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Based on fieldwork in maternity wards in Tanzania, I argue that the partograph – a graphical representation of a pregnant woman’s labor – far exceeds its intended role as tracking and surveillance of labor progress. Through surveillance and its concomitant documentation, nurses, especially, also utilize this document to co-create care for themselves and their colleagues. These forms of care proliferate largely unseen by global health systems but are vital for understanding the meeting point of bureaucracy, surveillance, and care and the dynamics of maternity care in this and other lower resource settings. Nurses use the partograph to generate novel forms of surveillance-care. [ABSTRACT FROM AUTHOR]

Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background High rates of labour augmentation with oxytocin have been found in some low- and lower-middle-income countries, causing potential perinatal harm. It is critical to understand the reasons for this overuse. Aim was to explore factors that shape practices around using oxytocin for labour augmentation in a high-volume labour ward in Dar es Salaam, Tanzania. Methods Mixed-methods data collection was conducted from March 2021 to February 2022, including structured observations of 234 births, 220 h of unstructured labour ward observations and 13 individual in-depth interviews with birth attendants. Thematic network analysis and descriptive statistics were used to analyse data. We used a time-lens to understand practices of oxytocin for labour augmentation in time-pressured labour wards. Results Birth attendants constantly had to prioritise certain care practices over others in response to time pressure. This led to overuse of oxytocin for augmentation to ensure faster labour progression and decongestion of the, often overburdened, ward. Simultaneously, birth attendants had little time to monitor foetal and maternal condition. Surprisingly, while oxytocin was used in 146 out of 234 (62.4%) structured labour observations, only 9/234 (4.2%) women had active labour lasting more than 12 h. Correspondingly, 21/48 (43.8%) women who were augmented with oxytocin in the first stage of labour had uncomplicated labour progression at the start of augmentation. While the partograph was often not used for decision-making, timing of starting oxytocin often correlated with natural cycles of ward-rounds and shift-turnovers instead of individual women’s labour progression. This resulted in co-existence of ‘too early’ and ‘too late’ use of oxytocin. Liberal use of oxytocin for labour augmentation was facilitated by an underlying fear of prolonged labour and low alertness of oxytocin-related risks. Conclusions Time scarcity in the labour ward often made birth attendants deviate from clinical guidelines for labour augmentation with oxytocin. Efforts to navigate time pressure resulted in too many women with uncomplicated labour progression receiving oxytocin with little monitoring of labour. Fear of prolonged labour and low alertness to oxytocin-mediated risks were crucial drivers. These findings call for research into safety and benefits of oxytocin in low-resource settings and interventions to address congestion in labour wards to prevent using oxytocin as a time-management tool.

Background: High rates of labour augmentation with oxytocin have been found in some low- and lower-middle-income countries, causing potential perinatal harm. It is critical to understand the reasons for this overuse. Aim was to explore factors that shape practices around using oxytocin for labour augmentation in a high-volume labour ward in Dar es Salaam, Tanzania. Methods: Mixed-methods data collection was conducted from March 2021 to February 2022, including structured observations of 234 births, 220 h of unstructured labour ward observations and 13 individual in-depth interviews with birth attendants. Thematic network analysis and descriptive statistics were used to analyse data. We used a time-lens to understand practices of oxytocin for labour augmentation in time-pressured labour wards. Results: Birth attendants constantly had to prioritise certain care practices over others in response to time pressure. This led to overuse of oxytocin for augmentation to ensure faster labour progression and decongestion of the, often overburdened, ward. Simultaneously, birth attendants had little time to monitor foetal and maternal condition. Surprisingly, while oxytocin was used in 146 out of 234 (62.4%) structured labour observations, only 9/234 (4.2%) women had active labour lasting more than 12 h. Correspondingly, 21/48 (43.8%) women who were augmented with oxytocin in the first stage of labour had uncomplicated labour progression at the start of augmentation. While the partograph was often not used for decision-making, timing of starting oxytocin often correlated with natural cycles of ward-rounds and shift-turnovers instead of individual women's labour progression. This resulted in co-existence of 'too early' and 'too late' use of oxytocin. Liberal use of oxytocin for labour augmentation was facilitated by an underlying fear of prolonged labour and low alertness of oxytocin-related risks. Conclusions: Time scarcity in the labour ward often made birth attendants deviate from clinical guidelines for labour augmentation with oxytocin. Efforts to navigate time pressure resulted in too many women with uncomplicated labour progression receiving oxytocin with little monitoring of labour. Fear of prolonged labour and low alertness to oxytocin-mediated risks were crucial drivers. These findings call for research into safety and benefits of oxytocin in low-resource settings and interventions to address congestion in labour wards to prevent using oxytocin as a time-management tool. [ABSTRACT FROM AUTHOR]

Objective: Prolonged labor is the commonest indication for intrapartum cesarean section, but definitions are inconsistent and some common definitions were recently found to overestimate the speed of physiological labor. The objective of this review is to establish an overview of synonyms and definitions used in the literature for prolonged labor, separated into first and second stages, and establish types of definitions used. Data sources: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier. Study eligibility criteria: All articles in English that (1) attempted to define prolonged labor, (2) included a definition of prolonged labor, or (3) included any synonym for prolonged labor, were included. Methods: Data on study design, year of publication, country or region of origin, synonyms used, definition of prolonged first and/or second stage, and origin of provided definition (if not primarily established by the study) were collected into a database. Results: In total, 3402 abstracts and 536 full-text papers were screened, and 232 papers were included. Our search established 53 synonyms for prolonged labor. Forty-three studies defined prolonged labor and 189 studies adopted a definition of prolonged labor. Definitions for prolonged first stage of labor were categorized into: time-based (n=14), progress-based (n=12), clinician-based (n=5), or outcome-based (n=4). For the 33 studies defining prolonged second stage, the majority of definitions (n=25) were time-based, either based on total duration or duration of no descent of the presenting part. Conclusions: Despite efforts to arrive at uniform labor curves, there is still little uniformity in definitions of prolonged labor. Consensus on which definition to use is called for, in order to safely and respectfully allow physiological labor progress, ensure timely management, and assess and compare incidence of prolonged labor between settings.

Introduction: Efficient care by labour monitoring tools manages labour, identifies the abnormalities and avoids the fatalities. Various studies are being undertaken by the researchers to understand the limited use of these therapeutic tools. The present study aimed to develop a novel labour monitoring instrument after understanding the barriers and enablers of the currently used tools and using it in the health setting for improving clinical outcomes. Materials and Methods: Methodological research design was adopted to develop the novel tool. Item pool was generated by literature review, focus group discussions and retrospective observations of the partographs. Developed tool was evaluated by various experts by undergoing three rounds and was found to be reliable in terms of stability and equivalency. After undergoing pilot runs by researcher and nurses, tool was found to be feasible and understandable. The developed novel labour monitoring tool was used on 200 intranatal women. Results: Focus group discussions revealed various barriers in the current labour tools, such as lack of clarity, complexity, staff shortage, workload etc. Retrospective observation of filled partographs revealed the incomplete recording of the components of the partograph. The prepared first draft underwent rigorous review by the experts. The prepared novel tool, after being used on 200 intranatal women resulted in 90% of normal vaginal deliveries. Duration of 1st stage of labour was around 5 hours. Conclusion: A novel labour monitoring tool was developed after methodological approach resulting in adequate monitoring and improved labour outcomes.

