Use Of Partogram Research Articles

“Routine Partographic Assessment of Progress of Labour & Pregnancy Outcome”

Background: Partograph is a simple, of low cost but most important tool for record of progress of labour In the developing country like ours, where both pregnancy and maternal mortality rate is so high, the use of this inexpensive partograph is essential. Objective: To assess the importance of partographic control of labour in preventing prolongs labour and its consequences, thereby decreasing maternal morbidity and mortality and improvement of neonatal outcome. Method: This study was done in the Obstetrics and Gynaecology department of Institute of Child and Mother Health, Matuail, Dhaka. Total 196 patients were included in this study. Data were collected by predesigned data collection sheet. Data were analyzed by using Statistical Package for Social Science (SPSS) version 14. Result: 74% of these patients had spontaneous vaginal delivery, 7.14% required assisted delivery (forceps or ventouse) and 18.9% needed caesarean section. Caesarean section was done in 18.9% patients because of fetal distress (32.4%) and prolonged labour (67.6%) due to malrotation and cephalopelvic disproportion. Patients with non-engaged head in labour required more intervention than who had engaged head. With the use of partograph, unnecessary interventions were reduced. It was found that 66.7% of the patients were delivered within 7 hours and all patients were delivered within 10 hours from active phase of labour. Thus prolonged labour and its consequences, such as obstructed labour and ruptured uterus, can be avoided by using partograph. In 100% of the patients, crossing the action line in partograph required interference, but 92.5% within alert line of partograph delivered vaginally spontaneously and 7.5% required assisted delivery (forceps or ventouse). When IDR was 1 cm/hr 85.1% women delivered spontaneously. When IDR was <0.4 cm/hr, 100% of patients required some kind of interference. Thus, the maintenance of partograph in labour enables the obstetricians to recognize very early dystocic labour and act accordingly. Conclusion: With the help of a partogram, time of delivery can be estimated and if the progress is slow, an appropriate interference at the right time can be instituted before the labour becomes dangerously protracted. IDR very helpful in making early decisions about the prognosis for the type of labour. With the use of partogram and its scientific application, the result showed that operative interventions were reduced, duration of labour was within normal limit and there was no obstructed labour and no maternal or perinatal mortality.

451 Assessment of partogram use during labour in a tunisian maternity

The partogram is an important tool in obstetrics. The rigour of its dress is a testament to the quality of care provided during labor and in the immediate postpartum period. The main objective of our study was to evaluate our partograms according to quality criteria while proposing solutions to the deficiencies identified and adaptations according to our practice. Methods: We conducted a retrospective, monocentric descriptive cross-sectional study in the maternity ward of Mongi Slim Hospital - Tunisia.

Attitudes, Practices and Factors Affecting the Use of the Partogram by Professionals Attending to Women in Labour and Delivery in the Bafut Health District

Introduction: Given that the provision of care to the childbirth process is not purely in the hands of educated and trained midwives, the competency in application of midwifery tools may be inadequate and consequently affect the quality of care. The Partogram is the single most important tool which has been scientifically proven to reduce maternal and foetal morbidity and mortality. Though important, many healthcare providers do not use it regularly in the monitoring of labour. Objectives: Our objectives were to determine the attitudes, practices, proportion of parturients monitored using a Partogram and the factors limiting the use of the Partogram by professionals attending to women in labour and delivery (PAWLD) in the Bafut Health District. Methods: This was a cross-sectional study carried out amongst 65 Professionals attending to women in labour and delivery in the Bafut Health District that lasted 6 months. All the data were collected by our self. First through a face to face interview with a questionnaire, secondly with an observational guide used to assess Partograms filled and lastly using delivery registers to obtain the proportion of parturients monitored with a Partogram. The data analysis was done using the statistic software Epi Info version 7 and Microsoft Excel. Results: This study revealed that 47 (72.3%) of participants had good attitudes, 34 (52%) had good practices, 375 (79.3%) parturients were monitored using a Partogram, and the lack of in-service training, low number of staff and poor knowledge on Partogram use were identified as the main limiting factors to the use of the Partogram. Being a health assistant was statistically significantly associated with having a poor practice with a p-value of 0.047 and odds ratio 5.33 [1.03 - 26.45] we obtained just 1 (1.54%) filled according to the WHO standards. Conclusions and Recommendations: In the Bafut Health District, 7 out of 10 PAWLDs have a positive attitude towards the use of the Partogram, while a poor practice is predominant as a result 4 out of 5 deliveries were monitored using a Partogram with only 1.54% of the Partograms filled according to WHO standards. The lack of in-service training, lack of PAWLD and poor knowledge on Partogram usage are the major drawbacks to the use of the Partogram. We therefore recommend that continues medical education (CME) be organised on the use of the Partogram.

Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership

BackgroundObstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it.MethodsObservational study, based on a cross-sectional design, carried out with data deriving from the study “Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento” (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of–delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients’ profile.ResultsResults have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2.Conclusion(s)Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

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

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.

Correlation among experience of person-centered maternity care, provision of care and women's satisfaction: Cross sectional study in Colombo, Sri Lanka.

Person-centered maternity care (PCMC) is defined as care which is respectful of and responsive to women's and families' preferences, needs, and values. In this cross-sectional study we aimed to evaluate the correlations among the degree of PCMC implementation, key indicators of provision of care, and women's satisfaction with maternity care in Sri Lanka. Degree of PCMC implementation was assessed using a validated questionnaire. Provision of good key practices was measured with the World Health Organization (WHO) Bologna Score, whose items include: 1) companionship in childbirth; 2) use of partogram; 3) absence of labor stimulation; 4) childbirth in non-supine position; 5) skin-to-skin contact. Women's overall satisfaction was assessed on a 1-10 Likert scale. Among 400 women giving birth vaginally, 207 (51.8%) had at least one clinical risk factor and 52 (13.0%) at least one complication. The PCMC implementation mean score was 42.3 (95%CI 41.3-43.4), out of a maximum score of 90. Overall, while 367 (91.8%) women were monitored with a partogram, and 293 (73.3%) delivered non-supine, only 19 (4.8%) did not receive labour stimulation, only 38 (9.5%) had a companion at childbirth, and 165 (41.3%) had skin-to-skin contact immediately after birth. The median total satisfaction score was 7 (IQR 5-9). PCMC implementation had a moderate correlation with women's satisfaction (r = 0.58), while Bologna score had a very low correlation both with satisfaction (r = 0.12), and PCMC (r = 0.20). Factors significantly associated with higher PCMC score were number of pregnancies (p = 0.015), ethnicity (p<0.001), presence of a companion at childbirth (p = 0.037); absence of labor stimulation (p = 0.019); delivery in non-supine position (p = 0.016); and skin-to-skin contact (p = 0.005). Study findings indicate evidence of poor-quality care across several domains of mistreatment in childbirth in Sri Lanka. In addition, patient satisfaction as an indicator of quality care is inadequate to inform health systems reform.

Labour and its outcome compared with and without partogram use in primiparous and multiparous women

Labour and its outcome compared with and without partogram use in primiparous and multiparous women

Caesarean section rates analysed using Robson’s 10-Group Classification System: a cross-sectional study at a tertiary hospital in Ethiopia

ObjectiveThe aim of this study was to assess the caesarean section (CS) rates using Robson’s 10-Group Classification System among women who gave birth at Hawassa University Referral Hospital in southern...

Aplicação adequada do partograma e o seu impacto na taxa de cesarianas: revisão narrativa

Objetivo: Analisar se a aplicação adequada do partograma influencia na taxa de cesarianas, bem como, discutir sua importância na escolha da via de parto, incluindo possíveis benefícios da utilização desse instrumento no acompanhamento do trabalho de parto e avaliar a qualidade da assistência ao parto em locais onde o partograma é aplicado regular e corretamente. Revisão Bibliográfica: Trata-se de uma revisão narrativa acerca do uso do partograma e o seu impacto no número de cesarianas. Sabe-se que o partograma tem seu uso recomendado amplamente pela OMS, entretanto seu uso ainda não é amplo em qualquer local. Sendo que, o uso do mesmo mostrou-se de maior impacto em países em desenvolvimento, onde há evidências de que o uso adequado pode diminuir a taxa de cesáreas, fato não observado em regiões de serviços de saúde com maiores recursos econômicos. Considerações finais: Não foi possível estabelecer de forma definitiva uma relação entre a diminuição nas taxas de cesariana e o uso do partograma. O resultado inconclusivo aponta para diferenças relativas ao local de aplicação do partograma, sendo necessário mais dados para confirmar sua relevância como uma ferramenta que contribua para diminuir o número de cesáreas realizadas.

