Revising the primigravid partogram: does it make any difference?

Original Article

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.

Keywords

Partogram Primigravidae Customisation 

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyMEDUNSA Satellite Campus, Philadelphia HospitalDenniltonSouth Africa
  2. 2.GroblersdalSouth Africa

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