Introduction: Efficient care by labour monitoring tools manages labour, identifies the abnormalities and avoids the fatalities. Various studies are being undertaken by the researchers to understand the limited use of these therapeutic tools. The present study aimed to develop a novel labour monitoring instrument after understanding the barriers and enablers of the currently used tools and using it in the health setting for improving clinical outcomes. Materials and Methods: Methodological research design was adopted to develop the novel tool. Item pool was generated by literature review, focus group discussions and retrospective observations of the partographs. Developed tool was evaluated by various experts by undergoing three rounds and was found to be reliable in terms of stability and equivalency. After undergoing pilot runs by researcher and nurses, tool was found to be feasible and understandable. The developed novel labour monitoring tool was used on 200 intranatal women. Results: Focus group discussions revealed various barriers in the current labour tools, such as lack of clarity, complexity, staff shortage, workload etc. Retrospective observation of filled partographs revealed the incomplete recording of the components of the partograph. The prepared first draft underwent rigorous review by the experts. The prepared novel tool, after being used on 200 intranatal women resulted in 90% of normal vaginal deliveries. Duration of 1st stage of labour was around 5 hours. Conclusion: A novel labour monitoring tool was developed after methodological approach resulting in adequate monitoring and improved labour outcomes. [ABSTRACT FROM AUTHOR]

Abstract Aim This study was conducted to determine the correctness and completeness of documentation of partographs. Design This was a retrospective descriptive study. Methods We included 365 partographs of deliveries conducted from January 1st to October 31st 2019. Data were collected using a checklist and analysed descriptively. The study based on 13 partograph parameters. Results About 8–13 parameters were correctly documented in 71.5 % of the partographs. About 38.9%, 24.7%, 99.7%, 22.5% and 16 % of the partographs had no documentation of obstetric risk factors, foetal heart rate, colour of liquor, uterine contractions and cervical dilatation respectively. About 12.1% of the cervicographs crossed the action line and 61.4% of partographs where cervicographs crossed the action line had no documentation of action(s) taken.

Plain language summary The new WHO Labour Care Guide (LCG) is an innovative partograph that emphasises women-centred, evidence-based care during labour and childbirth. Together with clinicians working at four hospitals in India, we will develop and test a strategy to implement the LCG into routine care in labour wards of these hospitals. We will use a randomised trial design where this LCG strategy is introduced sequentially in each of the four hospitals, in a random order. We will collect data on all women giving birth and their newborns during this period and analyse whether the LCG strategy has any effects on the use of Caesarean section, women’s and newborn’s health outcomes, and women’s experiences during labour and childbirth. While the trial is being conducted, we will also collect qualitative and quantitative data from doctors, nurses and midwives working in these hospitals, to understand their perspectives and experiences of using the LCG in their day-to-day work. In addition, we will collect economic data to understand how much the LCG strategy costs, and how much money it might save if it is effective. Through this study, our international collaboration will generate critical evidence and innovative tools to support implementation of the LCG in other countries.

Majority of the maternal deaths, still births, and neonatal deaths occurring in low- to middle-income countries are preventable through timely interventions. In this context, World Health Organization (WHO) recently came up with the Labour Care Guide (LCG). It is the revised version of the WHO partograph and focuses on timely clinical interventions and the importance of respectful maternity care. Various sections of LCG facilitate early identification of potential complications and timely referral when required. However, it was realized that there were some concerns while using the LCG at various sites particularly in developing countries like India. The present manuscript analyses the barriers in implementation of LCG and also suggests feasible measures that could be taken to overcome them. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to determine the correctness and completeness of documentation of partographs. Design: This was a retrospective descriptive study. Methods: We included 365 partographs of deliveries conducted from January 1st to October 31st 2019. Data were collected using a checklist and analysed descriptively. The study based on 13 partograph parameters. Results: About 8–13 parameters were correctly documented in 71.5 % of the partographs. About 38.9%, 24.7%, 99.7%, 22.5% and 16 % of the partographs had no documentation of obstetric risk factors, foetal heart rate, colour of liquor, uterine contractions and cervical dilatation respectively. About 12.1% of the cervicographs crossed the action line and 61.4% of partographs where cervicographs crossed the action line had no documentation of action(s) taken. [ABSTRACT FROM AUTHOR]

Documentation and assessment of progress in labour using a partograph is recommended by the World Health Organisation to assist in the timely recognition of labour dystocia. Recent studies have tested new designs of partographs that aim to account for more variable rates of labour progress. However, other studies have suggested that poor compliance in the completion of partographs affects utility. The objective of this study was to compare two types of partographs for compliance in documentation and use for managing labour. Low-risk nulliparous women in spontaneous labour (n = 228) were randomised to either an Action Line (control) (n = 114) or Dystocia Line partograph (intervention) (n = 114). Primary outcome was compliance with instructions for commencement of the partograph following a multifaceted training strategy. Secondary outcomes included compliance with the accompanying clinical management protocol for each partograph; and labour and birth outcomes. The compliance rate for commencing the Action line partograph was 43.2% compared to 67.0% (p = 0.02) for the Dystocia line partograph. Other than a reduction in artificial rupture of membranes in the Dystocia Line group there were no other differences in labour management or birth outcomes. The use of centralised electronic display of labour progress may be a contributing factor. Compliance with the commencement and use of either partograph was low. There was little indication that the partograph was being utilized in the assessment and management of prolonged labour. Further studies are needed to explore the current utility of partographs in labour management and the effect of centralised monitoring of progress in high resource settings [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) Labour Care Guide (LCG) is a paper-based labour monitoring tool designed to facilitate the implementation of WHO's latest guidelines for effective, respectful care during labour and childbirth. Implementing the LCG into routine intrapartum care requires a strategy that improves healthcare provider practices during labour and childbirth. Such a strategy might optimize the use of Caesarean section (CS), along with potential benefits on the use of other obstetric interventions, maternal and perinatal health outcomes, and women's experience of care. However, the effects of a strategy to implement the LCG have not been evaluated in a randomised trial. This study aims to: (1) develop and optimise a strategy for implementing the LCG (formative phase); and (2) To evaluate the implementation of the LCG strategy compared with usual care (trial phase). Methods: In the formative phase, we will co-design the LCG strategy with key stakeholders informed by facility assessments and provider surveys, which will be field tested in one hospital. The LCG strategy includes a LCG training program, ongoing supportive supervision from senior clinical staff, and audit and feedback using the Robson Classification. We will then conduct a stepped-wedge, cluster-randomized pilot trial in four public hospitals in India, to evaluate the effect of the LCG strategy intervention compared to usual care (simplified WHO partograph). The primary outcome is the CS rate in nulliparous women with singleton, term, cephalic pregnancies in spontaneous labour (Robson Group 1). Secondary outcomes include clinical and process of care outcomes, as well as women's experience of care outcomes. We will also conduct a process evaluation during the trial, using standardized facility assessments, in-depth interviews and surveys with providers, audits of completed LCGs, labour ward observations and document reviews. An economic evaluation will consider implementation costs and cost-effectiveness. Discussion: Findings of this trial will guide clinicians, administrators and policymakers on how to effectively implement the LCG, and what (if any) effects the LCG strategy has on process of care, health and experience outcomes. The trial findings will inform the rollout of LCG internationally. Trial registration: CTRI/2021/01/030695 (Protocol version 1.4, 25 April 2022). Plain language summary: The new WHO Labour Care Guide (LCG) is an innovative partograph that emphasises women-centred, evidence-based care during labour and childbirth. Together with clinicians working at four hospitals in India, we will develop and test a strategy to implement the LCG into routine care in labour wards of these hospitals. We will use a randomised trial design where this LCG strategy is introduced sequentially in each of the four hospitals, in a random order. We will collect data on all women giving birth and their newborns during this period and analyse whether the LCG strategy has any effects on the use of Caesarean section, women's and newborn's health outcomes, and women's experiences during labour and childbirth. While the trial is being conducted, we will also collect qualitative and quantitative data from doctors, nurses and midwives working in these hospitals, to understand their perspectives and experiences of using the LCG in their day-to-day work. In addition, we will collect economic data to understand how much the LCG strategy costs, and how much money it might save if it is effective. Through this study, our international collaboration will generate critical evidence and innovative tools to support implementation of the LCG in other countries. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare WHO modified partogram and paperless partogram in the effective management of labor. Methods: This hospital-based prospective observational study included 200 pregnant women. They were randomized into Group A (n=100) who were monitored with paperless partogram during active labor and Group B (n=100) who were monitored with WHO modified partogram. Resident doctors compared the partographs on the basis of user friendliness (1-10), teachability (1-10), and overall usefulness (1-10). Statistical Package for Social Sciences (SPSS) version 21.0 was used for statistical analysis. P-value of 0.05). Among residents, 57% expressed difficulty with plotting and maintaining WHO Modified partograph. WHO Modified partograph had significantly lower user friendliness score (5.83 ± 0.75 vs. 9 ± 0.89, P=0.0001), teachability score (7 ± 0.63 vs. 9.5 ± 0.55, P=0.003), and overall usefulness (7.5 ± 0.55 vs. 8.83 ± 0.41, P=0.005) than paperless partograph. Conclusion: Paperless partogram was found to be better compared to WHO partogram with respect to user friendliness, teachability, and overall usefulness. It appears to be promising to replace the WHO partograph for monitoring of labor.

