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Effect of different partogram action lines on birth outcomes: a randomized controlled trial
Tina Lavender1, Zarko Alfirevic, Stephen Walkinshaw
1University of Central Lancashire, Preston, United Kingdom. Tinalav@yahoo.co.uk
Obstetrics and Gynecology
|August 2, 2006
Summary
A 2-hour partogram action line for prolonged labor in first-time mothers increases interventions without improving birth outcomes. The World Health Organization’s 4-hour guideline is recommended for low-intervention care.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Labor Management
Background:
- The World Health Organization (WHO) recommends a 4-hour action line on partograms to guide intervention timing for prolonged labor.
- Alternative recommendations suggest earlier intervention for prolonged labor.
- This study assessed the impact of different partogram action line placements on birth outcomes.
Purpose of the Study:
- To evaluate the effect of 2-hour versus 4-hour partogram action lines on cesarean delivery rates and maternal satisfaction.
- To determine if an earlier intervention threshold (2-hour line) impacts labor management and outcomes compared to the WHO's 4-hour guideline.
Main Methods:
- A randomized trial involving 3,000 primigravid women with uncomplicated pregnancies in spontaneous labor at term.
- Women were assigned to partograms with action lines set at 2 or 4 hours after the alert line.
- Primary outcomes included cesarean delivery rate and maternal satisfaction; secondary outcomes involved labor interventions and care transfers.
Main Results:
- No significant difference was observed in cesarean delivery rates (RR 1.00, 95% CI 0.80-1.26) or maternal dissatisfaction (RR 0.89, 95% CI 0.66-1.21) between the 2-hour and 4-hour groups.
- The 2-hour action line group experienced more labors crossing the action line (RR 1.27, 95% CI 1.18-1.37) and received more interventions (RR 1.23, 95% CI 1.14-1.33).
- Women in the 2-hour group were also more likely to be transferred from midwife-led to consultant-led care (RR 1.26, 95% CI 1.13-1.42).
Conclusions:
- For primigravid women opting for low-intervention care, a 2-hour partogram action line increases the need for interventions.
- The 2-hour partogram did not lead to improved maternal or neonatal outcomes compared to the WHO's recommended 4-hour partogram.
- The findings suggest that the 4-hour partogram action line is preferable for women seeking low-intervention birth experiences.
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