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Table 16 Impact of use of the partograph in stillbirth and perinatal outcomes

From: Reducing stillbirths: screening and monitoring during pregnancy and labour

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.