A randomized controlled trial of a bedside partogram in the active management of primiparous labour.
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.
Windrim
Rory
R
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
Seaward
P Gareth
PG
Hodnett
Ellen
E
Akoury
Hani
H
Kingdom
John
J
Salenieks
Mary Ellen
ME
Fallah
Shafagh
S
Ryan
Greg
G
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