Knowledge and Attitude of Health Care Providers on the Use of Partogram: A Study in Rural Bangladesh

Background: This study was conducted to assess the knowledge and attitude of health care providers regarding effective use of the partogram in monitoring the progress of labour.&#x0D; Methods: A total fifty health care providers were assessed with a preformed questionnaire during pre and post exposure to a 5-day training program and their pre- and post-test scores were analyzed. Attitude was assessed by checking randomly selected 50 partographs filled up by trained health care providers. Their attitude also tested by direct interviewing with 50 service providers.&#x0D; Results: Mean age of the respondents was 31.22 (±6.32) years. There was significant improvement of test scores after the training program. Random partograph assessment showed 85.4% correct response. Majority respondents showed positive attitude towards the use of partograph.&#x0D; Conclusion: Results of this study shows that the 5-day training program on use of partograph is effective. But further training programs including refresher training and capacity building on programme is required for long term success on the use of partograph.&#x0D; Bangladesh J Obstet Gynaecol, 2019; Vol. 34(2): 99-105

Use of the partogram in a private hospital in South Africa

Objectiveto explore and describe the use of the partogram in private hospitals in South Africa. Designan explanatory mixed method design. In-depth interviews were conducted with the midwives and midwife specialists to explicate the significance of the initial quantitative questionnaires. Settinga private maternity hospital in Gauteng Province, South Africa. Participants11 midwives and 3 advanced midwives working in the labour unit of the private maternity hospital. Findingsalthough all the midwives and midwife specialists knew the purpose of the partogram, where to find the recommendations on the use of the partogram and the signs of true labour, not all were sure when the partogram had to be completed and who is accountable for plotting the findings. Fetal heart rate monitoring during the active phase of labour remains a concern. Key conclusionthe findings revealed that the midwives understood the importance of the partogram but are not using it within the parameters for which it was intended. The obstetricians intervened during labour with no or little use of the partogram. Implications for practicethe study identified the knowledge strengths and deficits of midwives working in a private hospital on partogram use that would benefit from training interventions and professional development. Evidence suggests a culture where the partogram is not central to care as obstetricians are not using the partogram. The purpose of the partogram in the private sector needs to be reviewed.

Effect of training on the knowledge and use of the partograph for low risk pregnancies among health workers in a tertiary hospital in Lagos State, Nigeria

Background: Partogram use is important for early recognition of deviations in labour. This study assessed the effect of training on the knowledge and use of the partogram in low-risk pregnancy (LRP). Methods: This is an analytical before and after study at the Lagos University Teaching Hospital. Fifty-two health personnel who conduct deliveries in the labour ward were assessed before and after a training on the proper utilization of the partogram which used WHO recommendations on the integrated management of pregnancy and child birth. Comparison of knowledge and utilization of the partogram before and after the training was estimated using the chi square test. The level of significance was p<0.05. Results: Thirty-two (61.5%) of the respondents were resident doctors while 38.5% were midwives. Only 27% of them had had any formal training on partogram use in the three years preceding the intervention. Training significantly improved knowledge of the partogram by improving standard records for cervical dilatation, uterine contraction and fetal descent; reducing substandard records for uterine contraction and fetal descent and no records, (p=0.0001). Training only significantly affected the utilization of the partogram in reference to blood pressure readings. There was a significant increase in substandard records and a reduction in standard records, (p=0.001) Conclusion: Training improved knowledge, but not the use of the partogram by health workers. Greater emphasis should be placed on the use of the partogram in monitoring labour progress in women with low risk pregnancies. Keywords: Partogram; Training; Labour management; Intrapartum care

The perceptions of midwives regarding audit and feedback on the use of the partogram at Vhembe District of Limpopo Province, South Africa.

