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This article briefly describes principle and use of Partograph in obstetrical practices. This article includes objectives and scope of the tool, the WHO partograph model, the principle of partograph use, components of partograph, problems with the who partograph and advantages and disadvantages of partograph use.
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Background:Labour progress in partograph plotting helps to early recognition and prevention of the complication of labour. This helpful in better maternal and perinatal outcome. Aim of the study is to evaluate the maternal and perinatal outcome in primigravida and multigravida by comparing their partograph in labour.Material And Methods:This prospective observational study was carried out in Smt. SCL General Hospital a teaching tertiary care hospital from May-2018 to November-2019. Total 250 cases out of which 125 cases of primigravida and 125 cases of multigravida admitted in labour room were randomly selected and monitored by using modified WHO partograph. All the cases reporting to labour room and fulfilled the inclusion criteria were included in thisstudy. Individual partograph was studied to know the various aspect of course of labour.Result:208 out of 250 cases were before alert line, 34 cases were between alert and action line and 8 cases were beyond action line. Rate of cervical dilatation in most primigravida was between 1.1-2cm/hour and in multigravida was >2.1cm/hour. In Zone A, in primigravida 90.7% had VD and 9.3% had LSCS whereas in multigravida 96.4% had VD and 3.6% had LSCS. In Zone B, in primigravida 47.8% had vaginal delivery and 52.2% had LSCS whereas in multigravida 54.4% had VD and 45.5% LSCS. In Zone C, in primigravida and multigravida there were no VD and 100% had LSCS. Protracted active phase (50%) was presents the most common abnormality of first stage of labour in both group inpresent study and in second stage, arrest of decent (82%) was more common. In both groups, NICU admission were more in Zone C (3.2%) as c ompared to Zone A (2%) and Zone B (1.6%).Conclusion:This study has shown that using the partograph can be highly effective in reducing complications from both mother and neonate. It is also helpful in monitoring of labour and early diagnosis of abnormal labour. It prevents maternal mortality and morbidity.
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Background: Induced or spontaneous labour has implication on the eventual mode of delivery and neonatal outcome. The aim of study is to compare mean duration of labour andmaterno-foetal outcome of induced versus spontaneous labour among nulliparous women using modified WHO partograph.Methods: The study was conducted in nulliparous women coming at term in active phase of labour (with cervical dilatation at least 4 cm) either spontaneous or induced, both labouring women were monitored using modified WHO partograph. Outcomes measures include requirement of augmentation of labour with oxytocin, mean duration of labour, eventual mode of delivery and the materno foetal outcome.Results: A total 100 women were compared in each group. There was no difference in mean age group, BMI, gestational age. More women had spontaneous vaginal delivery among those with spontaneous labour (76% versus 58%) (p=0.033). The mean duration of second stage of labour was significantly more in induced labour (16.25 minutes) than in spontaneous labour (14.60 minutes) (p=0.0212). The mean Apgar scores were comparable in two groups. Induced labour is comparable to spontaneous labour regarding fetomaternal outcomes but with increased rate of caesarean deliveries.Conclusions: Study concluded from our study that in spontaneous group mean duration of labour was less than induced group and most of the patient delivered vaginally. In induced group rate of caesarean was higher and requirement of oxytocin for labour augmentation was also more than spontaneous group. Maternal complications were also found more in induced group than spontaneous group whereas neonatal outcome was similar in both the groups. We observed in our study that induced labour can be a safe procedure among nulliparous women if labour is partographically monitored by WHO modified partograph.
