Use Of Partogram Research Articles

Partographic analysis of spontaneous labour at term in primigravida.

To study the use of partogram in the analysis of spontaneous labour at term in primigravida with cephalic presentation. Partographic analysis of labour was done in 200 primigravidae. Partographic variables are plotted, and the study population was divided into three groups. Group I: Cervix dilatation and descent curve falling to the left of alert line; Group II: Cervix dilatation and descent curve falling to the right of alert line; and Group III: Cervix dilatation and descent curve falling to the right of action line. Maternal and neonatal outcomes were studied in each of three groups. Amongst the 200 primigravid labours analysed, 133 (66.5%) belonged to group I, 40 (20.0%) belonged to group II and 27 (13.5%) belonged to group III. Mean durations of active phases of labour were 4.1h, 6.9h and 9.6h, in groups I, II and III, respectively. In group I, 130 women (97.7%) delivered vaginally, 3 (2.3%) underwent LSCS. In group II, 29 (72.5%) delivered vaginally, 4 (10%) delivered instrumentally and 7 (17.5%) underwent LSCS, and in group III, 5 (18.5%) delivered vaginally, 7 (25.9%) delivered instrumentally and 15 (55.5%) delivered by LSCS. Mean duration of active phase of labour increased as the partographic curve fell to the right of alert and action line. Increased rates of instrumental deliveries, LSCS, babies with lower APGAR score at 5min, and NICU admissions were observed in group III compared with groups I and II.

Disengaging the deeply impacted fetal head during cesarean section

Sir, It's a really challenging situation for the obstetrician to dislodge the impacted fetal head with least maternal and neonatal morbidity. A smiling incision on the uterus as mentioned by you in the letter definitely gives room for different maneuvers and decreases the complications such as extension. We follow this in our routine practice when we require more space especially for the delivery of large babies. In our study, the skin incision type used was based upon the preference and experience of the operating surgeon. We feel that the skin incision does not make much difference as a transverse incision gives more access to the pelvis. The use of clinical pelvimetry, monitoring of labor by the use of partogram and a second opinion from a senior colleague in case of doubtful cases, can decrease the incidence of an impacted head. As mentioned in the letter by Dr. Karasahin and colleagues, we require a study including a larger population for establishing the method of choice and formulating an optimal protocol for the management of such patients in future.

Successful implementation of evidence‐based routines in Ukrainian maternities

To describe the process of change and assess compliance and effect on maternal and infant outcome when the WHO package Effective Perinatal Care (EPC) was implemented at maternities in Ukraine. Intervention study comparing outcomes before and during 2.5 years after training. Three maternities in Donetsk, Lutsk and Lviv 2003-2006. Baseline data were collected for 652, 742 and 302 deliveries and 420, 381 and 135 infants, respectively, in Donetsk, Lutsk and Lviv. Follow-up data included 4,561, 9,865 and 7,227 deliveries and 3,829, 8,658 and 6,401 infants. Staff training on evidence-based guideline. Interventions during labor, maternal outcomes and hypothermia in the infants. EPC procedures were successfully implemented and adherence to the protocols was excellent. For most variables, the change occurred during the first three months but was well sustained. The use of partogram increased fourfold in Donetsk and from 0% to 60% in Lviv. Induction and augmentation of labor decreased to less than 1% and less than 5%, respectively. Cesarean section rate dropped significantly in two of the maternities. The proportion of hypothermic infants decreased from 60% (Donetsk), 85% (Lutsk) and 77% (Lviv) to 1% in all three maternities during the first three months and was stable throughout the study period. Admission to Neonatal Intensive Care Unit decreased significantly in two of the maternities and there was no effect on early neonatal mortality. The process of education and change was well anchored in the organization, and implementation of new procedures was quick and successful.

Dressings for superficial and partial thickness burns; Effect of partogram use on outcomes for women in spontaneous labour at term; Exercise for depression; Vitamin C for preventing and treating tetanus

Journal of Advanced NursingVolume 65, Issue 7 p. 1365-1369 Dressings for superficial and partial thickness burns; Effect of partogram use on outcomes for women in spontaneous labour at term; Exercise for depression; Vitamin C for preventing and treating tetanus Prepared byThe Joanna Briggs Institute, Prepared byThe Joanna Briggs InstituteSearch for more papers by this author Prepared byThe Joanna Briggs Institute, Prepared byThe Joanna Briggs InstituteSearch for more papers by this author First published: 01 June 2009 https://doi.org/10.1111/j.1365-2648.2009.05008.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume65, Issue7July 2009Pages 1365-1369 RelatedInformation

Recording labour: a national survey of partogram use

There is little consensus regarding the use of partograms and labour charts in the western world. As a consequence there are variations in practices within and between units. Prior to implementation of the National Institute for Clinical Excellence (NICE) Intrapartum Care Guidelines we conducted a survey of all Heads of Midwifery exploring the current status of labour documentation across England. This enabled a baseline of current practice to be established and offers insight into disparities. The results indicated general support for the partogram, although some units chose not to use it for certain women. There was some consistency in recorded quantifiable details, although most charts lacked any psychological data. A minority of units had pre-printed alert or action lines although often the associated guidelines were similar. Few units provided evidence to support their particular guidelines. Awareness of national variations in partogram use highlighted useful variations in partogram designs which may assist midwives in their own practice. Units should re-evaluate their own charts in line with the recommendations of the National Intrapartum Care Guidelines.

