Introduction- Partogram is the most commonly used labour monitoring tool recommended by the World Health Organisation (WHO) for use in active labour [1]. While it is a basic tool [2,3], it has been noted that it is not being used or completed as intended, affecting labour management and outcomes [4,5]. Few studies reported that the partogram was difficult to use or time-consuming.(6) Recently, WHO developed the "next-generation" partogram called the WHO Labour Care Guide (LCG). It is evidence based with updated definitions (7). The primary goal of our research will be to compare the current WHO Modified Partogram with LCG in terms of record completeness and resident doctor satisfaction. Objective Primary Objective: Compare LCG with WHO modified partogram for completion of records and satisfaction among the resident doctors with each tools Secondary objective: Compare maternal outcomes using LCG and WHO modified partogram for - mortality and morbidity namely, PPH, LSCS and Instrumental delivery. Compare fetal outcomes using LCG and WHO modified partogram for - stillbirth, five minute Apgar score, and NICU stay. Justification : In a random survey conducted in September 2021 of 100 case records at our institution, it was found that of 78% of normal vaginal deliveries were monitored through Partogram, 22% were incomplete, and 13% were left blank(unpublished). The present study is to identify if LCG is found better compared to modified Partogram as intended by WHO. Given the lack of senior and skilled medical personnel in low resource settings, appropriate labour monitoring is extremely important to ensure well being of the mother and baby. This study is expected to highlight the practical aspects of LCG use among medical personnel. Methodology This analytical observational study would be conducted in the Department Obstetrics and Gynecology, UCMS and GTB Hospital over 3 months. Consenting resident doctors posted in labour room will be requested to fill WHO modified partogram and LCG for 10 days each, followed by a questionnaire to compare both the tools to assess their satisfaction. Sample size: With an assumption of improvement of 50% with LCG use, to estimate this difference at alpha-5% and power-80% a sample size of 35 subjects is required Statistical Analysis: Both groups will be compared using the Student t-test and Chi-square test with SPSS software version 21. Potential Risks - None Potential benefits – Improvements in labour monitoring lead to better mother and fetal outcomes. Outcome measures: Comparison for The proportion of completeness of WHO modified partogram with LCG Participants’ satisfaction with the WHO modified partogram versus the LCG on Likert scale and proportion of minimum score of 3 for each tool. Maternal outcomes - mortality and morbidity namely PPH, Instrumental delivery, LSCS Fetal outcomes - stillbirth, Apgar score at 5 minutes, and NICU stay National Significance Maternal and neonatal morbidity and mortality following labour continues to be high in India. Given the continuing lack of senior and skilled medical personnel, appropriate labour monitoring is extremely important to ensure well being of the mother and baby. This study would provide a feedback from the user end and would facilitate for the next step for wider use. References: 1. World Health Organisation. WHO recommendations for augmentation of labour. Geneva: WHO; 2014. 2. Mathews JE, Rajaratnam A, George A, Mathai M. Comparison of two World Health Organisation partographs. Int J Gynecol Obstet. 2007;96(2):147–50. 3. Mathai M. The partograph for the prevention of obstructed labour. Clin Obstet Gynecol. 2009;52(2):256–69. 4. Windrim R, Seaward G, Hodnett E, Akoury H, Kingdom J, Salenieks ME, et al. A randomized controlled trial of a bedside partogram in the active management of primiparous labour. J Obstet Gynaecol Can. 2007;29(1):27–34. 5. Fistula Care and Maternal Health Task Force. Revitalizing The Partograph: Does The Evidence Support A Global Call To Action?—Report of an Expert Meeting, New York, November 15–16, 2011. EngenderHealth/Fistula Care. 2012. Available from: http://www.fistulacare.org/pages/pdf/program-reports/EngenderHealth-Fistula-Care-Partograph-Meeting-Report-9-April-12.pdf. 6. Completion of the modified World Health Organization (WHO) partograph during labour in public health institutions of Addis Ababa, Ethiopia.Yisma E, Dessalegn B, Astatkie A, Fesseha N, Reprod Health. 2013 Apr 18; 10():23. 7. WHO recommenations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization;2018. |