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Obstructed labour is the situation where in spite of adequate uterine contraction the progressive decent of presenting part is arrested due to mechanical obstruction. Obstructed labour contributes to around eight percent of maternal deaths in India. It is also one of the leading causes of perinatal morbidity and mortality in developing countries. We wanted to study the risk factors and fetomaternal outcome in obstructed labour at Chittaranjan Seva Sadan College of Obstetrics, Gynaecology and Child Health. This will help us to assess obstetric near miss cases and to develop strategies to decrease the complications arising from obstructed labour.METHODSThis was a three year retrospective observational study conducted by reviewing the records of obstructed labour during the period April 2014 - March 2017. The study was approved by Institutional Ethics Committee. All the mothers who were admitted in the labour room with signs and symptoms of obstructed labour were included in this study. All the relevant information such as age, parity, socioeconomic status, risk factors, complications, mode of delivery, and fetomaternal outcome were collected.RESULTSThere were 219 cases of obstructed labour among a total of 23,815 deliveries. Most common cause for obstructed labour was cephalopelvic disproportion (77%) followed by malposition/malpresentation (17.3%). Majority of the patients (69.2%) belonged to poor socioeconomic group. Sepsis (10.6%) and pyrexia (9.6%) were the common complications. Neonatal mortality was 30.8% and maternal morbidity was 5.8%.CONCLUSIONSLack of health education, antenatal care, low socioeconomic condition, poor referral system and demographic factors are important contributory factors leading to adverse outcome of obstructed labour. This can be sorted out by proper antenatal care, improving health care delivery system and by timely referral of cases according to partograph monitoring.
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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.
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Background: The progress of labour can be graphically represented using the WHO partogragh, which helps in early detection and prevention of complication of labour, thus resulting in a better feto-maternal outcome especially in high risk cases.Methods: The study was undertaken at Hitech Medical College and Hospital, Bhubaneswar from March 2017 to February 2019 on 200 high risk patients. The progress of labour was plotted and assessed on Modified WHO partograph.Results: Majority of the cases were referred cases. Augmentation of labour was carried out in 56 cases. The mean duration of labour in the first stage was 5.4 hours and 4.1 hours in primi and multigravidas, whereas that of the second stage of labour are 37.5 minutes and 26.3 minutes respectively. 51 cases had prolonged labour and 15 cases had arrest of labour in the second stage. Maximum number of cases underwent LSCS due to abnormal labour progression. 8.7% of the cases had PPH and 2.3% had puerperal sepsis. Neonatal asphyxia was seen in 13.6% cases and 2.8% had early neonatal death.Conclusion: The results conclude that the WHO modified partograph is an inexpensive useful tool in monitoring the progress of labour and reducing foeto maternal morbidity in high risk groups.
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Background: Modified WHO Partograph is a simple, inexpensive pre-printed form on which labour observation are recorded. It generally comprises three sections of information: maternal condition, fetal condition and labor progress. To study on usefulness of Modified WHO Partograph in management of labour of low risk women, this indirectly improved maternal and perinatal outcome.Methods: In this study the progress of labour of 150 women with uncomplicated full term pregnancies with cephalic presentation in active labour was studied using modified WHO partograph. 150 historical matched controls comprising of low risk women who delivered without the use of partograph were identified from the labour register and their course of labour studied. The hospital records were studied to obtain the demographic variables. Maternal and perinatal outcome was analyzed for both cases and controls.Results: The emergency cesarean section rate was reduced from 38.7% in controls to 24.7% in cases and both are significant statistically. None of the cases had labour beyond 16 hours, thus indicating significant reduction in prolonged labour. Neonatal intensive care admissions decreased from 18.6% in controls to 6% in cases indicating an improved maternal and neonatal outcome.Conclusions: Modified WHO Partograph work as “early alarming warning system” which help in detecting delayed progress of labour which improves maternal as well as perinatal outcome.
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Study design: This is a cross-sectional study which reports the development and pilot of a digital mobile partograph application in 5 primary healthcare centers of North Karnataka, India. Background: The DAKSH is a tablet-based application designed to improve care for women in the intrapartum period by addressing the issue related to paper partograph usage. Application is designed to provide real-time labor monitoring, basic decision making support by alerts and better record-keeping. The primary objective of the study was to evaluate the feasibility and acceptability of mobile partograph in low resource primary healthcare centers. Methods: The digital partograph was introduced at 5 primary healthcare centers in North Karnataka, India. Following 2 days of training, remote monitoring was done through a dashboard and a bi-monthly evaluation visit was conducted. Results were analyzed in terms of quantitative analysis (data filled into the application was compared against hospital records) and qualitative analysis (during each bi-monthly visit staff nurses were interviewed). Results: A total of 10 staff nurses from these healthcare centers used the application to monitor 424 pregnancies for a period of 10-months. During this period the hospital observed around 463 childbirths and out of which 91.56% (n=424) were recorded into the application. Conclusion: This shows good acceptability of application among staff nurses. Plotting of partograph, auditory reminders to monitor labour vitals were helpful.
