Partogram and its relevance in modern obstetrics
Keywords:Labor abnormalities, Partogram, Relevance in modern obstetrics, Utility
Background: Normal labor and childbirth is fraught with complexities. In the modern times the child birth has proven to be more challenging than ever. Partogram has proven to be a simple and useful tool in monitoring normal labor. The objective of this endeavor was to site our experiences in using partogram for ‘plotting’ labors, to assess its utility, limitations and cite controversies.
Methods: Authors analyzed progress of labor plotted on partograms in parturient women to see whether their labor patterns conform to the standard partogram, and can logical conclusions be drawn from their use to decide partogram’s utility and applicability.
Results: The use of partogram was not universal and its charting inadequate due to lack of motivation on part of labor room residents, busy labor rooms. When plotted meticulously they showed a wide variation, and many women did not conform to the rates of dilatation of the graph. The use of partogram did not alter the rate of cesarean section for non-progressive labors with use and non-use of partogram.
Conclusions: Philpott’s partogram is a very visual and useful tool to monitor labours and detect labour abnormalities timely. Although it has served as a labour management tool across the labour rooms its use is not universal. There is a plethora of conflicting opinions regarding its utility in modern obstetrics today, ranging from a complete faith in the tool to finding it obsolete and in need of a revision to calling it a medicalization of a natural process.
The Partograph: An Essential Tool for Decision-Making during Labour, Best practice, Maternal and neonatal health, USAID, Baltimore, Maryland, JHPIEGO, Maternal and Neonatal Health Program, 2002 Sep.
Soni BL. Effect of Partogram Use on Outcomes for Women in Spontaneous Labour at Term: RHL Commentary. The WHO Reproductive Health Library. World Health Organization, Geneva. 2009.
Friedman EA. Primigravid labour. A graphic statistical analysis. Obstet Gynecol 1955;6: 567-89.
Philpott RH. Graphic records in labour. BMJ 1972; 4(5833):163-5.
World Health Organisation. World Health Organisation partograph in the management of labour. Lancet 1994;343(8910):1399-1404.
Magon N. Partogram revisited. Int J Clinic Cases Investigat. 2011;3(1):1-6.
Philpott RH, Castle WM. Cervicographs in the management of labour in primigravidae. II. The action line and treatment of abnormal labour. Int J Obstet Gynaecol.1972;79(7):599-60.
Kwast BE, Poovan P, Vera E, Kohls E. The modified WHO partograph: do we need a latent phase? Brit J Midwife. 2008;16(8):527-32.
Sam McCulloch, Friedman’s Curve – How It’s Used During Labour. 2016
Zhang JL, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002;187(4):824-8.
Zhang J, Landy HJ, Branch DW, Burkman R, Haberman S, Gregory KD et al. Contemporary Patterns of Spontaneous Labor with Normal Neonatal Outcomesfor the Consortium on Safe Labor. Obstet Gynecol. 2010;116(6):1281-87
Lavender T, Hart A, Smyth RM. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane database of systematic reviews. 2013(7).
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. International J Women's Health. 2014;6:873.
de Azevedo Aguiar C, Gonçalves R, Tanaka AC. Use of the partogram in labor: analysis of its application in different care models. Open J Obstet Gynecol. 2013;3(09):1.
Caughey AB, Cahill AG, Guise JM, Rouse DJ, American College of Obstetricians and Gynecologists. Safe prevention of the primary cesarean delivery. Am J Obstetrics and Gynecol. 2014;210(3):179-93.
Mathibe-Neke JM, Lebeko FL, Motupa B. The partograph: A labour management tool or a midwifery record?. Int J Nursing Midwife. 2013;5(8):145-53.
Bedwell C, Levin K, Pett C, Lavender DT. A realist review of the partograph: when and how does it work for labour monitoring?. BMC Pregnancy Childbirth. 2017;17(1):31.
Rebecca Dekker. Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned Cesareans. Evidence Based Birth; 2013.
Laughon SK, Zhang J, Grewal J, Sundaram R, Beaver J, Reddy UM. Induction of labor in a contemporary obstetric cohort. Am J Obstet Gynecol. 2012 ;206(6):486-e1.
Reuwer P, Bruinse H, Franx A. Proactive support of labor: the challenge of normal childbirth. Cambridge University Press; 2009.