Comparative evaluation of composite and simplified who partograms in a tertiary care centre in North India

Prachi Sarin Sethi, Sujata Sharma, Indu Chawla


Background: Early detection of abnormal progress and prevention of prolonged labour can significantly improve the outcome of labour. Partograph is an inexpensive tool which can provide a continuous pictorial overview of labour and is essential to monitor and manage labour. The objectives were to study the course of normal and abnormal labour and to evaluate the maternal and perinatal outcome using simple and composite WHO partogram.

Methods: This was a randomized study conducted at Department of Obstetrics and Gynaecology, Government Medical College, Amritsar, a tertiary care centre in North India. 200 women with term, singleton, vertex gestation, in spontaneous labor were included in the study. In 100 cases composite partograph was plotted and in rest 100 cases simple partograph was plotted. The following outcomes were compared: labor crossing the alert and action line, augmentation of labor, rate of cesarean section, perinatal and maternal outcome.

Results: The partogram crossed the alert line (p 0.008) and action lines (p 0.017), causing increased need for augmentation (p 0.034) in the composite partogram which was statistically significant. The numbers of vaginal deliveries were high (p<0.001) and decrease number of cesarean sections (p 0.007) and instrumental deliveries (p 0.009) in the simplified group. NICU admissions were also higher in the composite group (p<0.05), though most of the NICU admissions were due to hyperbilirubinemia and low birth weight and was not directly related to monitoring of labour.

Conclusions: It was observed in the present study that labour can be managed without the latent phase being plotted on the partograph. The interventions were higher when the latent phase was included, with increased number of labours crossing the alert and action lines, increased no. of augmentations and larger number of caesarean sections. Our study favours the use of the WHO modified partograph, which should become routine practice in monitoring labour for better maternal and perinatal outcome.


Action line, Alert line, Labour, Partogram

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