Partographic analysis of labour by modified WHO partograph in tertiary care centre

Prekshi Jain, Akshay C. Shah, Babulal S. Patel, Shashwat K. Jani


Background: The partograph is a simple, inexpensive tool to provide a continuous pictorial overview of labor. The goal of this study is to use partograph to monitor labor, initiate uterine activity that is sufficient to produce cervical changes, fetal descent while avoiding uterine hyperstimulation, hypostimulation and fetal distress and provide timely surgical intervention where required. 

Methods: A hospital-based observational study involving prospective review of partographs for births that occurred in 2020 was conducted in 2 hospitals including SVP Hospital and V.S hospital Ahmedabad. A partographic analysis of labour was done in randomly selected 200 patients using modified WHO partogram. The study population was divided into Primigravida (96) and Multigravida (104) term patients. partograph recording were commenced at 4 cm dilatation. close maternal and fetal monitoring was done throughout the labour and partogram was plotted to detect any deviation from normal course.

Results: Patients were grouped into primigravida and multigravida and based on partogram finding divided into mode of delivery. 22 of total 96 primigravida underwent caesarean section and 74 delivered vaginally. 8 of total 104 multigravida underwent caesarean section and 96 delivered vaginally. Out of 200 newborn only 11 had Apgar score <7 at 5 minutes.

Conclusion: The WHO modified partograph is highly effective in reducing both maternal and neonatal morbidity. It aids in assessing the progress of labour and to identify when intervention is necessary. It is effective in preventing prolonged labour, obstructed labour, reducing operative intervention and improving neonatal outcome.


Documentation, Obstructed labour, Partograph

Full Text:



Souza JP, Oladapo OT, Bohren MA, Mugerwa K, Fawole B, Moscovici L, et al. The development of a simplified, effective, labour monitoring-to-action (SELMA) tool for better outcomes in labour difficulty (BOLD): study protocol. Reprod Health. 2015;12(1):49.

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.

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(1):1-9.

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.

Levels and causes of maternal mortality and morbidity. In: Black RE, Laxminarayan R, Temmerman M, Walker N, editors. 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. Chap 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 P-O, 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.

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

WHO. Training modules 11. The use of the Partograph (also known as Partogram). Essential Antenatal, Perinatal and Postpartum Care Copenhagen: World Health Organisation.2002:184-94.

Opoku BK, Nguah SB. Utilization of the modified WHO partograph in assessing the progress of labour in a metropolitan area in Ghana. Res J Womens Health. 2015;2(1):2.

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.

Lavender T, Alfirevic Z, Walkinshaw S. Effect of different partogram action lines on birth outcome: A randomized controlled trial. Obstet Gynecol. 2006;108:295-302.

Frigoletto Jr FD, Lieberman E, Lang JM, Cohen A, Barss V, Ringer S et al. Clinical trial of active management of labor. N Engl J Med. 1995;333(12):745-50.

Pattinson RC, Howarth GR, Mdluli W, Macdonald AP, Makin JD, Funk M. Aggressive or expectant management of labor: A randomized clinical trial. Obstet Gynecol Surv. 2003;58(11):708-10.