BackgroundAudit and feedback is regarded as the cornerstone of clinical teaching to guarantee good practice and to correct poor performance. Feedback given to health professionals assists in narrowing the gap between the actual and the desired information. The findings of the research study on perceptions of midwives on audit and feedback highlighted aspects that needed improvement to address challenges on the use and documentation of the partogram.ObjectivesThe objectives of this article were to explore and describe the perceptions of midwives on auditing of the partogram by health professionals and to explore and describe the perceptions of midwives on the feedback that was given after audit was done.MethodA qualitative, exploratory and descriptive study was conducted to answer the two research objectives. Semi-structured face-to-face interviews were conducted with 17 midwives who were working in the labour wards of three hospitals. Eight steps of qualitative data analysis as indicated by Tesch were used to analyse the data.ResultsThe findings revealed that auditing and feedback is sometimes done by midwives themselves, midwives’ managers and district managers. Audit is done monthly or on a daily basis and sometimes inconsistently because of shortage of staff. Challenges indicated were lack of knowledge on the use of the partogram and lack of encouragement and praise when documentation was done correctly and that emphasis was mostly placed on negative aspects.ConclusionThe findings revealed that auditing and feedback and in-service education is done at the three hospitals, although challenges such as inconsistency in auditing because of shortage of staff, lack of knowledge on partogram use and on principles of giving feedback were highlighted.

Midwives’ Views on Improved Use of the Partogram in Vhembe District of Limpopo Province, South Africa

The purpose of the study was to explore and describe the views of midwives on the improved use of the partogram. A qualitative, explorative, descriptive and contextual study on the partogram as a clinical practice guideline was conducted in Limpopo Province as a requirement for a doctoral degree. Midwives working at Vhembe District hospitals formed the population of the study. A sample of 17 midwives was conveniently selected from the three hospitals in the district. Semi-structured interviews were conducted with midwives who signed the consent form. Midwives were asked to describe their experiences with the use of the partogram and their views on how its implementation could be improved. Interviews were recorded and transcribed verbatim. Tesch’s eight steps of qualitative data analysis were used to analyse the data. The findings of the research study highlight several challenges experienced by midwives, including their views on the improved use of the partogram. In this article, only the views of midwives on the improved use of the partogram are discussed. Midwives suggested that they be empowered with knowledge and given support by ward managers, that the partogram document be redesigned and that communication take place with midwives by ward and district managers related to changes on the partogram. It is recommended that midwifery training programmes and in-service training emphasise the partogram; that midwives be encouraged and supported by ward managers and provided with enough staff and equipment; that managers redesign the partogram document format and that communication with midwives be improved when changes are made.

Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: a case-referent study in Nepal.

BackgroundNewborns are at the greatest risk for dying during the intrapartum period, including labor and delivery, and the first day of life. Fetal heart rate monitoring (FHRM) and partogram use to track labor progress are evidence-based techniques that can help to identify maternal and fetal risk factors so that these can be addressed early. The objective of this study was to assess health worker adherence to protocols for FHRM and partogram use during the intrapartum period, and to assess the association between adherence and intrapartum stillbirth in a tertiary hospital of Nepal.MethodsA case-referent study was conducted over a 15-month period. Cases included all intrapartum stillbirths, while 20 % of women with live births were randomly selected on admission to make up the referent population. The frequency of FHRM and the use of partogram were measured and their association to intrapartum stillbirth was assessed using logistic regression analysis.ResultsDuring the study period, 4,476 women with live births were enrolled as referents and 136 with intrapartum stillbirths as cases. FHRM every 30 min was only completed in one-fourth of the deliveries, and labor progress was monitored using a partogram in just over half. With decreasing frequency of FHRM, there was an increased risk of intrapartum stillbirth; FHRM at intervals of more than 30 min resulted in a four-fold risk increase for intrapartum stillbirth (aOR 4.17, 95 % CI 2.0–8.7), and the likelihood of intrapartum stillbirth increased seven times if FHRM was performed less than every hour or not at all (aOR 7.38, 95 % CI 3.5–15.4). Additionally, there was a three-fold increased risk of intrapartum stillbirth if the partogram was not used (aOR 3.31, 95 % CI 2.0–5.4).ConclusionThe adherence to FHRM and partogram use was inadequate for monitoring intrapartum progress in a tertiary hospital of Nepal. There was an increased risk of intrapartum stillbirth when fetal heart rate was inadequately monitored and when the progress of labor was not monitored using a partogram. Further exploration is required in order to determine and understand the barriers to adherence; and further, to develop tools, techniques and interventions to prevent intrapartum stillbirth.Clinical trial registrationISRCTN97846009.

