Effect of partographic monitoring on outcomes for women in spontaneous labour at term

Background: Partogram is a graphic record of progress of labour and fetal condition during labour. The main parameter for recording progress of labour is the rate of cervical dilatation. Aim and objectives: To determine if routine partographic monitoring of spontaneous labour will optimize the maternal and fetal outcome. Materials and methods: This study involved a detailed prospective workup of 200 women all term gestation patients for vaginal delivery, from 37-42 weeks at term with vertex presentation, spontaneous onset of labour and those who had singleton pregnancy were included. Results: This was a prospective study conducted on 200 patients. The WHO partogram was used which is similar to Philpott and Castle's original description, retaining the Action Line in the active phase drawn four hours to the right of, and parallel to the Alert Line. The central feature is the cervicograph in which cervical dilatation is plotted against time. The study divided the patients into three groups and the partogram into three zones: Group A: Safe zone: Patients who deliver before the alert line is reached. Group B: Observation Zone: Patients who deliver after the alert line but before the action line is reached. Group C: Intervention zone: Patients who deliver after the action line is crossed. In the present study, the mean age of the patients was 22.54 years. Most of the cases went into spontaneous onset of labour. Maximum numbers of deliveries were FTND, i.e., 67%, outlet forceps 18% and LSCS rate was 15%. Significant association was found in relation to station of head at admission and mode of delivery where majority of LSCS had -2 station. The majority of FTNDs had -I and 0 stations. The patients having a favorable partogram, i.e. group A, had a high incidence of FTND. The incidence of intervention was found to be more in Group B, while the majority of patients in group C were at risk and required operative intervention. Mean birth weight in the study was 2861g. Majority of babies were delivered at term. The number of babies having an APGAR between 7-8 at one minute and 9-10 at five minutes was more. 96.5% of the patients had no complication. 12.5% of the babies had complication. Conclusion: It is evident that the routine use of the partogram is helpful in detecting abnormalities in the progress of labour and permits early corrective therapy. The key to early diagnosis and detection of disorders in labour progression is by following the evolution of characteristic patterns of cervical dilatation and fetal descent.