title: A randomized controlled trial of a bedside partogram in the active management of primiparous labour.
abstract: OBJECTIVE
  The partogram is a pictorial representation of the progress of labour, used in an effort to enhance early recognition of dystocia and help avoid Caesarean section (CS). The objective of this study was to evaluate the effect of partogram use on the CS and obstetric intervention rates.
  
  
  METHODS
  We conducted a randomized controlled trial of use of the partogram in 1932 primiparous women with uncomplicated pregnancies at term. Patients were randomly assigned to one of two groups: the standard group, who had the progress of labour charted in written notes, or the partogram group, whose progress in labour was recorded using a bedside graphical partogram as well as in written notes. Outcomes were stratified according to whether labour was spontaneous or induced and whether membranes were initially intact or ruptured. The primary outcome was the rate of CS; secondary outcome measures were rates of obstetric intervention for dystocia.
  
  
  RESULTS
  There was no significant difference between the groups in rates of CS (partogram 24%, standard notes 25%), rates of other interventions, amniotomy, oxytocin use, or the mean cervical dilatation in labour.
  
  
  CONCLUSIONS
  In this study, the use of a partogram without a mandatory management of labour protocol had no effect on rates of CS or other intrapartum interventions in healthy primiparous women at term.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.forename: P Gareth
authors.initials: PG
authors.lastname: Seaward
authors.forename: Ellen
authors.initials: E
authors.lastname: Hodnett
authors.forename: Hani
authors.initials: H
authors.lastname: Akoury
authors.forename: John
authors.initials: J
authors.lastname: Kingdom
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Salenieks
authors.forename: Shafagh
authors.initials: S
authors.lastname: Fallah
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008991:Monitoring, Physiologic / Q000379:methods; D010298:Parity; D019095:Point-of-Care Systems; D011247:Pregnancy; D014599:Uterus / Q000502:physiology