Knowledge and attitudes of midwives on the use of the partogram: a study among midwives in the Tamale Metropolis.

BackgroundThe partogram is the most effective tool to use to monitor the progress of labour and complications associated with labour.The main objective of this study was to assess the knowledge level of midwives on the effective use of the partogram in monitoring the progress of labour in the Tamale Metropolis of Ghana.MethodsThis study was a cross-sectional descriptive study conducted on 140 midwives selected using random sampling technique from March to July, 2011.ResultsThe study revealed that all respondents had knowledge of the supposed use of the partogram. However, the study also identified inadequate knowledge on the proper use of the tool (as observation showed that some of the partogram sheets were inadequately filled). Inadequate knowledge, inadequate staffing (1.0 % of respondents) and extra workload on the few midwives (2.6 %) were some of the factors that militated against the effective use of the partogram. There were enough partogram sheets in the health facilities under study as 91.4 % of respondents had access to the partogram.ConclusionMidwives in Ghana know about the supposed use of partogram as a monitoring tool for labour; however inadequate knowledge on the proper use of the tool and inadequate staffing militated against effective use. We recommended constant refresher training on the use of the partogram and also training of more midwives to enhance effective utilisation of the partogram.

Various Health Care Providers’ Knowledge of the Partogram Use during Childbirth, at the Bamenda Health District, Cameroon

Various Health Care Providers’ Knowledge of the Partogram Use during Childbirth, at the Bamenda Health District, Cameroon

Quality of intrapartum care by skilled birth attendants in a refugee clinic on the Thai-Myanmar border: a survey using WHO Safe Motherhood Needs Assessment

BackgroundIncreasing the number of women birthing with skilled birth attendants (SBAs) as one of the strategies to reduce maternal mortality and morbidity must be partnered with a minimum standard of care. This manuscript describes the quality of intrapartum care provided by SBAs in Mae La camp, a low resource, protracted refugee context on the Thai-Myanmar border.MethodsIn the obstetric department of Shoklo Malaria Research Unit (SMRU) the standardized WHO Safe Motherhood Needs Assessment tool was adapted to the setting and used: to assess the facility; interview SBAs; collect data from maternal records during a one year period (August 2007 – 2008); and observe practice during labour and childbirth.ResultsThe facility assessment recorded no ‘out of stock’ or ‘out of date’ drugs and supplies, equipment was in operating order and necessary infrastructure e.g. a stand-by emergency car, was present. Syphilis testing was not available. SBA interviews established that danger signs and symptoms were recognized except for sepsis and endometritis. All SBAs acknowledged receiving theoretical and ‘hands-on’ training and regularly attended deliveries. Scores for the essential elements of antenatal care from maternal records were high (>90%) e.g. providing supplements, recording risk factors as well as regular and correct partogram use. Observed good clinical practice included: presence of a support person; active management of third stage; post-partum monitoring; and immediate and correct neonatal care. Observed incorrect practice included: improper controlled cord traction; inadequate hand washing; an episiotomy rate in nulliparous women 49% (34/70) and low rates 30% (6/20) of newborn monitoring in the first hours following birth. Overall observed complications during labour and birth were low with post-partum haemorrhage being the most common in which case the SBAs followed the protocol but were slow to recognize severity and take action.ConclusionsIn the clinic of SMRU in Mae La refugee camp, SBAs were able to comply with evidence-based guidelines but support to improve quality of care in specific areas is required. The structure of the WHO Safe Motherhood Needs Assessment allowed significant insights into the quality of intrapartum care particularly through direct observation, identifying a clear pathway for quality improvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0444-0) contains supplementary material, which is available to authorized users.