Introduction: Safe motherhood ensures safe pregnancy and childbirth. One of the noteworthy causes of maternal morbidity and mortality is the complications arising from prolonged or obstructed labour. World Health Organization recommends the use of partograph to significantly reduce the maternal mortality crisis. This study aimed to evaluate the effectiveness of a novel partograph in terms of maternal and perinatal outcomes along with its utility. Materials and Methods: A total of 400 intranatal women were selected in a non-randomized control trial to evaluate the effectiveness of novel partograph on selected maternal and perinatal outcomes. Subjects in experimental group (n=200) received care with newly developed partograph whereas subjects in control group (n=200) received standard care. Effectiveness was determined at a significance level of α ≤ 0.05. Utility of the novel partograph was determined as perceived by nurses. Results: There was significant reduction in the duration of the 1st and 2nd stage of labour (P=0.023 and 0.006 respectively) and number of vaginal examinations performed during labour (P=0.017) among mothers in the experimental group. Significant improvement in the Apgar score (P=0.005) was also observed among the infants of mothers in experimental group. Novel partograph was considered as of having extreme utility by 71% nurses. Conclusion: Study concluded that subjects monitored by the partograph experienced improved maternal and perinatal outcomes. It was found to be having extreme utility.

Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Safe motherhood ensures safe pregnancy and childbirth. One of the noteworthy causes of maternal morbidity and mortality is the complications arising from prolonged or obstructed labour. World Health Organization recommends the use of partograph to significantly reduce the maternal mortality crisis. This study aimed to evaluate the effectiveness of a novel partograph in terms of maternal and perinatal outcomes along with its utility. Materials and Methods: A total of 400 intranatal women were selected in a non-randomized control trial to evaluate the effectiveness of novel partograph on selected maternal and perinatal outcomes. Subjects in experimental group (n=200) received care with newly developed partograph whereas subjects in control group (n=200) received standard care. Effectiveness was determined at a significance level of α ≤ 0.05. Utility of the novel partograph was determined as perceived by nurses. Results: There was significant reduction in the duration of the 1st and 2nd stage of labour (P=0.023 and 0.006 respectively) and number of vaginal examinations performed during labour (P=0.017) among mothers in the experimental group. Significant improvement in the Apgar score (P=0.005) was also observed among the infants of mothers in experimental group. Novel partograph was considered as of having extreme utility by 71% nurses. Conclusion: Study concluded that subjects monitored by the partograph experienced improved maternal and perinatal outcomes. It was found to be having extreme utility. [ABSTRACT FROM AUTHOR]

Background/Aims: Low levels of partograph documentation and completion in Uganda by skilled health personnel is an ongoing problem. Completion of the partograph lowers the maternal mortality ratio by allowing for the early detection and management of childbirth complications, lowering the incidence of maternal death from preventable causes. However, there is a scarcity of recent studies focused on assessing partograph completion to the required standards. The aim of this study was to assess partograph documentation during monitoring of labour by skilled health personnel. Methods: A retrospective desk review of 400 partographs from women who laboured and gave birth at the Lira Regional Referral Hospital between 1 July and 31 December 2019 was conducted. A structured checklist was used to extract data on completion of the partograph. Results: Only 5% of the partographs were filled to the required standards. Average documentation of the parameters of a partograph to the required standards was 45.1% for fetal monitoring, 44.8% for labour progress, and 15.6% for maternal monitoring. Conclusions: Documentation of different parameters of the partograph by skilled health personnel in public health facilities in northern Uganda was generally low. The Ministry of Health should strengthen partograph audit exercises and support supervision of and in-service capacity development training for skilled health personnel in high-volume facilities on partograph documentation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Maternal deaths from uterine rupture continue to occur globally, with particularly high rates in sub-Saharan Africa. Maternal death reviews have been shown to be an effective part of cohesive strategies to prevent future deaths. OBJECTIVE: This study aimed to conduct maternal death reviews for all deaths following uterine rupture in the study center, to assess preventability, and to synthesize key learning points that may help to prevent future maternal deaths following uterine rupture. STUDY DESIGN: Thorough case reviews of all maternal deaths from 2016 to 2018 at the study center (a national referral hospital in urban Uganda) were conducted by trained multidisciplinary panels of obstetricians and midwives. Medical records of women who died following uterine rupture (n=37, 10.6% of all maternal deaths) were extracted for further analysis. RESULTS: Most maternal deaths due to uterine rupture (36/37, 97%) were preventable, with most having been still potentially preventable after the women reached the study center (24/36, 67%). Obstructed labor was the leading cause of uterine rupture, accounting for 73% (27/37) of cases. Previous cesarean delivery was confirmed in 38% (14/37) of cases. The incidence of grand multiparity was 11% (4/37), and 11% (4/37) were primiparous. Most women (28/37, 76%) died within 24 hours of admission. On arrival at the study center, 19 (51%) were critically ill. Exploratory laparotomy was performed in 54% (20/37) of cases, and a further 35% (13/37) died while awaiting laparotomy. Four women died shortly after arrival at the study center (within 1 hour) and received basic resuscitative treatment; 27% (10/37) of women who died had received antenatal planning or preparation. CONCLUSION: Most deaths due to uterine rupture were preventable. The key lessons that emerged from the reviews were: (1) careful birth preparation and complication awareness for women with known risk factors, (2) early recognition of obstructed labor, (3) close monitoring of obstetrical interventions known to be associated with uterine rupture, and (4) treating incipient or suspected uterine rupture as a time-critical obstetrical emergency. The recommendations emerging from our narrative reviews are suitable for implementation in low-resource obstetrical settings, where high numbers of deaths involving uterine rupture occur.

