The modified WHO partograph: do we need a latent phase?

Abstract

The objective was to study the frequency and mode of delivery of women admitted in the latent and active phase of labour in St. Luke's Catholic Hospital in Wolisso, Southwest Shoa Zone, Oromia Regional State, Ethiopia. It was a descriptive, retrospective design. Admission phases of labour and mode of delivery were collected for seven months. The modified World Health Organization (WHO) partograph was introduced in Wolisso in January 2007. Analysis of mode of delivery of women admitted in the latent and active phase, showed that women admitted in the latent phase had more operative (both abdominal and vaginal) deliveries as labour progressed to the right of the alert line in active phase compared to women admitted in the active phase of labour. Partographs were generally plotted very well, with 86% of those eligible for partography available for analysis. Application of the management protocol needs to improve as the average monthly C/S rate is 22.5% and augmentation of labour is rarely applied. It is recommended that a management protocol for women admitted in the latent phase is formulated and applied. Space for these women needs to be organized closer to the labour ward for regular observation in the latent phase and earlier diagnosis of the onset of the active phase of labour. Considering the mean number of 5.857 hours until the active phase was diagnosed, re-introduction of the latent phase on the WHO partograph remains a controversial subject. However, development of, and adherence to, a management protocol for these women is strongly recommended. One-third of the women were admitted in the second stage of labour which means that frequency of partograph use should not be used as a quality of care indicator in management information systems but criterion-based audits would definitely improve management of labour.