The Role of Partograph in the Outcome of Spontaneous Labor

Aims: The objective of the paper is to study the role of partogram in the outcome of spontaneous labour in primigravidae at term with singleton pregnancy and vertex as the presenting part. Methods: This prospective observational study was carried out in the labour room of the department of Gynaecology and Obstetrics of Medical College &amp; Hospital, Kolkata, over a period of one year i.e. from June 2011 to May 2012 after obtaining approval from the institutional ethical committee. Analysis of the progress of labour was done in five hundred women with the help of modified WHO partograph. The study population was divided into three groups. Group I had a total observed duration of active stage six hours or less and their cervicograph remained on or to the left of the alert line. Group II had total observed duration of active phase between more than six hours and less than ten hours and their cervicograph remained between the alert and action line. Group III, who had the duration of observed active phase more than 10 hours, had their cervicograph crossing the action line. The different types of abnormal labor were studied. The maternal and fetal outcomes were assessed. Results: 80.8% of the women belonged to group I, 15.2% to group II and 4% to group III. Surgical interference increased as the labour curve moved to the right of the alert line. Use of partogram helped in overall reduction in the duration of labour. Timely intervention reduced the incidence of prolonged labour and its sequelae. 19.2% of the women showed abnormal labour . Severe complications were successfully averted. There were no cases of maternal death, puerperal sepsis, ruptured uterus or fresh still births. Overall neonatal mortality rate was also reduced. Conclusions: The use of modified WHO partograph significantly improves the outcome of labour in both maternal &amp; neonatal perspective. The WHO partograph should be used in all maternity units with incorporated management guidelines. DOI: http://dx.doi.org/10.3126/njog.v9i1.11189 NJOG 2014 Jan-Jun; 2(1):52-57

Effect of partogram use on outcomes for women in spontaneous labour at term

The partogram (sometimes known as partograph) is usually a pre-printed paper form on which labour observations are recorded. The aim of the partogram is to provide a pictorial overview of labour, to alert midwives and obstetricians to deviations in maternal or fetal wellbeing and labour progress. Charts often contain pre-printed alert and action lines. An alert line represents the slowest 10% of primigravid women's labour progress. An action line is placed a number of hours after the alert line (usually two or four hours) to prompt effective management of slow progress of labour. To determine the effect of use of partogram on perinatal and maternal morbidity and mortality.To determine the effect of partogram design on perinatal and maternal morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013). Randomised and quasi-randomised controlled trials involving a comparison of partogram with no partogram, or comparison between different partogram designs. Three review authors independently assessed eligibility, quality and extracted data. When one review author was also the trial author, the two remaining authors assessed the studies independently. We have included six studies involving 7706 women in this review; two studies assessed partogram versus no partogram and the remainder assessed different partogram designs. There was no evidence of any difference between partogram and no partogram in caesarean section (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.24 to 1.70); instrumental vaginal delivery (RR 1.00, 95% CI 0.85 to 1.17) or Apgar score less than seven at five minutes (RR 0.77, 95% CI 0.29 to 2.06) between the groups. When compared to a four-hour action line, women in the two-hour action line group were more likely to require oxytocin augmentation (RR 1.14, 95% CI 1.05 to 1.22). When the three- and four-hour action line groups were compared, caesarean section rate was lowest in the four-hour action line group and this difference was statistically significant (RR 1.70, 95% CI 1.07 to 2.70, n = 613, one trial). When a partogram with a latent phase (composite) and one without (modified) were compared, the caesarean section rate was lower in the partograph without a latent phase (RR 2.45, 95% CI 1.72 to 3.50, n = 743, one trial). On the basis of the findings of this review, we cannot recommend routine use of the partogram as part of standard labour management and care. Given the fact that the partogram is currently in widespread use and generally accepted, it appears reasonable, until stronger evidence is available, that partogram use should be locally determined. Further trial evidence is required to establish the efficacy of partogram use.