PARTOGRAM
What is a partogram?
Br J Obstet Gynaecol.
1998 Sep;105(9):976-80 Partogram action
line study: a randomised trial.
Liverpool Women's Hospital,
UK. To assess the
effect of three different partograms on caesarean section and maternal
satisfaction. Prospective randomised clinical trial. Regional teaching hospital in North West of England.
Objectives:
Design:
Setting:
PARTICIPANTS:
Nine
hundred and twenty-eight primigravid women with uncomplicated
pregnancies who presented in spontaneous labour at term. INTERVENTIONS:
The women were randomised to have their progress of labour recorded on a
partogram with an action line 2, 3 or 4 hours to the right of the alert
line. If the progress reached the action line, a diagnosis of prolonged
labour was made. Prolonged labour was managed according to the standard
ward protocol.
Main Outcome Measures:
Primary: Caesarean section rate
and maternal satisfaction; secondary: need for augmentation, duration of
labour, analgesia, cord blood gas analysis, postpartum haemorrhage,
number of vaginal examinations, Apgar score and admission to special
care baby unit.
Results:
Caesarean section rate was lowest when labour
was managed using a partogram with a 4-hour action line. The difference
between the 3- and 4-hour partograms was statistically significant (OR 1
8, 95% CI 1.1-3.2), but the difference between 2 and 4 hours was not (OR
1.4, 95% CI 0.8-2.4). The women in the 2-hour arm were more satisfied
with their labour when compared to the women in the 3-hour (P < 00001)
and 4-hour (P <00001) arm.
Conclusion:
Our data suggest that women
prefer active management of labour. It is possible that partograms which
favour earlier intervention are associated with higher caesarean section
rate. As the evidence on which to base the choice of partograms remains
inconclusive further research is required.