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Background & objectives: India has recorded a marked increase in facility births due to government's conditional cash benefit scheme initiated in 2005. However, concerns have been raised regarding the need for improvement in the quality of care at facilities. Here we report the monitoring patterns during labour and delivery documented by direct observation in reference to the government's evidence-based guidelines on skilled birth attendance in five districts of India. Methods: A cross-sectional study design with multistage sampling was used for observation of labour and delivery processes of low-risk women with singleton pregnancy in five districts of the country. Trained research staff recorded the findings on pre-tested case record sheets. Results: A total of 1479 women were observed during active first stage of labour and delivery in 55 facilities. The overall frequency of monitoring of temperature, pulse and blood pressure was low at all facilities. The frequency of monitoring uterine contractions and foetal heart sounds was less than the expected norm, while the frequency of vaginal examinations was high at all levels of facilities. Partograph plotting was done in only 15.8 per cent deliveries, and labour was augmented in about half of the cases. Interpretation & conclusions: The findings of our study point towards a need for improvement in monitoring of maternal and foetal parameters during labour and delivery in facility births and to improve adherence to government guidelines for skilled birth attendance.
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Objectives: This study was to analyse the patterns of labour amongst term primigravida in active labour using WHO modified partograph & study the outcomes of labour, mode of delivery & neonatal outcomes amongst the different partograph pattern. Method: A retrospective study was carried out analysed on 270 primigravida women by using WHO modified partograph in the labour room, Department of Obstetrics & Gynaecology, Belagavi institute of Medical Sciences, Belagavi, Karnataka. This was carried during the months of November and December 2017. The women were divided into 3 groups. Group I includes women whose partograph remained to the left of the alert line. Group II includes women whose partograph remained between alert line and action line & group III includes women whose partograph crosses action line. The different types of abnormal labour, maternal & neonatal outcomes was studied in each of the three groups. Statistical analysis: was done by Chi-square test. Result: Among 270 women, 178 (65.92%) cases belonged to group I, 62 (22.96%) belonged to group II and 30 (11.11%) belonged to group III. Cervical dilatation was at the rate of 1.5 cm per hour in group I. 0.9 cm per hour in group II and 0.6 cm per hour in group III. The mean duration of active phase of labour were 4.3 hrs, 6.9 hrs and 10.15 hrs in group I, II and III respectively. Conclusion: Surgical interference, requirement of augmentation and mean duration of active phase of labour increased as the labour curve moved to the right of alert line. Increased rate of instrumental deliveries, LSCS, babies with lower APGAR score at 5 minute and NICU admissions were observed in group III compared to group I and II.
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Background: The management of labour and its complication is an issue of great importance worldwide. Still it is unclear from available information that when to admit a Women in labour in order to achieve maximum maternal and fetal benefit. The present study was an attempt to assess how the outcome of woman changed with timing of admission either in active or latent phase of spontaneous labour in a tertiary care hospital. Aim: 1) To determine and compare the rate of intervention among low risk women admitted in latent and active phase of labour. 2) To determine and compare the rate of complications among them. 3) To determine and compare the foetal APGAR Scores and admission to NICU. Methods: It’s a cross-sectional observational study, conducted at NIMS Hospital, Jaipur from a period between October 2015 to July 2016 with Sample Size of 180 low risk term women presenting during latent or active phase of labour. Result: Out of 180 patients, 96 patients (53.3%)were admitted during latent phase (group I) and 84 patients (46.7%) during active phase of labour (group II). Duration of labour was significantly greater in-group I compared to group II (mean± SD 17.0 ± 2.1 vs 12.7 ± 3.2). Caesarean was more in group I compared to group II (62.5% vs 28.5%) which was significant. Most common indication of caesarean was dystocia followed by fetal distress. Augmentation with oxytocin was required in 66 cases (68.75%) in group I and 42 cases (50.0%) in group II and the difference was not significant. Although PPH, cervical and perineal tear,fetal distress was more in group I but the difference was insignificant.