This article briefly describes principle and use of Partograph in obstetrical practices. This article includes objectives and scope of the tool, the WHO partograph model, the principle of partograph use, components of partograph, problems with the who partograph and advantages and disadvantages of partograph use.

Plain language summary Pregnancy and childbirth are natural phenomena, but sometimes have risk for mothers and babies. Therefore, childbirth should be carefully and continuously monitored by the health care professional. The ‘partograph’ is a useful tool that defines three monitoring aspects of the delivery progress, and conditions of the mother and intrauterine baby. However, it is often used inaccurately or inappropriately in low- and middle-income countries. We hypothesised that health professionals who assist childbirth cannot effectively monitor delivery conditions because their knowledge is insufficient. Therefore, we evaluated the knowledge on monitoring the process of childbirth and explored factors which affect the level of knowledge among health care providers in Cambodia. Midwives and nurses were targeted in this study who deal with normal deliveries in the capital city and two provinces. The questionnaire was designed to evaluate if their knowledge on three monitoring aspects is accurate. Of 542 eligible personnel, 523 (96%) participated. The mean score was 58%. Only 3% got scores of more than 90%. According to the statistical analysis, ‘working in Kampong Cham province’, ‘younger age’, and ‘higher qualification’ were significantly associated with higher scores. Previous training experience was not associated with the score. This study found that basic knowledge was low on delivery management among health care providers. We suspect that a deficiency of basic medical knowledge, such as physiology and anatomy, causes the lack of knowledge on the childbirth process. Further intervention should be attempted to improve the knowledge and quality of maternity services in Cambodia.

Aim: The aim of this study is to assess midwives and nurses' knowledge and skills of the partograph before and after the training. Methods: This cross-sectional study was conducted in Balikesir in Turkey. This study was 45 midwifes and nurses who were given partograph training. A scale measuring the partograph knowledge before and after the training was administered and participants were asked to mark on the partograph by giving a case sample to measure skills of using partograph. The questions prepared to measure knowledge of the partograph were multi-item propositions. Correct answers to the partograph knowledge questions were scored "2", missing answers were scored "1" and wrong answers or unanswered questions were scored "0". Results: Partograph knowledge score averages were meaningfully higher in midwives and nurses who worked in obstetrics clinics, who used partograph and who received partograph training previously (p

Abstract Background Partographs should be used universally to monitor the mother and fetus’s conditions during delivery. However, its application in different parts of the world, including Ethiopia, is inconsistent. Moreover, its magnitude has not been determined in study area. As a result, the aim of this study was to investigate the utilization of partograph and associated factors among obstetric caregivers in public health institutions of Southwest Ethiopian. Methods An institutional-based cross-sectional study was conducted in Southwest Ethiopia from March 1st to June 30th, 2018. A simple random sampling technique was used to select study participants. A self-administered questionnaire was used to gather data on background characteristics, knowledge of partograph, and partograph utilization. The collected data were entered into an EPI Info and analysed using SPSS Version 22. We used bivariate and multivariate logistic regression analysis. Frequencies, tables, and graphs were used to present the final results. To determine statistical significance, a P-value of less than 0.05 was used. Result The response rate of this study was 393(92.2 %). The magnitude of utilization of partograph was 43 % with (95 % CI: 38.4, 48.1). According to the multivariate analysis being nurse or health officer [AOR = 0.37(0.21, 0.66)], degree level educational qualification [AOR = 0.32 (0.17, 0.60)], being trainined on partograph [Adjusted OR = 7.83 (95 % CI: (4.54, 13.50)], good knowledge about partograph [AOR = 5.84 (95 % CI: (3.27, 10.44)] and working at health center [AOR = 1.99 (95 % CI: (1.12, 3.52)] were found as determinants of partograph utilization. Conclusions The magnitude of partograph utilization among obstetric caregivers was found to be low in this study. Partograph utilization was determined by the type of profession, qualification level, knowledge of partograph, in-service training, and type of institution. To ensure its regular, obstetric caregivers must receive training and gain knowledge about it.

Résumé Contexte Le partogramme est l'outil de suivi du travail le plus couramment utillis dans le monde. Cependant, il est utilisé de façon incorrecte ou non uniforme dans de nombreux contextes. En 2018, un groupe d'experts de l'OMS a examiné et révisé la conception du partogramme à la lumière de nouvelles données et a développé la première version du Guide de Gestion du Travail. L'objectif de cette étude était d'explorer les points de vue et les opinions du personnel de santé qualifié sur la première version du Guide de Gestion du Travail de l'OMS. Méthodes Un vaste réseau mondial de recherche a permis d'identifier le personnel de santé qualifié (y compris des obstétriciens, des sages-femmes et des médecins généralistes) des deux sexes, en Afrique, Asie, Europe et en Amérique latine. Les coordinateurs nationaux du réseau ont invité entre 5 et 10 personnels de santé qualifiés de niveau intermédiaire à supérieur, et ayant travaillé dans des services de maternité à au cours des 5 dernières années. Un questionnaire en ligne, structuré, anonyme et à remplir soi-même, comprenant des questions fermées et ouvertes, a été conçu pour évaluer la clarté, la pertinence, la convenance de la fréquence d'enregistrement et l’intégrité des variables du Guide de Gestion du Travail. Résultats Au total, 110 participants de 23 pays ont répondu à l'enquête entre décembre 2018 et janvier 2019. Les variables incluses dans le Guide de Gestion du Travail ont t généralement considérées claires, pertinentes et avec une fréquence d'enregistrement appropriée. La plupart des sections du Guide de Gestion du Travail sont considérées complètes. Les participants ont approuvé ou fortement approuvé le concept générale, la structure du Guide de Gestion du Travail et l'utilité des seuils de référence pour déclencher une évaluation et des actions supplémentaires. Ils ont également convenu que le Guide de Gestion du Travail aura potentiellement un impact positif sur les prise de décisions cliniques et les soins maternels respectueux. Les personnes interrogées ont exprimé leur désaccord avec la valeur de certaines variables, notamment la capacité d'adaptation, l'urine et l'état néonatal. Conclusions Les futurs utilisateurs du le Guide de Gestion du Travail ont estimé que les variables étaient claires, pertinentes et appropriées, et qu'elles pourraient avoir un impact positif sur la prise de décision clinique et les soins de maternit respectueux, moyennant quelques améliorations mineures.

Background: World Health Organization (WHO) recommended use of partograph during childbirth to ensure early identification of abnormalities and prompt referral for emergency obstetrics care. However, factors that determine use of partograph during childbirth among primary healthcare workers (PHCWs) remain inadequately documented. Objective: This study investigated the determinants of use of partograph in conduct of labor among PHCWs in Enugu, South-East Nigeria. Materials and Methods: It was a cross-sectional descriptive survey of public PHCWs in Enugu State, Nigeria. Multistage sampling technique was used to select 393 respondents. Data were collected using a structured self-administered questionnaire and analyzed with IBM-SPSS version 22. Tests of statistics were conducted using χ2 and binary logistic regression, and statistical significance was determined at P-value of < 0.05. Results: Majority (87.0%) of the respondents have good knowledge of partograph. Reported regular availability of partograph is 32.8% but regular use of it is 25.2%. Statistically significant association exists between use of partograph and reception of training on it (P=0.001), knowledge of it (P=0.001), and availability of it (P=0.001). Availability of partograph was a predictor of use of it (adjusted odds ratio (AOR)=27.129; confidence interval=14.780–49.797). Conclusion: Although there is high knowledge of partograph among PHCWs in Enugu state, there is poor usage of it. There are 27 times higher odds of using partograph when it is made available compared with when it is not. We recommend regular provision of partograph to labor ward personnel in PHCWs in Enugu state and other similar populations.

