Role of partogram in the management of spontaneous labour in primigravida and multigravida
Keywords:
Labour, Partogram, Prolonged labor, Alert line, Action lineAbstract
Background: The objective of this study was to analyze the patterns of labour amongst spontaneous parturients using a WHO modified partogram and compare outcomes of labour and their neonatal outcomes amongst the different partogram patterns
Methods: This prospective study was carried out in the labour room of the department of obstetrics and gynaecology of Acharya Vinoba Bhave rural hospital, Sawangi Meghe, Wardha, Maharashtra, over a period of two years i.e. from October 2012 to September 2014. Analysis of the progress of labour was done in two hundred and fifty women with the help of modified WHO partogram. The patients were divided into three groups. Group A whose partogram remained to the left of the alert line, group B whose partogram remained between the alert and action line and group C had their partogram crossing the action line. The different types of abnormal labour were studied. The maternal and fetal outcomes were assessed.
Results: 67.2% of the women belonged to group A, 22.8% to group B and 10% to group C. Surgical interference and requirement of augmentation increased as the labour curve moved to the right of the alert line. All patients delivered within 12 hours. Timely intervention reduced the incidence of prolonged labour and its sequelae. 82 patients showed abnormal labour patterns. There were no maternal death or neonatal death.
Conclusions: The use of modified WHO partogram significantly improves both maternal & neonatal outcome. Routine use of partogram should be implemented in all institutions and all labour rooms in India where delivery care is being given and especially in areas where operative and new-born facilities are lacking to facilitate early referral.
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References
Mishra R. Management of labour. In: Mishra R, eds. Practical Obstetric Problems. 6th ed. UK: Ian Donald; 2007: 506-521.
Iffat Javed, Shereen Bhutta, Tabassum Shoaib. Role of partogram in preventing prolonged labour. J Pak Med Assoc. 2007 Aug;57(8):408-11.
Neilson JP, Lavender T, Quenby S. Obstructed labour Reducing maternal death and disability during pregnancy. Br Med Bull. 2003;67(1):191-204.
Surekha Tayade, Pooja Jadhao. The impact of use of modified who partograph on maternal and perinatal outcome. IJBAR. 2012;03(04):256-62.
WHO, UNICEF, UNFPA, the World Bank. Trends in maternal mortality: 1990 to 2013. In: WHO, eds. Sexual and Reproductive Health. Geneva: WHO; 2014: 1-56.
Philpott RH. Graphic records in labor. Br Med J. 1972;4:163.
Friedman EA. Evolution of graphic analysis of labor. Am J Obstet Gynaecol. 1978 Dec;132(7):824.
World Health Organization. The partograph. A Managerial tool for the prevention of prolonged labour. In: WHO, eds. Section 1: The Principle and Strategy. WHO Document Number: WHO/MCH/88.3. Geneva: WHO; 1988.
Hendricks CH, Brenner WE. Normal cervical dilatation pattern in late pregnancy and labor. Am J Obstet Gynaecol. 1970;10:1065.
John Studd. Partograms and normograms of cervical dilatation in management of primigravida labor. Br Med J. 1973 Nov;4(5890):451-5.
Daftary SN, Mhatre PN. Cervicograph in the management of labour in primigravidas. J Obstet Gynaecol. 1997;27:687-91.
Sharmin S, Rashid M, Hazra SC, Khondker L. Implementation of partograph and its effect on outcome of spontaneous labour at term. Bangladesh Med J. 2012;41(1):42-4.
Lakshmidevi Muralidhar, Malini KV. Partographic analysis of spontaneous labour at term in primigravida; Shetty Vishma. J Obstet Gynaecol India. 2012 Nov-Dec;62(6):635-40.
Orji E. Evaluating progress of labor in nulliparas and multiparas using the modified WHO partograph. Int J Gynaecol Obstet. 2008;102(3):249-52.
Sanyal U, Goswami S, Mukhopadhyay P. The role of partograph in the outcome of spontaneous labour. NJOG. 2014 Jan-Jun;17(1):52-7.