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Introduction: The partograph, a graphic recording of labour and features in the mother and fetus has been used since 1970 to detect labour that is not progressing normally. The partograph serves early warning system and assist in early decision of transfer, augmentation and termination of labour. It also increases the quality and regularity of observing mother and fetus in labour. Material and methods: It was a prospective observational study conducted in the Department of Obstetrics and Gynaecology at Dhiraj General Hospital, Pipariya, Waghodiya during the period of 6 months. Total 100 patients were enrolled in my study. Plotting on partogram was started at cervical dilation > 4 cm dilation on alert line. Induction was done in needed cases. Augmentation was done as per requirement. Results: 48% cases were Primigravida and 52% cases were multigravida. Mean gestational age was 38.8 weeks. In 88% cases delivered spontaneous and 12% cases required induction of labour. 18.2% of spontaneous onset patients crossed the alert line as compared to 66.66%in the induced group. 72.7% patients in spontaneous group had vaginal delivery, 23.86% had LSCS and 3.4% had instrumental delivery. 25% patients in induced group had vaginal delivery, 75% had LSCS. 96% neonate had no morbidity. Conclusion: The proper use of partograph and application of the right decision at the right time that we can achieve the best for maternal and neonatal outcome
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Background: Obstructed labour and ruptured uterus contribute a significant proportion to the alarming maternal mortality ratio in sub-Saharan Africa. Proper management of labour by using the partograph, a simple tool that is designed to detect early signs of abnormal progress, can significantly reduce incidence and complications of prolonged labour. Objective: The objective of this study was to assess the knowledge and utilization of the partograph among non-physician obstetric health care providers in University of Calabar Teaching Hospital (UCTH). Methods: This was a descriptive cross-sectional survey which employed the use of a semi-structured self-administered questionnaire with purposive sampling conducted among 132 consenting non-physician obstetric health care providers in UCTH. Results: The mean age of the respondents was 37.84±9.38 years. About 66% of them used partograph but only 13.6% of those who had used partograph were very confident with the tool in monitoring labour. Fifty-six percent of them had received formal training on partograph. Only 34 percent of those surveyed could correctly interpret various sections of the partograph, like the cervicogram. The main reasons for non-utilization of the partograph were inadequate knowledge (73.5%), non-availability (46.2%) and shortage of manpower (34.8%). Knowledge of the partograph (X2=38.1, P=.00) and partograph availability (X2=52.5, P=.00) significantly affected its utilization. Years of experience did not significantly influence partograph use. Conclusion: The knowledge and utilization of the partograph in our hospital can be enhanced by periodic training and retraining of obstetric care givers, developing protocols, ensuring its availability, as well as increasing the staff strength in the delivery units.
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In diagnosis of obstructed labor, beside the line of cervical dilation comes to the right of the alert line and crosses the action line, the line of descent of fetal presentation should be noted. After 4 hours, if the contractions occur with frequency of 3 and last for 20 to 40 seconds and the fetal head has not descended further, it should be considered as a sign of obstructed labor. The partograph that was designed according to national standard is proper and useful in decision of cesarean section.
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Cesarean Section , ParturitionABSTRACT
The author analyzed 102 cases of Cesarean section at Hµ T©y Hospital. 4 main indications have been identified: 1) dystocia; 2) breech presentation; 3) previous Cesarean section; and 4) failure of augmentation of labor. Partograph is a useful tool to detect when a Cesarean is needed. If the patient has arrest of dilatation, arrest of descent or a fetal distress