Abstract Background The period around childbirth and the first 24 hours postpartum remains a perilous time for both mother and newborn. Health care providers’ compliance to the World Health Organization modified partogram across the active first stage of labor is a graphic representation of a mother’s condition that is used as a guide in providing quality obstetrics care. However, little evidence is documented on the health providers’ adherence to the use of the partograph in Ethiopia, which limits health care providers’ ability to improve quality care services. Therefore, this study assessed the adherence of partograph use and associated factors in Ethiopia. Methods Data from the Ethiopian 2016 National Emergency Obstetric and Newborn Care survey of 3,804 health facilities that provided maternity services were used. We extracted 2611 partograph charts over a 12 months period prior to the survey to review the proper recording of each component. Data analyses were performed using SPSS version 22.0 software. A logistic regression analyses was used to identify the association of explanatory variables with the outcome variable. A p-value of

Abstract Background Partograph is cost effective and affordable tool designed to provide a continuous pictorial overview and labour progress used to prevent prolonged and obstructed labour. It consists of key information about progress of labour, fetal condition and maternal condition. Its role is to improve outcomes and predict the progress of labour. The aim of this study was to assess utilization of partograph and its predictors among midwives working in public health facilities, Addis Ababa city administration, Ethiopia, 2017. Methods An institution based cross-sectional study design was conducted in Addis Ababa, Ethiopia from 15/10/2017–15/12/2017.Simple random sampling under multistage sampling technique was applied to select a total of 605 midwives working in maternity unit of selected public health facilities. Data were collected using structured self-administered questionnaire. Checklist based direct observations were made to all midwife participants to determine the actual practical use of partograph. Data first entered in to EpiInfo version 3.5.1 and transported to SPSS Version 21.Descriptive statistics such as frequency, percentage, mean, and median were calculated. Biviriate and multivariable logistic regression analysis were applied. Any personal identification of the study participants was not recorded during data collection to ensure confidentiality of information. Results In this study, the utilization of partograph was 409(69%) out of 594 study participants. Being mentored(AOR = 3.1; 95% CI: 1.7, 5.3),received training (AOR = 2.4; 95% CI:1.5,3.6),being knowledgeable about partograph (AOR = 1.6; 95% CI: 1.1, 2.5), health center workers(AOR = 12.6; 95% CI:5.1,31.6),supportive supervision 4 times per year (AOR = 18.6; 95% CI: 6.6,25),supportive supervision twice per a year (AOR = 4.7; 95% CI: 1.9, 11.3),supportive supervision once per year (AOR =3.8;95% CI:1.7,8.8) were positive predictors of partograph utilization. Two midwives per shift (AOR = 0.101; 95% CI: 0.05, 0.65), and 4 per shift (AOR = 0.105, 95% CI: 0.03, 0.40) were protective predictors of partograph utilization. Conclusions More than half of the respondents utilized partograph. All public health institutions avail partograph in their laboring room but didn’t utilize it according to WHO recommended standard. Working facility, supportive supervision, mentoring, training on partograph, number of midwives working per shift, and knowledge were factors affecting partograph utilization. Encouraging interventions are recommended to the response of the above significantly associated factors.

Context: It was hypothesized that knowledge of skilled birth attendants (SBAs) about partograph and its utilization can be improved by modifying their predictors through training workshops. Aim: To upgrade the knowledge regarding partograph and its utilization by SBAs by modifying their predictors through training workshops. Settings and Design: This was an intervention study, which was conducted in a rural area of the Jodhpur district of Rajasthan state. Subjects and Methods: The SBAs were interviewed through pre and postintervention with the help of a prevalidated semi-structured interview schedule. As a part of an intervention, a series of half-day training workshops were conducted in the intervention block. Data were analyzed using SPSS version 23. Statistical Analysis Used: Descriptive statistics, univariate (Chi-square, t-test), and multivariate (logistic regression) analysis. Results: A total of 213 SBAs (105 from intervention and 108 from control block) were included in the study. SBAs who had received training related to the partograph were having significantly higher odds of knowing (AOR = 22.6[10.7–47.9]) as well as utilization (AOR = 22.5[7.05–72.1]) of partographs as compared to their counterparts. Knowledge was also a significant predictor of the utilization of partograph. Intervention could significantly improve the knowledge of SBAs about partograph as well as its utilization in the intervention block. Conclusion: Significant impact of the intervention on knowledge about partograph and its utilization was evidenced in the present study. There is a need to conduct training and refresher courses for healthcare workers on partograph use.

Background: Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low- and middle-income countries., Objective: We evaluated the modified World Health Organization (WHO) Labour Care Guide (LCG) in detecting prolonged and or obstructed labour, and other delivery outcomes compared with a traditional partograph at publicly-funded maternity centers of rural Mbarara district and City, Southwestern Uganda., Methods: Since November 2023, we deployed the LCG for use in monitoring labour by trained healthcare providers across all maternity centers in Mbarara district/City. We systematically randomized a total of six health center IIIs (HCIIIs) out of 11, and all health center IVs (HCIVs), reviewed all their patient labour monitoring records for their first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction). Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Our secondary outcomes included; tool completion, mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage (PPH). Data was collected in RedCap and analyzed using STATA version 17. Statistical significance was considered at p<0.05., Results: A total of 2,011 women were registered; 991 (49.3%) monitored using the LCG, and 1,020 (50.7%) using a partograph, 87% (1,741/2011) delivered from HCIVs and 270/2011 (13%) from HCIIIs. Mean maternal age (25.9; SD=5.6) and mean gestation age (39.4; SD=1.8) were similar between the two groups. A total of 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph), with the LCG having six times higher odds to detect/diagnose prolonged/obstructed labour compared to the partograph (aOR=5.94; CI 95% 3.63-9.73, P<0.001). Detection of obstructed labour alone increased to 12-fold with the LCG compared to the partograph (aOR=11.74; CI 95% 3.55-38.74, P<0.001). We also observed increased Caesarean section rates (aOR=6.12; CI 4.32-8.67, P<0.001), augmentation of labour (aOR=3.11; CI 95% 1.81-5.35, P<0.001), and better Apgar Score at 5 minutes (aOR=2.29; CI 95% 1.11-5.77, P=0.025). The tool completion rate was better for LCG compared to (58.5% versus 46.3%), aOR=2.11; CI 95% 1.08-5.44, P<0.001. We observed no differences in stillbirths, maternal deaths, post-partum haemorrhage (PPH) and uterine rupture., Conclusions: Our data shows that LCG diagnosed more cases of prolonged and or obstructed labour compared to the partograph among women delivering at rural publicly funded facilities in Mbarara city/district. We also observed increased C-sections, labour augmentation, and 5-minute Apgar scores. There were no differences in stillbirths, maternal deaths, PPH and uterine rupture. More controlled and powered studies should evaluate the two tools for other delivery outcomes, in different sub-populations.Trial registration number NCT05979194 clinical trials.gov., Competing Interests: Competing interests: No conflict of interest declared

