the comparison group. There was no difference regarding maternal and newborn outcomes among women in the two study groups; Post-Partum Hemorrhage (p=0.69), Perineal trauma (p=0.65) and maternal death; APGAR score at 5 minutes (p=0.41), need for NICU admission (p= 0.80) and perinatal death (p=0.33). Parity of 3 and above was associated with better maternal outcome AOR= 3.05, 95%CI:1.40- 6.65; p=0.005 while augmentation of labour was associated with less chances of better maternal outcome AOR=0.33,95% CI: 0.16- 0.68: p= 0.003. Cesarean section was associated with poor newborn outcome AOR= 0.43, 95% CI: 0.19- 0 .96; p=0.04. Conclusion: From this study, monitoring labour in low-risk women using WHO LCG had similar maternal and newborn outcome when compared with use of a composite partograph.Large studies powered to compare maternal and newborn outcomes including high risk pregnant women in busy labour ward are highly recommended.

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Section: Discussionsupporting

confidence: 88%

Labour outcomes among low-risk women using WHO next-generation partograph versus WHO composite partograph: A quasi-experimental study

Sospeter

Al‐beity

Kidanto³

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Clear management guidelines with partograph use can improve outcomes [ 21 , 22 ]. Unfortunately, staffing and capacity gaps and other constraints have led to inadequate partograph use, and new WHO guidance on the partograph runs the risk of confusion leading to more prolonged labours ending in cesarean section, risking surgical complications such as iatrogenic fistula [ 22 , 23 ]. Training should emphasize the decision-making process that leads to cesarean birth, ensuring that cesareans are performed only when indicated.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic genito-urinary fistula following cesarean birth in nine sub-Saharan African countries: a retrospective review

Ngongo

Raassen

Mahendeka

et al. 2022

BMC Pregnancy Childbirth

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Background Genito-urinary fistulas may occur as complications of obstetric surgery. Location and circumstances can indicate iatrogenic origin as opposed to pressure necrosis following prolonged, obstructed labor. Methods This retrospective review focuses on 787 women with iatrogenic genito-urinary fistulas among 2942 women who developed fistulas after cesarean birth between 1994 and 2017. They are a subset of 5469 women who sought obstetric fistula repair between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. We compared genito-urinary fistula classifications following vaginal birth to classifications following cesarean birth. We assessed whether and how the proportion of iatrogenic genito-urinary fistula was changing over time among women with fistula, comparing women with iatrogenic fistulas to women with fistulas attributable to pressure necrosis. We used mixed effects logistic regression to model the rise in iatrogenic fistula among births resulting in fistula and specifically among cesarean births resulting in fistula. Results Over one-quarter of women with fistula following cesarean birth (26.8%, 787/2942) had an injury caused by surgery rather than pressure necrosis due to prolonged, obstructed labor. Controlling for age, parity, and previous abdominal surgery, the odds of iatrogenic origin nearly doubled over time among all births resulting in fistula (aOR 1.94; 95% CI 1.48–2.54) and rose by 37% among cesarean births resulting in fistula (aOR 1.37; 95% CI 1.02–1.83). In Kenya and Rwanda the rise of iatrogenic injury outpaced the increasing frequency of cesarean birth. Conclusions Despite the strong association between obstetric fistula and prolonged, obstructed labor, more than a quarter of women with fistula after cesarean birth had injuries due to surgical complications rather than pressure necrosis. Risks of iatrogenic fistula during cesarean birth reinforce the importance of appropriate labor management and cesarean decision-making. Rising numbers of iatrogenic fistulas signal a quality crisis in emergency obstetric care. Unaddressed, the impact of this problem will grow as cesarean births become more common.

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“…The combination of several strategies, rather than the type of techniques used, particularly improved women's self-efficacy, highlighting the multidimensional and complex nature of labor pain 1 . The promotion and use of non-pharmacological pain relief coping strategies is recommended by WHO 11 as part of respectful and supportive maternity care. Fetal and neonatal outcomes in relation to the use of coping strategies in labor were not reported by any of the selected article.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research on coping strategies mainly focused on these individually [7][8][9][10] , with international guidance partially covering them 5,11 and a systematic literature evidence synthesis of these not being available. The aim of this systematic review was therefore to explore coping strategies used by laboring women, related outcomes and factors influencing coping with labor pain.…”

Section: Introductionmentioning

confidence: 99%

Coping strategies for labor pain, related outcomes and influencing factors: A systematic review

Fumagalli¹,

Borrelli²,

Bulgarelli³

et al. 2022

Eur J Midwifery

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INTRODUCTION Laboring women's ability to cope with pain is likely to be dependent on a variety of inter-related factors, including the level of pain intensity, the nature of the environment and the perceived support. The aim of this systematic review was therefore to explore coping strategies used by laboring women, related outcomes and factors influencing coping with labor pain. METHODS A mixed-methods systematic review was undertaken. Electronic databases (Medline, EMBASE, CINAHL, PsycInfo) were searched to identify eligible studies from December 2020 to November 2021. The quantitative findings were narratively synthesized and reported thematically. The final mixed-methods synthesis involved gathering qualitative and quantitative data and producing a set of synthesized findings. RESULTS Twenty-three studies were included. Three themes were identified: 1) definition of coping and types of coping strategies, including behavioral and cognitive based techniques; 2) coping strategies related outcomes, including improvements in self-efficacy and reduction of pain intensity, fear, anxiety, time of admission and labor duration; and 3) factors influencing coping with labor pain, including continuity of carer; environment; presence of a birth companion; cardiotocography monitoring; and antenatal education. CONCLUSIONS This systematic review provides midwives and healthcare professionals with information to recognize coping strategies spontaneously adopted by laboring women and promote the use of a variety of techniques, as required by individual needs and preferences. Midwives are also provided with up-to-date knowledge on coping strategies related outcomes and influencing factors, which they can utilize to guide evidence-based practice decision-making and facilitate women and families' informed choice.

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WHO next‐generation partograph: revolutionary steps towards individualised labour care?

Cited by 7 publications

References 13 publications

Labour outcomes among low-risk women using WHO next-generation partograph versus WHO composite partograph: A quasi-experimental study

Labour outcomes among low-risk women using WHO next-generation partograph versus WHO composite partograph: A quasi-experimental study

Iatrogenic genito-urinary fistula following cesarean birth in nine sub-Saharan African countries: a retrospective review

Coping strategies for labor pain, related outcomes and influencing factors: A systematic review

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