Table 16

Impact of use of the partograph in stillbirth and perinatal outcomes

Source

Location and Type of Study

Intervention

Stillbirths/Perinatal Outcomes


Reviews and meta-analyses


Lavender et al. 2008 [140]

England and South Africa.

Meta-analysis (Cochrane). 5 RCTs included; 3 reported serious neonatal morbidity or PMR. N = 6963 women.

Assessed the use of partograph vs. no partograph; and compared impact of different versions of partograph (e.g. partogram with 2-hr, 3-hr, 4-hr, or no action line).

Serious neonatal morbidity or PMR: OR not estimable.

[0/1805 vs. 0/1796 in the 2-hour vs. 4-hour action line groups, respectively].


Intervention studies


Fahdhy 2005 [148]

Indonesia (Medan City).

Cluster RCT. 20 midwives in maternity homes. N = 626 pregnant women with vertex presentations (N = 304 intervention, N = 322 controls).

Assessed the impact of the use of the WHO partograph by trained midwives (intervention) vs. standard midwifery care without partograph (controls). 92% of partographs correctly completed; N = 71 had graph beyond alert line. 42/71 referred to hospital.

Fetal death: adj. OR = 0.62 (95% CI: 0.17–2.19) [NS]

[5/304 vs. 7/302 in intervention vs. control groups, respectively.]

END: adj. OR = 0.70 (0.16–3.11) [NS]

[3/304 vs. 7/302 in intervention vs. control groups, respectively.]

Significant decreases in obstructed labour, oxytocin use:, Apgar <7 at 1 min: No difference in Caesarean section rate, Apgar <7 at 5 min, or prolonged labour.


Lennox 1998 [147]

Indonesia, Thailand, Malaysia. Hospital-based study. Multicentre.

Before-after study. 8 hospitals. N = 1740 breech presentation pregnancies (N = 817 after, N = 923 before).

Assessed the impact of use of the partograph with an agreed labour-management protocol on perinatal outcomes.

Intrapartum SB (breech): 1.1% vs. 1.9% after vs. before, respectively. [NS]

Prolonged labour: Significant reduction with partograph (P < 0.05)


WHO 1994 [146]

Indonesia, Thailand, Malaysia. Hospital-based study. Multicentre.

Quasi-RCT. 8 hospitals. N = 35,484 women.

Assessed the impact of use of the partograph with an agreed labour-management protocol on perinatal outcomes.

Intrapartum SB: 0.3% vs. 0.5% in intervention vs. control groups, respectively.

Prolonged labour: 3.4% vs. 6.4% in intervention vs. control groups, respectively.

Oxytocin augmentation: 9.1% vs. 20.7% in intervention vs. control groups, respectively.

Emergency Caesarean sections: 8.3% vs. 9.9% in intervention vs. control groups, respectively.


Haws et al. BMC Pregnancy and Childbirth 2009 9(Suppl 1):S5   doi:10.1186/1471-2393-9-S1-S5

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