Labour care must balance aspirations of parents with vigilance for unanticipated calamities. The 'on-site midwife-led primary care birth unit' facilitates this. The World Health Organization have replaced the traditional partograph with the 'Labour Care Guide'. An implementation project in Botswana included the mnemonic COPE: Companion, Oral fluids, Pain relief and Eliminate the supine position. The Parto-Ma project in Tanzania used guidelines, training and support to improve childbirth outcomes. We list labour practices supported by recent evidence, and highlight new developments. Foetal macrosomia increases risk but mistaken diagnosis increases caesarean births. Obstructed labour is a complex clinical diagnosis, and is difficult to predict. For shoulder dystocia prioritise delivery of the posterior shoulder, facilitated if needed by posterior axilla sling traction. 'Extended balloon labour induction' with two or three Foley catheters side by side, may reduce risks associated with uterine stimulants. Bedside ultrasound may facilitate the diagnosis of cephalic malpositions and malpresentations., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Oxytocin augmentation is essential in labor management, but how to optimize its use is still debated. Joint international guidelines regarding prolonged labor and the use of oxytocin augmentation are still not available. Due to its potential harmful side effects, a decreased use of oxytocin is encouraged. We aimed to implement a structured protocol on the use of oxytocin augmentation and to observe changes in labor outcomes.Materials and Methods: The protocol was implemented at the Obstetric Department of Sørlandet Hospital, Kristiansand, Norway on 1 January 2012; therefore, data from the hospital were collected prospectively and compared for two time-period cohorts: the historic control cohort (2009-2010) and the study period cohort (2012-2013). The structured protocol instructs, and restricts, the birth attendants to diagnose prolonged labor, by protocol definition only, before commencing oxytocin infusion for augmentation. Nulliparous women with singleton, term deliveries (≥37 weeks), cephalic presentation, and spontaneous onset of labor (Ten-Group Classification System (TGCS) group 1) were included in the analysis. The main outcome was use of oxytocin augmentation.Results: The study cohort and control cohort comprised 1103 (26.2%) and 1399 (33.1%) of all laboring women, respectively (p < .01). The protocol was followed satisfactorily in 78% of the study cohort. The use of oxytocin augmentation was reduced in the study cohort versus the control cohort; 41.3 versus 48.9% (p < .01); mean oxytocin infusion duration was shorter (100 versus 123 min; p < .01); and mean total oxytocin dose decreased (1009 versus 1293 mU; p < .01). The cesarean section rate was 5.9% in the study cohort versus 8.0% in the control cohort (p = .04). The estimated mean duration of the active phase of labor increased by 47 min (p < .01) after the implementation. The frequency of estimated postpartum hemorrhage >1000 ml was higher, 4.9 versus 2.0% (p < .01), but the use of blood transfusions remained stable, 2.5 versus 2.7% (p = .78), the study cohort versus control cohort, respectively.Conclusions: Implementation of a protocol of structured use of oxytocin augmentation reduced the frequency, dosage, and duration of oxytocin without increasing the cesarean section rate in TGCS group 1. [ABSTRACT FROM AUTHOR]

Background: Labour progress in partograph plotting helps to early recognition and prevention of the complication of labour. This helpful in better maternal and perinatal outcome. Aim of the study is to evaluate the maternal and perinatal outcome in primigravida and multigravida by comparing their partograph in labour. Material And Methods: This prospective observational study was carried out in Smt. SCL General Hospital a teaching tertiary care hospital from May-2018 to November-2019. Total 250 cases out of which 125 cases of primigravida and 125 cases of multigravida admitted in labour room were randomly selected and monitored by using modified WHO partograph. All the cases reporting to labour room and fulfilled the inclusion criteria were included in this study. Individual partograph was studied to know the various aspect of course of labour. Result: 208 out of 250 cases were before alert line, 34 cases were between alert and action line and 8 cases were beyond action line. Rate of cervical dilatation in most primigravida was between 1.1-2cm/hour and in multigravida was >2.1cm/hour. In Zone A, in primigravida 90.7% had VD and 9.3% had LSCS whereas in multigravida 96.4% had VD and 3.6% had LSCS. In Zone B, in primigravida 47.8% had vaginal delivery and 52.2% had LSCS whereas in multigravida 54.4% had VD and 45.5% LSCS. In Zone C, in primigravida and multigravida there were no VD and 100% had LSCS. Protracted active phase (50%) was presents the most common abnormality of first stage of labour in both group in present study and in second stage, arrest of decent (82%) was more common. In both groups, NICU admission were more in Zone C (3.2%) as compared to Zone A (2%) and Zone B (1.6%). Conclusion: This study has shown that using the partograph can be highly effective in reducing complications from both mother and neonate. It is also helpful in monitoring of labour and early diagnosis of abnormal labour. It prevents maternal mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background/aims: Effective labour monitoring is integral to intrapartum care. Yet, to date, tools to facilitate this have not reached their potential. This study aims to explore midwives' initial reactions to the latest World Health Organization labour care guide, which is a replacement to the existing partograph, to enable adaptations to be made and to inform implementation strategies. Methods: This was a qualitative study that used interviews and focus groups to gather data from a convenience sample of midwife delegates from six sub-Saharan Africa countries who were attending a midwifery conference in Malawi. Data were analysed thematically. Results: A total of 43 participants participated; six focus groups and 12 individual interviews were conducted. Participants expressed both positive and negative views of the guide. Three main themes were found. The theme 'sticking to what is familiar' demonstrated reluctance to change; 'chart based on usual or optimum practice' suggested that midwives wanted a chart that reflects the routine care provided as opposed to the evidence-based care they should provide; and 'measures for effective implementation' highlighted the importance of having carefully considered and robust strategies for implementing the guide. Conclusions: This rapid evaluation provided a snapshot of midwives' initial reactions to the new labour care guide. Although the existing partograph has not reached its full potential, midwives showed a reluctance to change it for something new. Feedback from participants has been fed into the development phase of the guide, informing its presentation, contents and field testing. [ABSTRACT FROM AUTHOR]

Background: The Investigator conducted a study to Assess the Effectiveness of Breast Crawl Technique on selected, Maternal and neonatal Outcomes Among Mothers Admitted in Labour Ward at selected hospitals of Kheda-anand District Gujarat. was carried out by researcher. The objectives of the study were: (1) To assess the effectiveness of breast crawl technique on maternal and neonatal outcome among experimental group and control group. (2) To find out the association between maternal and neonatal outcomes and selected demographic variables in experimental group. Research Design: A quasi experimental research approach was used with non-equivalent control group post test only design. The researcher used nonprobability purposive sampling technique for selecting the 40 samples. Tools: Latch scale was used to assess the initiation of breast feeding, Visual analogue pain scale was used to assess the intensity of pain, and APGAR score was used for newborn assessment. Validity was assessed by 7 experts. Reliability of latch scale, Visual analogue pain scale and APGAR Score was ascertained by using Karl Pearson's co-relation coefficient formula. Data Analysis & Results: The data will be analyzed by descriptive statistics such as Mean, Standard deviation, Frequency, Percentage. The mean score of effectiveness of breast crawl technique on initiation of breast feeding, intensity of pain, newborn assessment was higher in experimental group than the control group. So it was revealed that there was significant difference between experimental group and control group. For comparison of effectiveness of breast crawl technique on initiation of breast feeding, intensity of pain, newborn assessment in that mean score was higher and calculated "t" test value is 4.83 which is greater than tabulated value 2.09. So, that the research hypothesis is accepted and proved that there will be significant association between initiation of breast feeding, intensity of pain, newborn assessment between the experimental group and control group. The finding of the study also revealed that there was significant association between the initiation of breast feeding, intensity of pain, newborn assessment with selected demographic variables. [ABSTRACT FROM AUTHOR]