Maternal mortality: it’s time to get political

Nigeria has the 47th highest gross domestic product (GDP) worldwide and is the world’s 8th largest exporter of petroleum. It has a maternal mortality ratio (MMR) of 800/100 000 live births. In contrast, Sri Lanka is 78th on the GDP list but has an MMR of only 92. Among the wealthy countries, Sweden has the 20th highest GDP and a MMR of 2, while USA, despite being the richest country in the world, has a MMR of 17.1,2 If we are to reduce maternal mortality worldwide, it is crucial that we understand the reasons for the wide variation in MMRs. One would expect that the MMR would correlate with the prevalence of major complications of pregnancy, but such complications occur in a remarkably constant 15% or so of pregnancies throughout the world. Nor does the MMR correlate well with a country’s wealth as the examples above show. What is, however, highly predictive of a country’s MMR is the quality of its health services. Comparing each country’s MMR and healthcare quality (as defined in the World Health Organization World Health Report of 2000) shows the two to be closely correlated (Figure 1).2,3 ‘Quality of health care’ is used here in its holistic sense—not just as a measure of the best the country can provide in its large teaching hospitals and private clinics but how effectively good quality health care reaches the country’s poorest in rural areas well away from the capital. It also takes into account the health services’ effect on the nation’s health, the way the health workers treat individuals on a personal level (as regards dignity, confidentiality and client orientation) and the fairness of financial contributions. The UK provides a classic example of the importance of the effect of a good quality health service on maternal mortality rates. It is no coincidence that the major fall in its MMR coincided with the launch of the NHS in the 1940s which provided free care for all at the point of delivery.4 The quality of maternity care also improved greatly at this time as blood transfusions and antibiotics became available. The NHS made these advances available to the many and not just the privileged few. Conversely, the recent crisis at Northwick Park Hospital in London shows how quickly maternal mortality rates can rise if the quality of maternal care deteriorates.5 The impressive second report on the South African Confidential Enquiries into Maternal Deaths emphasises the pivotal role of health services in reducing MMRs.6 Of their ten key recommendations, all but one relates to improvements in the health services rather than introducing new procedures or therapies. They recommend speeding up access to services (better ambulance services and referral systems), service development (better contraceptive/abortion services and improved antenatal screening) and improved quality of care (written protocols, optimising levels of staff and equipment, blood transfusion, partogram use and effective anaesthetic services). The one recommendation that is not directly health service related is the final one that calls for the empowerment of women. If tuberculosis is the disease of poor housing, and gonorrhoea a ‘social disease’, then surely maternal mortality is the classic example of a disease of poor health services. For those of us trying to reduce maternal mortality from a medical perspective, we will be unable to achieve fundamental change without a massive improvement in health services in those areas of the world that are currently poorly served. Indeed, as exemplified in the title of the BJOG 2005 supplement on the developing world, much of the research on DOI: 10.1111/j.1471-0528.2006.01185.x www.blackwellpublishing.com/bjog Editorial

A Randomized Controlled Trial of a Bedside Partogram in the Active Management of Primiparous Labour

ObjectiveThe partogram is a pictorial representation of the progress of labour, used in an effort to enhance early recognition of dystocia and help avoid Caesarean section (CS). The objective of this study was to evaluate the effect of partogram use on the CS and obstetric intervention rates. MethodsWe conducted a randomized controlled trial of use of the partogram in 1932 primiparous women with uncomplicated pregnancies at term. Patients were randomly assigned to one of two groups: the standard group, who had the progress of labour charted in written notes, or the partogram group, whose progress in labour was recorded using a bedside graphical partogram as well as in written notes. Outcomes were stratified according to whether labour was spontaneous or induced and whether membranes were initially intact or ruptured. The primary outcome was the rate of CS; secondary outcome measures were rates of obstetric intervention for dystocia. ResultsThere was no significant difference between the groups in rates of CS (partogram 24%, standard notes 25%), rates of other interventions, amniotomy, oxytocin use, or the mean cervical dilatation in labour. ConclusionIn this study, the use of a partogram without a mandatory management of labour protocol had no effect on rates of CS or other intrapartum interventions in healthy primiparous women at term.

