A didactic protocol for labour and delivery: the partogram

Abstract

Aim: The aim of this paper was to evaluate the didactic protocol on the management of both labour and birth.

Methods: Selection criteria were carried out with randomized, quasi-randomized controlled trials and other relevant articles involving a comparison of partogram with no partogram, or comparison between different partogram designs. A printed alert and/or action lines are designed to prevent the deviation. Particularly partograms where divided in: 1) partogram versus no partogram in labour-delivery; 2) partogram with two-hour action line versus partogram with four-hour action line; 3) partogram with two-hour action line versus partogram with three-hour action line; 4) partogram with three-hour action line versus partogram with four-hour action line; 5) partogram with alert line versus partogram with alert and action line; 6) earlier versus later intervention.

Results: We included twenty-eight studies in this review, involving 7 827 women; six studies assessed partogram versus no partogram and the remainder assessed different partogram designs. There was no evidence of significant difference between partogram and no partogram in caesarean section. When compared the use or less of partogram in vaginal deliveries, this tool with defined management protocols prevents obstructed labour (protracted phase or arrest of dilatation). Quality monitoring of the labour with the partogram will reduce the morbidity and mortality in both mother and newborn. Deviation of the curve from the standard partogram is an alert graphic expression of risk and moves forward an adequate management of treatment. Regarding the use of partogram as didactic protocol, it is considered useful in the comprehension of the various evolutions of labor and delivery.

Conclusion: On the basis of literature, the data regarding the use of partogram is controversial. Regarding elective caesarean section partogram doesn't give any advantages owing to the absence of labor. Relating the employ of partogram in labour, it is helpful for correcting the deviation from the normality, permitting the opportune use of both drugs (oxytocin) and procedures (amniotomy). Even if the literature does not recommend a routine use of the partogram as part of standard labour management, it always represents an instrument for a better determination of the parameters evaluated (dilatation, mechanical curve, contractions). Both physicians and midwives have to be trained to a correct use the partogram in order to have satisfactory results. A challenge to improve the graph and facilitate the compilation of the model should be addressed. Further trial evidence is required to establish the real and significant utility of partogram. Besides, the partogram is a practical graph for medico-legal evaluation in case of contentiousness.