Background: The article seeks to document the experience of implementing Maternal Death Surveillance and Response (MDSR) in the Center Region of Cameroon. The paper raises awareness on the need for implementing MDSR, shares progress and lessons learned and reflects on the implications for public health practice. Methods: A desk research involving the collection and analysis of secondary data using tables with specific themes in excel, following the review of existing resources at the Regional Delegation of Public Health-Center from the year 2016 to 2019. Results: The findings depict the existence of MDSR policies and sub-regional committees. Although, the number of regional maternal death notifications increased from 19 to 188 deaths between 2016 and 2019, the implementation of death review recommendations was only estimated at 10% in 2019. While 66% of deaths occurred in Yaoundé, 72% of these were deaths reported to have occurred in tertiary institutions out of which 75% were attributed to late referrals. Hemorrhage constituted 70/144 (48.6%) of the known direct causes of death. Maternal death related co-factors such as the use of partograph during labor had a high non-response rate (84%) and represents a weakness in the data set. Conclusion and Global Health Implications: Across the board, stakeholder engagement towards MDSR was increased through continuous awareness-raising, dissemination of surveillance tools, the institutionalization of the District Health Information Software (DHIS 2) and the “No Name No Blame” policy. However, the reporting and investigation of deaths for informed decisions remain a daunting challenge. For a resource-scarce setting with limited access to blood banks, the application of life-saving cost-effective interventions such as the use of partographs and the institution of a functional referral system among health units is likely to curb the occurrence of deaths from hemorrhage and other underlying causes. The success of these will require a robust strengthening of the health system. Copyright © 2021 Bongajum, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Background/Aims: Malawi has very high maternal and neonatal mortality rates, often resulting from complications during labour and delivery. Complete recording of a partograph during labour monitoring has been associated with a reduction and prompt management of fatal complications. Although the partograph is an essential tool for monitoring women during labour, there is limited evidence on the status of its recording and associated factors among skilled birth attendants in northern Malawi. The aim of this study was to assess partograph recording and explore factors affecting its recording among skilled birth attendants at the Mzuzu Central Hospital in Malawi. Methods: The study used a descriptive cross-sectional design with mixed methods. The study involved a retrospective review of 369 patient partographs, using a data extraction sheet to gather quantitative data, which were analysed using descriptive statistics. Qualitative data were collected through individual in-depth interviews with seven skilled birth attendants working at the hospital, using a semi-structured interview guide and analysed by content analysis. Results: Of the 369 partographs that were reviewed, recording was complete in only 12.7% of fetal assessments, 13.3% of maternal assessments and 24.7% of sections recording the progress of labour. The most completely recorded parameter was liquor (71.8%), followed by cervical dilatation (70.5%). The least completely recorded parameters were temperature (13.6%) and urine protein (2.2%). Factors that influenced the recording of a partograph included skilled birth attendants' general knowledge on the partograph, the availability of equipment for assessments, supportive supervision, staffing levels, attendance to in-service training and clients' perception of the frequency of assessments. Conclusions: Skilled birth attendants at Mzuzu Central Hospital partially complete partographs during labour. Staffing levels, availability of equipment for assessments, in-service training and supportive supervision are all factors that affect complete partograph recording. Therefore, it is essential to implement strategies that can promote complete partograph recording in order to reduce maternal and newborn morbidity and mortality at this health facility. [ABSTRACT FROM AUTHOR]

Abstrait Objectif Il n’ya pas de consensus sur les paramètres essentiels à surveiller pendant l’accouchement, quand commencer et le taux de surveillance. Le désaccord des utilisateurs contribue à une utilisation incohérente du partogramme modifié de l’Organisation mondiale de la Santé en douze éléments qui est. démarré lorsque le col. de l’utérus est. dilaté à au moins 4 cm. L’utilisation incohérente est. associée à de mauvais résultats à la naissance. Notre objectif était d’identifier les points de vue des experts en matière d’accouchement sur ce qu’il convient de surveiller régulièrement pendant l’accouchement dans les pays à faibles ressources, et à quel moment, afin de développer un outil d’aide à la décision clinique plus acceptable pour l’accouchement. Méthode Nous avons mené une étude Delphi avec deux enquêtes au début de 2018. Le questionnaire en ligne couvrait les éléments du partogramme tels que le cœur du fœtus, la dilatation du col. utérin et la pression artérielle, ainsi que leurs taux de surveillance. Nous avons invité des intervenants expérimentés dans les soins à l’accouchement en Afrique subsaharienne. Le consensus était prédéfini à 70%. Les membres du panel évaluaient un paramètre et quelques raisons qualitatives des choix recueillis. Résultats Nous avons analysé les réponses de 76 experts de 13 pays. Un consensus s’est. dégagé sur six paramètres importants, notamment la fréquence cardiaque fœtale, la clarté du liquide amniotique, la dilatation du col. utérin, la force des contractions utérines, le pouls maternel et la pression artérielle. Deux experts sur trois se sont déclarés favorables à la modification des intervalles de surveillance pour certains paramètres dans le partogramme. 63% des experts élèveraient le point de départ du partogramme alors que 58% en supprimeraient certains éléments. Un consensus s’est. dégagé sur le suivi de la dilatation cervicale toutes les 4 heures et un accord sur le suivi du rythme cardiaque fœtal toutes les heures. Cependant, d’autres paramètres ne montraient que les intervalles de majorité et sans atteindre les scores d’accord. Les intervalles suggérés étaient de deux heures pour la force des contractions utérines et de quatre heures pour l’épaisseur du liquide amniotique, le pouls de la mère et la pression artérielle. La raison la plus commune de leurs opinions était les conditions de travail les plus exigeantes. Conclusion il y avait accord sur le fait que six items du partogramme étaient essentiels pour le suivi systématique à la naissance, mais la fréquence du suivi pourrait être modifiée. Pour accroître l’acceptabilité, il est. nécessaire de réviser les lignes directrices sur la surveillance des naissances en tenant compte des opinions et des conditions de travail de plusieurs experts en matière d’accouchement dans des pays à faibles ressources.

Abstract Background Morbidity of birth asphyxia has been estimated to be 42 million disability-adjusted life years. The study sought to assess the impact of the use and completion of partograph during labour on reducing birth asphyxia at the St Anthony’s Hospital, Dzodze, in the Volta Region of Ghana. Methods A retrospective study design using a quantitative approach was adopted for the study. A simple random sampling technique was used to select a total of 200 folders of labouring women who were admitted and delivered at St Anthony’s Hospital, Dzodze, between 1st May 2015 and 30th April 2016. A structured checklist, which was developed by using labour and foetal monitoring parameters based on the standards of the World Health Organization partograph usage, was used to review all the 200 existing maternal records. Results The findings revealed that partographs were used by midwives at St Anthony’s Hospital with the majority of the maternal folders fully completed. The use and completion of partograph were found to be associated with less non-asphyxiated birth outcomes. Labours which were monitored with partograph were 4.29 times less likely to result in birth asphyxia [AOR (95% CI) 4.29 (1.35–14.81)], and those that were monitored with a completed partograph were 5.3 times less likely to result in birth asphyxia [AOR (95% CI) 5.31 (2.011–16.04)]. Conclusion Midwives used partographs during labour at St Anthony’s Hospital. The use and completion of partograph were significantly associated with a reduced incidence of birth asphyxia at the hospital. Birth asphyxia could be reduced if partographs are used and completed by midwives during labour in all cases.

