Effect of partogram use on outcomes for women in spontaneous labour at term.

BACKGROUND: The partogram (sometimes known as partograph) is usually a pre-printed paper form, on which labour observations are recorded. The aim of the partogram is to provide a pictorial overview of labour, to alert midwives and obstetricians to deviations in maternal or fetal wellbeing and labour progress. Charts often contain pre-printed alert and action lines. An alert line represents the slowest 10% of primigravid women's labour progress. An action line is placed a number of hours after the alert line (usually two or four hours) to prompt effective management of slow progress of labour. OBJECTIVES: To determine the effect of use of partogram on perinatal and maternal morbidity and mortality.To determine the effect of partogram design on perinatal and maternal morbidity and mortality. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2008) and CENTRAL (The Cochrane Library, Issue 3, 2007). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials involving a comparison of partogram with no partogram, or comparison between different partogram designs. DATA COLLECTION AND ANALYSIS: Three authors independently assessed eligibility, quality and extracted data. When one author was also the trial author, the two remaining authors assessed the studies independently. MAIN RESULTS: We have included five studies in this review, involving 6187 women; two studies assessed partogram versus no partogram and the remainder assessed different partogram designs. There was no evidence of any difference between partogram and no partogram in caesarean section (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.24 to 1.70); instrumental vaginal delivery (RR 1.00, 95% CI 0.85 to 1.17) or Apgar score less than seven at five minutes (RR 0.77, 95% CI 0.29 to 2.06) between the groups. When compared to a four-hour action line, women in the two-hour action line group were more likely to require oxytocin augmentation (RR 1.14, 95% CI 1.05 to 1.22). When the three- and four-hour action line were compared, caesarean section rate was lowest in the four-hour action line group and this difference was statistically significant (RR 1.70, 95% CI 1.07 to 2.70, n = 613 , one trial). AUTHORS' CONCLUSIONS: On the basis of the findings of this review, we cannot recommend routine use of the partogram as part of standard labour management and care. We do recommend that the evidence presented should be used as a basis for discussion between clinicians and women. Further trial evidence is required to establish the efficacy of partogram use.