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Arch Gynecol Obstet. 2009 May;279(5):643-7. doi: 10.1007/s00404-008-0788-z. Epub 2008 Sep 6.

Revising the primigravid partogram: does it make any difference?

Author information

  • Department of Obstetrics and Gynaecology, MEDUNSA Satellite Campus, Philadelphia Hospital, Dennilton, South Africa. ljfvanbo@lantic.net

Abstract

OBJECTIVE:

To investigate the distribution of the rate of cervical dilatation of primigravid labour and its deviation from the standard partogram.

DESIGN:

Retrospective observational study.

SETTING:

South African district hospital serving an indigent rural population.

POPULATION:

Expectant management of labour of healthy nulliparous women in active labour, at term, with a singleton pregnancy and cephalic presentation.

METHODS:

Audit of 1,595 partograms of spontaneous primigravid labour. The standard partogram's alert line was replaced by a customised alert line based on the lowest 10th centile of the rate of cervical dilatation of the study population and an alert line representing the 10% slowest labours. The action line was placed parallel and 4 h to the right of the alert lines.

MAIN OUTCOME MEASURE:

The distribution of labours left to and on the respective alert lines, and right to the action lines.

RESULTS:

The lowest 90th centile of the customised alert line yielded a rate of cervical dilatation of 0.860 cm/h. Three quarters of labours evolved left to the revised alert line as opposed to 56.1% left of the standard alert line [Odds ratio (OR) 0.49, 95% confidence interval (CI) 0.42-0.56]. The mean rate of cervical dilatation of the 10% slowest labours was 0.535 +/- 0.076 cm/h (P < 0.0001), and 95.7% of labours evolved left to the corresponding alert line (OR 8.40, 95% CI 6.44-11.0).

CONCLUSION:

The alert line representing the mean of the 10% slowest labours leads to an unrealistic distribution of labour on the partogram. A revised alert line based on the lowest 10th centile of the local population is more representative and should perhaps be used in the management of labour.

PMID:
18777032
[PubMed - indexed for MEDLINE]
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