Partograph adherence and its barriers in a tertiary care hospital: A mixed-method study

Abstract

Background: Partograph is a low cost, effective and mandatory tool for intrapartum monitoring. However, the partograph has been grossly underutilised. Aims and Objectives: The present study aims to find out the extent of the use of a partograph and the barriers to effectively using the same in a tertiary care facility. Materials and Methods: This cross-sectional study comprises quantitative and qualitative methods. The quantitative component consisted of a retrospective review of case sheets of patients undergoing uncomplicated vaginal delivery between 1 January 2020 and 15 February 2020. The percentage of cases where a partograph was initiated and completed was assessed. For the qualitative part, staff nurses on duty in the labour room during the study period and responsible for recording the partograph were invited to participate in a focused group discussion (FGD). Sister-in-charges, supposed to supervise the staff nurses were invited to participate an In-depth interview (IDI). Results: Out of 131 case sheets, a partograph was initiated in 64 (48.85%) cases and completed in 4 out of 64 partographs (6.25%). The 'Cervical dilatation' parameter was plotted in all 64 cases, while the 'amniotic fluid condition' was the least plotted parameter (12 [18.75%]). Data regarding the 'time of rupture of membranes' (15.63%) and 'condition at birth' (4.69%) were also neglected parameters. The FGD and IDI revealed 'shortage of staff and heavy workload', 'presentation in advanced labour', 'poor training and supervision', 'incomplete documentation of clinical information by doctors' and 'policy level lacunae' as the potential barriers to partograph adherence and completeness. Conclusion: Partograph adherence and completeness appeared inadequate in this tertiary care centre.