Comparative analysis of WHO labour care guide versus WHO modified partogram on labour outcomes
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20263041Keywords:
Caesarean section, Intrapartum care, Labour care guide, Maternal satisfaction, Neonatal outcomesAbstract
Background: Effective intrapartum monitoring is essential for improving maternal and neonatal outcomes while minimizing unnecessary obstetric interventions. The World Health Organization (WHO) labour care guide (LCG) is an updated labour monitoring tool that emphasizes individualized assessment and respectful maternity care compared with the WHO modified partogram. This study compared labour outcomes between these two approaches.
Methods: A prospective randomized controlled trial was conducted among 300 women with term singleton pregnancies in spontaneous active labour with cephalic presentation at a tertiary care centre. Participants were randomized to labour monitoring using the WHO labour care guide (n=150) or the WHO modified partogram (n=150). The primary outcome was mode of delivery. Secondary outcomes included labour characteristics, maternal complications, neonatal outcomes, and maternal satisfaction assessed using the birth satisfaction scale-revised.
Results: The WHO LCG group had a significantly higher normal vaginal delivery rate than the modified partogram group (85.33% versus 68.67%; p=0.001) and a lower caesarean section rate (14.67% versus 31.33%). The active phase of labour was significantly shorter (4.56±0.99 versus 4.95±1.13 hours; p=0.002). Non-progress of labour as an indication for caesarean section was less frequent (9.09% versus 42.55%; p=0.028). Maternal complications and neonatal outcomes were comparable, whereas maternal satisfaction was significantly higher with the WHO LCG (96.00% versus 88.67%; p=0.014).
Conclusions: The WHO labour care guide improved labour outcomes by increasing vaginal deliveries, reducing caesarean sections, shortening labour duration, and enhancing maternal satisfaction without compromising neonatal outcomes.
References
Hutchison J, Mahdy H, Jenkins SM, Hutchison J. . Normal Labor: Physiology, Evaluation, and Management. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026.
Wei Y, Luo H, Liu X, Sun G, Liu J, Wei X, et al. Global, regional, and national levels of maternal mortality, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. BMC Pregnancy Childbirth 2025;25(1):1359.
Friedman E. The graphic analysis of labor. Am J Obstet Gynecol. 1954;68:1568-75.
Philpott RH, Castle WM. Cervicographs in the management of labour in primigravidae. I. The alert line for detecting abnormal labour. J Obstet Gynaecol Br Commonw. 1972;79:592-8.
World Health Organization partograph in management of labour. World Health Organization Maternal Health and Safe Motherhood Programme. Lancet. 1994;343:1399-404.
Mathai M, Engelbrecht SM, Bonet M. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Second edition. Geneva: World Health Organization: UNFPA: UNICEF; 2017.
Zhang J, Troendle J, Mikolajczyk R, Sundaram R, Beaver J, Fraser W. The natural history of the normal first stage of labor. Obstet Gynecol Survey. 2010;65(7):414-5.
Laughon SK, Branch DW, Beaver J, Zhang J. Changes in labor patterns over 50 years. Am J Obstet Gynecol. 2012;206(5):419.e1-9.
Lavender T, Cuthbert A, Smyth RM. Effect of partograph use on outcomes for women in spontaneous labour at term and their babies. Cochrane Database Syst Rev. 2018;8:CD005461.
Ollerhead E, Osrin D. Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2014;14:281.
World Health Organization. WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018.
World Health Organization. WHO labour care guide: user’s manual. Geneva: World Health Organization; 2020.
Oladapo OT, Souza JP, Fawole B, Mugerwa K, Perdoná G, Alves D, et al. Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries. PLoS Med. 2018;15(1):e1002492.
Vogel JP, Comrie‐Thomson L, Pingray V, Gadama L, Galadanci H, Goudar S, et al. Usability, acceptability, and feasibility of the World Health Organization Labour Care Guide: a mixed-methods, multicountry evaluation. Birth. 2021;48:66-75.
Hollins Martin CJ, Martin CR. Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R). Midwifery. 2014;30:610-9.
Singh KA, Singhal S, Sharma R, Khan I. Comparative evaluation of maternal and neonatal outcomes using the WHO labour care guide versus the WHO-modified partograph: a prospective observational study. Int J Reprod Contracept Obstet Gynecol. 2025;14(10): 3392-7.
Priya KV, Kori S, Yaliwal RG, Malapure P, Sangolli L, Priya Jr KV. A comparative observational study on the WHO labour care guide versus the who modified partograph on labour outcome. Cureus. 2026;18(1).
Pandey D, Bharti R, Dabral A, Khanam Z. Impact of WHO labor care guide on reducing cesarean sections at a tertiary center: an open-label randomized controlled trial. AJOG Glob Rep. 2022;2(3):100075.
Jogi SR, Singh D, Kanwar R. A comparative open label randomized controlled trial to evaluate feto-maternal outcome in spontaneous labour between WHO labour care guide versus WHO modified partograph. CME J Geriatr Med. 2025;17:68-76.
Mugyenyi GR, Tumuhimbise W, Atukunda EC, Tibaijuka L, Ngonzi J, Kayondo M, et al. Effectiveness of the modified WHO labour care guide to detect prolonged and obstructed labour among women admitted at eight publicly funded, midwife-led community health facilities in rural Mbarara District, Southwestern Uganda: an ambispective cohort study. Int J Women’s Health. 2025:271-85.
Srividya N, Lakshmi SJM. A study on implementation of WHO labour care guide in low-risk pregnant women and its impact on maternal and perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2023;12:226-30.
Fayaz I, Qureshi A, Iqbal A. Comparison of labour outcome using the new WHO labour care guide versus standard partogram in a tertiary care hospital in Kashmir. Int J Clin Obstet Gynecol. 2025;9:1269-73.
Downloads
Published
How to Cite
Issue
Section
