From the Guidelines
The primary goal of the World Health Organization (WHO) partogram is to monitor labor progress and maternal-fetal wellbeing during childbirth, ensuring timely interventions and preventing complications. The partogram serves as a visual representation of labor, helping healthcare providers identify deviations from normal labor patterns by tracking cervical dilation, fetal descent, uterine contractions, fetal heart rate, maternal vital signs, and amniotic fluid status over time 1. This standardized tool enables early detection of obstructed labor, fetal distress, and maternal complications, allowing for timely decision-making regarding augmentation of labor, cesarean delivery, or other interventions.
Key Components of the WHO Partogram
- Cervical dilation: The partogram tracks the rate of cervical dilation, with an expected rate of 1 cm per hour in the active phase of labor 1.
- Alert and action lines: The partogram includes alert and action lines, which signal the need for medical intervention if labor is prolonged or if other complications arise 1.
- Maternal and fetal monitoring: The partogram tracks maternal vital signs, fetal heart rate, and amniotic fluid status to ensure the wellbeing of both the mother and the fetus 1.
Importance of the WHO Partogram
The WHO partogram is particularly valuable in resource-limited settings, where it helps reduce maternal and neonatal mortality by providing a clear framework for monitoring labor and making clinical decisions 1. The partogram enables healthcare workers to quickly recognize when labor is prolonged or when other complications arise, allowing for timely interventions to prevent adverse outcomes.
Recent Studies and Guidelines
Recent studies have highlighted the importance of the WHO partogram in reducing maternal and neonatal mortality, with some studies showing a reduction in cesarean delivery rates and adverse outcomes 1. However, other studies have raised concerns about the safety and effectiveness of the guidelines, highlighting the need for further research and evaluation 1. Despite these concerns, the WHO partogram remains a valuable tool for healthcare providers, enabling them to provide high-quality care and improve outcomes for mothers and newborns.
From the Research
Goal of the World Health Organization (WHO) Partogram
- The primary goal of the WHO partogram is to improve labour management and reduce maternal and fetal morbidity and mortality 2.
- The partograph is designed to provide a pictorial overview of labour, alerting midwives and obstetricians to deviations in maternal or fetal well-being and labour progress 3.
- The WHO partograph aims to differentiate normal from abnormal progress in labour and identify women who are likely to require intervention 2.
Key Features of the WHO Partogram
- The partograph includes pre-printed alert and action lines to signify slow progress and prompt effective management of slow progress of labour 3.
- The alert line is based on the slowest 10% of primigravid women's labours, and the action line is placed a number of hours after the alert line to prompt intervention 3.
- The partograph is recommended for use in all labour wards to improve outcomes for women and their babies 2.
Effectiveness of the WHO Partogram
- Studies have shown that the use of the WHO partograph can reduce prolonged labour, emergency caesarean sections, and intrapartum stillbirths 2, 3.
- However, the evidence is not consistent, and further research is needed to establish the efficacy of partograph use per se and its optimum design 3.
- A realist review of the partograph found that it can be an effective tool for labour monitoring, but its success depends on various factors, including health worker acceptability, health system support, and effective referral systems 4.