Abstract
Background
Documentation and assessment of progress in labour using a partograph is recommended
by the World Health Organisation to assist in the timely recognition of labour dystocia.
Recent studies have tested new designs of partographs that aim to account for more
variable rates of labour progress. However, other studies have suggested that poor
compliance in the completion of partographs affects utility. The objective of this
study was to compare two types of partographs for compliance in documentation and
use for managing labour.
Methods
Low-risk nulliparous women in spontaneous labour (n = 228) were randomised to either
an Action Line (control) (n = 114) or Dystocia Line partograph (intervention) (n = 114).
Primary outcome was compliance with instructions for commencement of the partograph
following a multifaceted training strategy. Secondary outcomes included compliance
with the accompanying clinical management protocol for each partograph; and labour
and birth outcomes.
Results
The compliance rate for commencing the Action line partograph was 43.2% compared to
67.0% (p = 0.02) for the Dystocia line partograph. Other than a reduction in artificial
rupture of membranes in the Dystocia Line group there were no other differences in
labour management or birth outcomes. The use of centralised electronic display of
labour progress may be a contributing factor.
Conclusions
Compliance with the commencement and use of either partograph was low. There was little
indication that the partograph was being utilized in the assessment and management
of prolonged labour. Further studies are needed to explore the current utility of
partographs in labour management and the effect of centralised monitoring of progress
in high resource settings
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women and BirthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Obstetric care consensus No. 1: Safe prevention of the primary cesarean delivery.J. Obstet. Gynecol. 2014; 123: 693-711
Queensland Health. Queensland Perinatal statistics 2019 2021. 〈https://www.health.qld.gov.au/hsu/peri/peri2019/queensland-perinatal-statistics-2019〉.
- Primary cesarean delivery in the US.Obstet. Gynecol. 2013; 122: 33-40
World Health Organization. The partograph: the application of the WHO partograph in the management of labour. Report of a WHO multicentre study 1990–1991. 1994. World Health Organization, Geneva, Switzerland 1994.
- Cervicographs in the management of labour in primigravidae. II. The action line and treatment of abnormal labour.BJOG. 1972; 79: 599
- Primigravid labor: A graphicostatistical analysis.Obstet. Gynecol. 1955; 6: 567-589
- Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries.PLoS Med. 2018; 15e1002492
- Partograph in management of labour. World Health Organization maternal health and safe motherhood programme.Lancet. 1994; 343: 1399-1404
- Effect of partograph use on outcomes for women in spontaneous labour at term and their babies.Cochrane Database Syst. Rev. 2018; 6
- Contemporary patterns of spontaneous labor with normal neonatal outcomes.Obstet. Gynecol. 2010; 116: 1281
- Reassessing the labor curve in nulliparous women.Am. J. Obstet. Gynecol. 2002; 187: 824-828
- Physiologic partograph to improve birth safety and outcomes among low-risk, nulliparous women with spontaneous labor onset.Med. Hypotheses. 2012; 78: 319-326
- Use of the partogram in labor: analysis of its application in different care models.Open J. Obstet. Gynecol. 2013; 3: 1
- First stage of labour management practices: A survey of Australian obstetric providers.Aust. N. Z. J. Obstet. Gynaecol. 2017; 57: 266-271
- Effect of partogram use on outcomes for women in spontaneous labour at term.Cochrane Lib. 2013;
- A realist review of the partograph: When and how does it work for labour monitoring?.BMC Pregnancy Childbirth. 2017; 17: 31
- Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: A systematic review.BMC Pregnancy Childbirth. 2014; 14: 281
- Comparing different partograph designs for use in standard labor care: A pilot randomized trial.Matern. Child Health J. 2018; 22: 355-363
- Comparison of a single vs. A four intradermal sterile water injection for relief of lower back pain for women in labour: A randomised controlled trial.Midwifery. 2013; 29: 585-591
- Caesarean delivery rates and analgesia effectiveness following injections of sterile water for back pain in labour: A multicentre, randomised placebo controlled trial.EClinicalMedicine. 2020; 25100447
- Increase in caesarean deliveries after the Australian Private Health Insurance Incentive Policy Reforms.PloS One. 2012; 7e41436
- Impact of private health insurance incentives on obstetric outcomes in NSW hospitals.Aust. Health Rev. 2004; 27: 27-38
Queensland Maternity and Neonatal Clinical Guidelines Program. Normal birth. In: Queensland Health, editor. Brisbane: Queensland Government; 2012.
- Epidural versus non-epidural or no analgesia in labour.Cochrane Database Syst. Rev. 2011; : 12
- Confidence interval or p-value?: Part 4 of a series on evaluation of scientific publications.Dtsch. Arztebl. Int. 2009; 106: 335-339
- Hate to burst your balloon: Successful REBOA use takes more than a course.J. Endovasc. Resusc. Trauma Manag. 2020; 4: 21
- “I’m not doing what I should be doing as a midwife”: An ethnographic exploration of central fetal monitoring and perceptions of clinical safety.Women Birth. 2021;
- Use of the partograph - Current thinking.Best Pract. Res. Clin. Obstet. Gynaecol. 2020; 67: 33-43
- The frequency of intrapartum caesarean section use with the WHO partograph versus Zhang's guideline in the Labour Progression Study (LaPS): a multicentre, cluster-randomised controlled trial.Lancet. 2019; 393: 340-348
- The Labor Progression Study: The use of oxytocin augmentation during labor following Zhang’s guideline and the WHO partograph in a cluster randomized trial.Acta Obstet. Gynecol. Scand. 2019; 98: 1187-1194
- The Labour Progression Study (LaPS): Duration of labour following Zhang's guideline and the WHO partograph – A cluster randomised trial.Midwifery. 2020; 81102578
- Birth outcomes, intervention frequency, and the disappearing midwife-Potential hazards of central fetal monitoring.Single Center Rev. Birth. 2016; 43: 100-107
- The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review.Plos Med. 2015; 12e1001847
- Frequency and determinants of misuse of augmentation of labor in France: A population-based study.Plos One. 2021; 16e0246729
Article info
Publication history
Published online: April 07, 2022
Accepted:
April 2,
2022
Received in revised form:
March 15,
2022
Received:
October 21,
2021
Identification
Copyright
© 2022 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
