ABSTRACT
Background:One of the major causes of maternal mortality is obstructed labor. Identificationof abnormal labor at earliest and timely management can prevent prolonged labor and significantly reduce its sequel. Partograph is a useful tool in hands of labor caregiversto monitor labor course.The study was done to compare feasibility of two WHO partographs a composite partograph including the latent phase with a simplified one without the latent phase to predict prolonged laborin randomized control trial.Methods:A randomized controlled trial, with parallel arm design was conducted. Sample size was calculated as 404 pregnant women .They were randomly categorized in two groups,each group having 202 participants.Results:labor had crossed the alert line in 108 (53.4%) cases monitored by composite partograph and 38(18.8%) cases monitored with simplified partograph. The calculated P value was <0.0001. The odds ratio calculate was 4.95 and 95% confidence interval was 3.16 to 7.76. Labor crossing the action line was found in 16 (7.9%) in composite partograph whereas in simplified partograph, labor had crossed the action line in 18 casesin simplified group. Calculated P value was 0.72 (>0.05). The odds ratio was 0.8793and 95% confidence interval 0.43 to 1.77 which was not significant statistically .Most participants (70%) experienced difficulty with the composite partograph, but no participant reported difficulty while plotting the simplified partograph. Conclusions: WHO simplified partograph was found to be as good as WHO composite partograph in identifying maternal and perinatal outcomes and was more user friendly.
ABSTRACT
Background: The number of maternal deaths as a result of obstructed labor is 8% globally but this number varies in developing country, it ranges 4-70% of all maternal deaths and it is also associated to high perinatal mortality rate. Objective of the study was to find out the proportion of obstructed labour cases and their feto-maternal outcome during last 3 years at tertiary level institute.Methods: A cross sectional observation study was done at Department of Obstetrics and Gynecology, People’s College of Medical Sciences and Research Centre Bhopal. All pregnant women presenting with obstructed labor who delivered at our hospital during last 3 years duration (January 2015 to December 2017) were studied for their feto -maternal outcome.Results: 53% cases had duration of trail more than 16 hours. 84% were referred from primary health centers of nearby rural areas. All cases of obstructed labor delivered by cesarean section (100%). 44% were primigravida. 72% of cases had Cephalopelvic disproportion as the cause. 28% of cases had longer stay more than 7 days at hospital. 32% had fever during post operative period 12.5% cases had wound sepsis and 6% of cases required re-suturing of wound during post operative period. 72% baby's birth weight was between 3 to 3.4 kg. 94% of the babies survived where as 6% of babies were still birth. 16% of babies born to obstructed labor mother had APGAR less than 7 at 5 minutes of birth. 6% fetus were IUFD.Conclusions: Cephalopelvic disproportion was the most common cause for obstructed labor. Timely identification of prolonged labor and timely referral and management at place where operation theatre, NICU and blood bank facilities are available can save the life of both baby and mother.