New World Health Organization labour care guide in reducing intrapartum caesarean section rates at tertiary care hospital-Hassan institute of medical sciences, Hassan


  • Poornima H. N. Department of Obstetrics and Gynaecology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
  • Nayanashree V. Department of Obstetrics and Gynaecology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
  • Premalatha H. L. Department of Obstetrics and Gynaecology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
  • Nirmala Doreswamy Department of Obstetrics and Gynaecology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India



Labour care guide, Cesarean section rate, Active phase of labour


Background: The Aim of this study was to assess whether labour monitoring using new WHO LCG will result in reducing intra partum caesarean sections.

Methods: A analytical study was conducted from the month of September 2022 to January 2023 among 1735 pregnant women admitted at Hassan institute of Medical Sciences, in active phase of labour (5cm cervical dilatation and above) after obtaining informed consent.

Results: In the present study, the New WHO Labour Care guide was plotted for 1735 pregnant women among which 1668 (96%) of the total patients had vaginal delivery, while 67 (4%) of the patients underwent Cesarean Section. Among the patients who underwent Cesarean Section it was found that1082 (94%) of the total Cesarean Sections were in latent phase of labour before plotting of the new WHO Labour care guide whereas only about 67 (6%) of Cesarean Section were conducted in active phase of labour.

Among the patients who underwent LSCS in the active phase of labour majority were due to fetal distress 29(43%), 21(31%) due to Cephalopelvic disproportion, 13(20%) due to Non progression of labour and about 4(6%) due to Deep Transverse Arrest

Conclusions: Majority of the caesarean sections were conducted in the latent phase of labour. The New WHO Labour Care guide has reduced the occurrence of intrapartum caesarean sections in the active phase of labour. However the overall rate of caesarean section must be controlled by reducing the number of Cesarean Sections conducted in latent phase of labour, that is before plotting the New WHO labour care guide.


Boerma T, Ronsmans C, Melesse DY, Barros AJ, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341-8.

Radhakrishnan T, Vasanthakumari KP, Babu PK. Increasing trend of caesarean rates in India: evidence from NFHS-4. J Med Sci Clin Res. 2017;5(8):26167-76.

Why C section deliveries are rising at an alarming rate in India. Available at: gender/c-section-births-33358. Accessed on 12 January 2023.

Chaillet N, Dubé E, Dugas M. Identifying barriers and facilitators towards implementing guidelines to reduce cesarean section rates in Quebec. World Health Org Bull. 2007;85(10):791-7.

WHO labour care guide: user’s manual. Available at: 9789240017566. Accessed on 12 January 2023.

Skilled birth delivery (SBA)- Joint UNICEF/WHO database. Available at: topic/maternal-health/delivery-care/. Accessed on 12 January 2023.

Hofmeyr GJ, Bernitz S, Bonet M. WHO next-generation partograph: revolutionary steps towards individualised labour care. BJOG. 2021;128:1658-62.

Vogel JP, Comrie-Thomson L, Pingray V. Usability, acceptability, and feasibility of the World Health Organization Labour Care Guide: A mixed-methods, multicountry evaluation. Birth. 2021;48(1):66-75.

Pandey D, Bharti R, Dabral A. Impact of WHO Labor Care Guide on reducing cesarean sections at a tertiary center: an open-label randomized controlled trial. Am J Obstet Gynecol Glob Rep. 2022;2:100075.

Anna M, Teresa C, Dena G. Cesarean delivery trends among patients at low risk for cesarean delivery in the US, 2000-2019. JAMA. 2023;6(3):e235428.

Vogel A, Pingray L, Althabe V. Implementing the WHO Labour Care Guide to reduce the use of Caesarean section in four hospitals in India: protocol and statistical analysis plan for a pragmatic, stepped-wedge, cluster-randomized pilot trial. Reprod Health. 2023;20:18

Ghulaxe Y, Tayade S, Huse S. Advancement in Partograph: WHO’s Labor Care Guide. Cureus. 2010;14(10):e30238

Patabendige T, Wickramasooriya P, Dasanayake V. WHO Labor Care Guide as the next generation partogram: Revolutionising the quality of care during labor. Eur J Midwifery. 2021;5(7):26.






Original Research Articles