The Frequency of Intrapartum Cesarean Section Use With the WHO Partograph Versus Zhang’s Guidelines in the Labor Progression Study (LAPS): A Multicenter, Cluster-randomized Controlled Trial

Abstract

(Lancet. 2019;393:340–348) As the rate of cesarean section has been increasing worldwide, there have been efforts to encourage clinicians to avoid medically unnecessary cesarean deliveries. Labor dystocia is the most common indication for intrapartum cesarean section (ICS). Adequate labor progression has been assessed for decades using tools based on Friedman’s work from >60 years ago, including the 1994 World Health Organization (WHO) partograph. However, there have been significant changes in labor management since Freidman reported his work and the patient population has also changed, with higher mean body mass index (BMI) and maternal age. Therefore, in 2010 Zhang and colleagues studied labor progression using a contemporary cohort of parturients. They found labor progressed more slowly than Freidman’s findings, especially in early labor before 6 cm dilation. They provided a guideline that allows for a longer period of time before diagnosing labor dystocia and proceeding with cesarean section in early labor. This study aimed to compare the rate of ICS when the WHO partograph versus Zhang’s contemporary guideline was used to assess labor progression and diagnose labor dystocia.