O41 - Is the partogram still relevant? Findings of a randomised trial comparing two partogram designs for monitoring active labour progress in low risk women

Abstract

Partograms with visual prompts such as Action lines are universally used to monitor labour progress. The Action line assumes a minimum rate of cervical dilation in the active phase of labour of 1 cm per hour. However, recent studies have demonstrated that normal labour progression is very variable and new partograms have been design to account for normal variations in progress with the use of a ‘Dystocia’ line. Correct commencement and use of any partogram is essential for utility in indicating labour dystocia. To compare two designs of partograms for compliance in documentation and use for managing labour. We randomised 228 low risk nulliparous women at term in spontaneous labour to a partogram with either an Action line (control) or Dystocia Line (intervention). Primary outcome was the proportion of partograms commenced correctly. Secondary outcomes included correct application of the partograms accompanying clinical management protocol and labour and birth outcomes. Compliance rates for correct commencement and utilisation by clinicians of the assigned partogram was poor in both groups. While rates of augmentation by artificial rupture of membranes were significantly lower in the Dystocia Line group there were no other differences in labour management or birth outcomes. There was little evidence that either partogram was being used correctly to document labour progress or the visual prompts of an Action or Dystocia line being considered in the assessment and management of prolonged labour. The use of centralised monitoring of labour progress may have been a contributing factor.