Quality of Partogram Recordings and Perinatal Outcome at Muhimbili National Hospital Tanzania

Background: The management of labor using partograph is the standard way of improving both maternal and perinatal outcomes. The partogram increases the quality and regularity of all observations on the fetus and the mother in labor and aids early recognition of problems in both mother and fetus. One third of stillbirths takes place during delivery and is largely avoidable. Aim: To assess the quality of partogram recordings and compare with fetal outcomes among women delivering at Muhimbili National Hospital. Methods: A cross-sectional study was conducted from 1st September to 30th November 2011. Partographs of women delivered at the hospital were reviewed immediately after delivery. Using checklist recordings of parameters, the progress of labour, fetal outcome (Apgar score at 5 minutes, still birth and admission to neonatal ward for special care) and immediate maternal outcomes (PPH, perineal tear, visceral injuries following cesarean section) were assessed. Partograph recordings were judged as standard if standard as per standard protocols. Results: Partograph was used for all women admitted with spontaneous labor. 1,051 partographs were reviewed during the study time. Majority (79.5%) had spontaneous vaginal delivery and 18.6% delivered by cesarean section. Only 8.9% of partographs had all parameters with standard recordings. The most unrecorded parameter was maternal pulse rate. Most (81.4%) of partographs had substandard recording of uterine contractions. There were 53 newborns with Apgar score less than 7 at 5 minutes and 17 fresh stillbirths. Substandard fetal heart rate recording was significantly associated with Apgar score less than 7 at 5 minute and with stillbirths (P-value<0.001, Chisquare 15.92). Conclusion: This study as other studies conducted as where found high proportion of substandard partogram recordings. Supportive supervision and on job training on correct use of partograph is recommended as a way of improving labor monitoring and improved fetal and maternal outcomes.