DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20221454

Analysis of labour by modified WHO partograph in primigravida and multigravida term patients: an observational study

Pushpa A. Yadava, Nausheen N. Gogia, Shital T. Mehta, Shashwat K. Jani, Silkey Mittal

Abstract


Background: The World Health Organization (WHO) recommends the use of a partograph to follow labor and delivery, with the aim of improving health care and reducing maternal and foetal mortality. The partograph is a graphic representation of events of labour and is an effective visual resource for early detection of abnormal progress of labour and prevention of prolonged labour. The aim of this study is to use partograph to monitor labor, analyse cervical effacement and dilatation, uterine contraction, foetal presentation while avoiding uterine hypo-stimulation, hyperstimulation and reducing the risk of sepsis, obstructed labor or postpartum haemorrhage (PPH).

Methods: This was a single year hospital-based observational study conducted in 2021 of the deliveries in Sardar Vallabhbhai Patel Institute of Medical Sciences and Research (SVPIMSR) and Sheth V.S General Hospital, Ahmedabad. Analysis of labor of 60 randomly selected patients was done using WHO modified partograph. The patients were classified as primigravida and multigravida. The partograph recording started at 4cm dilatation, continuous maternal and foetal monitoring was ensured throughout the labor and partogram was plotted against time in hours. Any deviations from the normal course were recorded.

Results: In this observational study, 60 patients were analysed. They were classified into primigravida and multigravida and based on the recordings from partograph further classified into mode of delivery. 3 out of 26 primigravida and 1 out of 34 multigravida patients underwent caesarean deliveries. 25 patients crossed the alert line and 4 patients crossed the action line. 5 deliveries out of 60 had APGAR score of <7 at 5 minutes.

Conclusions: The WHO modified partograph is highly effective in reducing both maternal and neonatal morbidity. It is an excellent visual resource to analyse cervical effacement and dilatation, uterine contraction and foetal presentation in relation to time. It is effective in early detection of abnormal progress of labor, prevention of prolonged labor, obstructed labor, PPH and improvement in neonatal outcome.


Keywords


Partograph, Primigravida, Multigravida, Maternal monitoring, Foetal monitoring

Full Text:

PDF

References


1. Philpott RH. Graphic records in labour. Br Med J. 1972;4:163.

Souza JP, Oladapo OT, Bohren MA, Mugerwa K, Fawole B, Moscovici L, et al. The development of a simplified, effective, labour monitoring-to-action Jain P et al. Int J Reprod Contracept Obstet Gynecol. 2021;10(5):1920-4.

Yisma E, Dessalegn B, Astatkie A, Fesseha N. Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia. BMC Pregnancy and Childbirth. 2013;13:17.

Lavender T, Hart A, Smyth R. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database Syst Rev. 2013;7:CD005461.

Harrison MS, Griffin JB, McClure EM, Jones B, Moran K, Goldenberg RL. Maternal mortality from obstructed labor: a MANDATE analysis of the ability of technology to save lives in sub-Saharan Africa. Am J Perinatol. 2016;33(9):873-81.

Asibong U, Okokon IB, Agan TU, Oku A, Opiah M, Essien EJ, et al. The use of the partograph in labor monitoring: a cross-sectional study among obstetric caregivers in general hospital, Calabar, Cross River state, Nigeria. Int J Women’s Health. 2014;6:873.

Mathai M. The partograph for the prevention of obstructed labor. Clin Obstet Gynecol. 2009;52(2):256-69.

Black RE, Laxminarayan R, Temmerman M, Walker N. Levels and causes of maternal mortality and morbidity. In: Reproductive, maternal, newborn, and child health: disease control priorities. Third edition (volume 2). Washngton, DC: The International Bank for Reconstruction and Development/The World Bank. 2016;3:51-70.

Kayiga H, Ajeani J, Kiondo P, Kaye DK. Improving the quality of obstetric care for women with obstructed labour in the national referral hospital in Uganda: lessons learnt from criteria based audit. BMC Pregnancy Childbirth. 2016;16(1):152.

Kabakyenga JK, Östergren PO, Turyakira E, Mukasa PK, Pettersson KO. Individual and health facility factors and the risk for obstructed labour and its adverse outcomes in south-western Uganda. BMC Pregnancy Childbirth. 2011;11(1):73.

Mukasa PK, Kabakyenga J, Senkungu JK, Ngonzi J, Kyalimpa M, Roosmalen VJ. Uterine rupture in a teaching hospital in Mbarara, western Uganda, unmatched case-control study. Reprod Health. 2013;10(1):29.

Kushwah B, Singh AP, Singh S, Kushwah B, Campus S, Huzur R. The partograph: an essential yet underutilized tool. J Evol Med Dent Sci. 2013;2(24):4373-9.

Penumadu KM, Hariharan C. Role of partogram in the management of spontaneous labour in primigravida and multigravida. Int J Reprod Contracept Obstet Gynecol. 2014;3(4):1043-9.

WHO. World Health Organization Partogram in management of labour. The Lancet. 1994:1399-404

Philpott RH, Castle WM. Cervicographs in the management of labour - the alert line for detecting abnormal labour. J Obstet Gynecol British Commonwealth. 1972;79(7):599-602.

Lakshmidevi, Malini KV, Shetty VH. Partographic analysis of spontaneous labour at term in primigravida. J Obstet Gynecol India. 2012;62(6):635-40.