Low Cost Level II Newborn Care Service: Experience Of Kathmandu Medical College Teaching Hospital

Newborn infants require special care when they become sick. Majority of the newborn require only feeding,warmth and loving care by the mothers. Nearly 15-20% of newborns become sick requiring care in hospital.Most of these babies can be managed using low cost locally made equipment which makes newborn careaffordable. This is a prospective study of 201 sick newborns looked after in the Special Care Baby Unit(SCBU) of Kathmandu Medical College Teaching Hospital (KMCTH) using locally made low cost equipment.In the period of 28 months from 2nd July, 2001 to 17th Oct. 2003, 882 babies were delivered at KathmanduMedical College Teaching Hospital (KMCTH). 859 were live births. Out of 859 live births, 173 (20.1%)were admitted in the special care baby unit (SCBU). SCBU of this hospital also admitted 28 babies bornoutside the hospital. The main causes of admission in SCBU were low birth weight (37.3%), neonataljaundice (18.9%), birth asphyxia (6.9%), septicaemia (2.4%) and out of 201 babies admitted in SCBU,89% were discharged in good condition, 3.9% of the babies left against medical advice, 2 babies (one withcongenital hydronephrosis and another with congenital hypertrophic pyloric stenosis) were transferred toKanti Children Hospital for surgery and 11 babies (5.4%) expired. The main causes of neonatal deathswere extreme prematurity (70%), septicaemia (23%), birth asphyxia (15.3%) and congenital anomalies(7.6%). The perinatal mortality rate (PMR) and neonatal mortality rate (NMR) during this period were26.4/1000 births and 15.1/1000 live births respectively. In SCBU, locally made low cost equipment(Resuscitaire, Warm cot, Phototherapy and Oxygen hood designed by Prof D.S. Manandhar) are beingused in the manangement of sick babies, since the unit was started on 2nd July, 2001. Babies with birthweight as low as 1020 gms and gestation as low as 28 weeks have survived in this unit. This unit has shownthat Level II care could be provided with simple and low cost equipment and results are quite satisfactory.Good antenatal care, good care during delivery including use of partogram and care during postnatalperiod have helped to make this result good. Expansion of such facilities in district and bigger hospitals inthe country are not only affordable but also will have great impact in saving many lives. This will have amajor impact in reducing the present high IMR and NMR of the country.Key Words: Care of sick neonates, low cost locally made equipment, common neonatal problems,special care baby unit, and level II care.

Perinatal practices in two rural districts of Zimbabwe: a community perspective.

To describe perinatal practices from a community perspective and identify factors associated with perinatal death. Cross sectional community based survey. Murewa and Madziwa rural areas, Zimbabwe. Women aged 15 to 50 years who had been pregnant within the 24 months preceding the survey. Where delivered, where preferred to deliver, model of delivery, use of herbs in labour, duration of labour, assistant at delivery, time of delivery, condition of baby at birth, resuscitation methods, birth weight, initiation of breast feeding, illness in the first week and outcome of pregnancy. 644 women were interviewed; 581/644 stated where they would have liked to deliver and 505/644 stated where they actually delivered their last baby. The majority 369/581 (62.4%) preferred to delivery at a government hospital and 240/505 (47.5%) actually delivered at a government hospital. Of the home deliveries only 27/581 (4.6%) preferred to deliver at home and yet 123/505 (24.4%) actually delivered at home. Primary care clinics were less preferred 151/581 (25.5%) as a place for delivery and 89/505 (17.6%) actually delivered there. Labour lasting more than 12 hours occurred in 20.4% of deliveries. Nurses were the commonest attendants at delivery 309/508 (60.4%) and morbidity following delivery was noted in 72/495 (14.5%). Resuscitation was carried out in 61/72 infants. Beating/shaking 36/61 (58.0%) and pouring cold water over the baby 11/61 (18.0%) were the commonest methods of resuscitation. Being delivered by a doctor compared to a nurse and being in Murewa district were statistically significant risk factors for mortality with Odds Ratio (OR) 5.21 (95% CI 2.86 to 9.51) and 3.90 (95% CI 1.51 to 10.09) respectively. The odds of dying when delivered by breech extraction were high, but not statistically significant OR 3.73 (95% CI 0.92 to 13.97) when compared to being delivered by vertex delivery. Labour more than 12 hours, use of herbs in pregnancy and time of delivery were not significantly associated with mortality with OR (95% CI) of 1.02 (0.40 to 2.19), 0.92 (0.00 to 4.38), 1.05 (0.56 to 1.97) respectively. On logistic regression analysis only being delivered in Murewa district remained significant. The utilisation of primary health care centres for delivery was unexpectedly low and home deliveries were unacceptably high. Increased mortality when delivered by a doctor and high early neonatal morbidity suggest poor monitoring and delayed intervention in labour. Infant morbidity following delivery was high and methods for neonatal resuscitation inappropriate. There is a need for more studies looking into health worker skills particularly in the areas of partogram use and neonatal resuscitation in these districts.

INTRODUCTION, USE AND RESULTS OF A NEW PARTOGRAM

INTRODUCTION, USE AND RESULTS OF A NEW PARTOGRAM