Abstract Background The appropriate use of the Partograph allows early identification of labour related complications and prevents deaths. We, therefore, sought to determine the level of Partograph completion and healthcare worker perspectives towards its utilization. Methods This study had two components; a hospital-based cross-sectional descriptive chart review at the Mulago National Referral Hospital, Kampala, Uganda and a qualitative study involving four Focus Group Discussions (FGDs) with ward nurses, midwives and postgraduate residents. Data from the FGDs were analyzed using thematic -content analysis in Open Code software. The quantitative data were summarized using descriptive statistical analysis, means and proportions. Results Among the 355 Partographs reviewed, 79.1% had incomplete documentation of age, 52.7% gravidity, and 3.2% parity. In about 61%, the specific parameters for fetal monitoring, maternal monitoring and labour progress were incomplete. From the FGDs, the healthcare workers reported being unable to complete the Partographs due to the overwhelming numbers of expectant mothers and other staff responsibilities. Congestion in the maternity ward reduced the Partograph completion rates. The availability of other monitoring tools, limitation in skills, inadequate equipment and supplies, and the state of the mother at the presentation to the hospital all made Partograph use and completion challenging. Conclusions The majority of Partographs started by health workers were incomplete. The time required to document, health system challenges, status of mother at presentation, and the high workload undermined completion of the Partograph at this high volume facility.

Context: Partograph is a simple, effective and low-cost intrapartum monitoring tool that helps in early identification of complications if any and helps in prompt intervention to save the life of the mother and the newborn. There is limited study about its usage and challenges in plotting from India particularly Odisha. Aim: To determine the usage of partograph and explore the issues/challenges in its plotting at various levels of health facilities Settings and Design: A cross-sectional study was carried out from April to June 2018 in ten different public health facilities from two tribal districts of Odisha, India. Materials and Methods: Quantitative information from 1552 mothers using pre-tested epi-info questionnaire tool and qualitative information through 22 in-depth interviews among health care providers. Statistical Analysis Used: Quantitative data using Ms Excel 10 and IBM SPSS ver. 22 and qualitative data using the inductive content analysis method. Results: Partograph plotting was found in 48.7% (adherence) while its completeness was only 1.03%. Partograph plotting was significantly better at CHCs compared to DHH and SDH (P = 0.000). No significant association of partograph adherence was observed with the birth outcome, complications, referral status and type of delivery. Though majority health care providers knew the importance of the partograph, hardly they use it. The main reasons were increased workload, shortage of staff, cases arriving at a later stage and lack of monitoring from a higher level. Conclusions: On job training on partograph, regular monitoring and strict policy will improve the adherence and completeness in partograph plotting.

Background: Delivery is a critical moment for pregnant women and babies, and careful monitoring is essential throughout the delivery process. The partograph is a useful tool for monitoring and assessing labour progress as well as maternal and foetal conditions; however, it is often used inaccurately or inappropriately. A gap between practices and evidence-based guidelines has been reported in Cambodia, perhaps due to a lack of evidence-based knowledge in maternity care. This study aims to address to what extent skilled birth attendants in the first-line health services in Cambodia have knowledge on the management of normal delivery, and what factors are associated with their level of knowledge. Methods: Midwives and nurses were recruited working in maternity in first-line public health facilities in Phnom Penh municipality, Kampong Cham and Svay Rieng provinces. Two self-administered questionnaires were applied. The first consisted of three sections with questions on monitoring aspects of the partograph: progress of labour, foetal, and maternal conditions. The second consisted of questions on diagnostic criteria, normal ranges, and standard intervals of monitoring during labour. A multiple linear regression analysis was performed to identify relationships between characteristics of the participants and the questionnaire scores. Results: Of 542 eligible midwives and nurses, 523 (96%) participated. The overall mean score was 58%. Only 3% got scores of more than 90%. Multivariate analysis revealed that 'Kampong Cham province', 'younger age', and 'higher qualification' were significantly associated with higher scores. Previous training experience was not associated with the score. Substantial proportions of misclassification of monitoring items during labour were found; for example, 61% answered uterine contraction as a foetal condition, and 44% answered foetal head descent and 26% answered foetal heart rate as a maternal condition. Conclusion: This study found that knowledge was low on delivery management among skilled birth attendants. Previous training experience did not influence the knowledge level. A lack of understanding of physiology and anatomy was implied. Further experimental approaches should be attempted to improve the knowledge and quality of maternity services in Cambodia. Plain language summary: Pregnancy and childbirth are natural phenomena, but sometimes have risk for mothers and babies. Therefore, childbirth should be carefully and continuously monitored by the health care professional. The 'partograph' is a useful tool that defines three monitoring aspects of the delivery progress, and conditions of the mother and intrauterine baby. However, it is often used inaccurately or inappropriately in low- and middle-income countries. We hypothesised that health professionals who assist childbirth cannot effectively monitor delivery conditions because their knowledge is insufficient. Therefore, we evaluated the knowledge on monitoring the process of childbirth and explored factors which affect the level of knowledge among health care providers in Cambodia. Midwives and nurses were targeted in this study who deal with normal deliveries in the capital city and two provinces. The questionnaire was designed to evaluate if their knowledge on three monitoring aspects is accurate. Of 542 eligible personnel, 523 (96%) participated. The mean score was 58%. Only 3% got scores of more than 90%. According to the statistical analysis, 'working in Kampong Cham province', 'younger age', and 'higher qualification' were significantly associated with higher scores. Previous training experience was not associated with the score. This study found that basic knowledge was low on delivery management among health care providers. We suspect that a deficiency of basic medical knowledge, such as physiology and anatomy, causes the lack of knowledge on the childbirth process. Further intervention should be attempted to improve the knowledge and quality of maternity services in Cambodia. [ABSTRACT FROM AUTHOR]

Background: Partographs should be used universally to monitor the mother and fetus's conditions during delivery. However, its application in different parts of the world, including Ethiopia, is inconsistent. Moreover, its magnitude has not been determined in study area. As a result, the aim of this study was to investigate the utilization of partograph and associated factors among obstetric caregivers in public health institutions of Southwest Ethiopian.Methods: An institutional-based cross-sectional study was conducted in Southwest Ethiopia from March 1st to June 30th, 2018. A simple random sampling technique was used to select study participants. A self-administered questionnaire was used to gather data on background characteristics, knowledge of partograph, and partograph utilization. The collected data were entered into an EPI Info and analysed using SPSS Version 22. We used bivariate and multivariate logistic regression analysis. Frequencies, tables, and graphs were used to present the final results. To determine statistical significance, a P-value of less than 0.05 was used.Result: The response rate of this study was 393(92.2 %). The magnitude of utilization of partograph was 43 % with (95 % CI: 38.4, 48.1). According to the multivariate analysis being nurse or health officer [AOR = 0.37(0.21, 0.66)], degree level educational qualification [AOR = 0.32 (0.17, 0.60)], being trainined on partograph [Adjusted OR = 7.83 (95 % CI: (4.54, 13.50)], good knowledge about partograph [AOR = 5.84 (95 % CI: (3.27, 10.44)] and working at health center [AOR = 1.99 (95 % CI: (1.12, 3.52)] were found as determinants of partograph utilization.Conclusions: The magnitude of partograph utilization among obstetric caregivers was found to be low in this study. Partograph utilization was determined by the type of profession, qualification level, knowledge of partograph, in-service training, and type of institution. To ensure its regular, obstetric caregivers must receive training and gain knowledge about it. [ABSTRACT FROM AUTHOR]