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Meta-Analysis
. 2012 Aug 15;8(8):CD005461.
doi: 10.1002/14651858.CD005461.pub3.

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

Tina Lavender  1 , Anna Hart, Rebecca M D Smyth
Affiliations
Meta-Analysis

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

Tina Lavender et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: 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.

Objectives: 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.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2012).

Selection criteria: Randomised and quasi-randomised controlled trials involving a comparison of partogram with no partogram, or comparison between different partogram designs.

Data collection and analysis: 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.

Main results: 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).

Authors' conclusions: 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.

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Figures

Figure 1
Figure 1. Section of partogram where labour progress is recorded
See this image and copyright information in PMC

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References

References to studies included in this review

    1. Kenchaveeriah SM, Patil KP, Singh TG. Comparison of two WHO partographs: a one year randomized controlled trial [Iki DSO partografinin karsilastirilmasi: Bir yillik randomize kontrollu calisma] Journal of the Turkish German Gynecology Association Artemis. 2011;12(1):31–4. - PMC - PubMed

    1. *

    2. Lavender T, Walkinshaw S, Alfirevic Z. Partogram action line study: a randomised trial. British Journal of Obstetrics and Gynaecology. 1998;105:976–80. - PubMed
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References to studies excluded from this review

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References to studies awaiting assessment

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Additional references

    1. Bosse G, Massawe S, Jahn A. The partograph in daily practice: It’s quality that matters. International Journal of Gynecology and Obstetrics. 2002;77(3):243–4. - PubMed
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    1. Fistula Care and Maternal Health Task Force Revitalizing The Partograph: Does The Evidence Support A Global Call To Action?-Report of an Export Meeting; New York. 2011; [accessed 12 June 2012]. Nov 15-16, 2011.

References to other published versions of this review

    1. Lavender T, Hart A, Smyth RMD. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database of Systematic Reviews. 2008;(4) DOI: 10.1002/14651858.CD005461.pub2. - PubMed

    1. * Indicates the major publication for the study

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