Evaluation of the use of the partogram in the obstetric gynecology department of the National Hospital Donka University Teaching Hospital Conakry Guinea

Abstract

Objectives: To calculate the proportion of partogram use in the department, to describe the epidemiological profile of parturients, to identify the main reasons for not filling out the partogram and to establish the maternal and fetal prognosis in the gynaecology-obstetrics department of the Donka National Hospital, University Teaching Hospital of Conakry. Methodology: This was a prospective analytical cross-sectional study lasting six (6) months. All patients admitted to the department during the study period with a longitudinal presentation (cephalic, breech), permeable pelvis with a minimum of 28 weeks of gestational age with a live fetus were included in the study. The following were not included in this study: patients admitted for extreme obstetric emergencies (haemorrhagic placenta previa, retro-placental haematoma, uterine rupture, eclampsia....), patients admitted for prophylactic caesarean section; patients with a gestational age of less than 28 weeks of amenorrhoea and all contraindications to vaginal delivery with a live foetus. Word software from the 2007 office pack, Epi DATA3.1 was used for data entry, SSPS 20.0 was used for data analysis and Power Point software for presentation. The Chi-square test was used for the variables and a probability of p<0.05 was obtained in favour of an association between the variables compared. Results: Out of a total of 402 patients, the partogram was opened in only 269 patients, i.e. 67%, while 133 patients, i.e. 33%, did not receive a partogram. The epidemiological profile of the patients was that of women aged 20-24 years (31.3%), a housewife (34.1%), primiparous women (64.2%) and women who had not attended school (39.1%). 13.02% of the partograms were filled in correctly and 86.98% were filled in inadequately. 60% of the partograms were filled in correctly when they were carried out by a doctor, and only 12.8% were carried out by a midwife. Hypokinesia was found to be the most common anomaly, 60.59%, and the majority of patients (96.3%) did not cross the alert line. The reasons given by the staff interviewed for not filling out the patients were: lack of motivation on the part of the providers (25.56%), emergencies and overflowing activities in the delivery room (15.03%). Half of the staff interviewed did not give any reason for not filling out the partogram (50.37%). A previous caesarean section at the last delivery was found in 2.7% of the patients. The proportion of newborns without labour monitoring with a partogram with an APGAR score of less than 7 was 30.8%, compared with 11.2% with labour monitoring with a partogram. More than 2/3 of the births, 79.56%, that took place before the alert line was crossed, against 20.44% of the alert line. The morbidity is 3.7% for births before crossing the alert line against 20% after crossing it. The overall maternal morbidity is 6.5%: It is 5.57% under partogram, and 8.3% without partogram. Fetal mortality is 2.6% for those who gave birth under labour monitoring with partogram, and 3% for those who did not give birth under labour monitoring with partogram. We did not record any maternal deaths. Conclusion: The partogram is an indispensable tool in labour monitoring. We note a better maternal-fetal prognosis in patients who have given birth under partogram monitoring. The improvement of the quality of filling in the partogram would be achieved through the motivation of medical staff and supervision.