Randomized controlled trial of labor outcomes with action line placement at 2 hours versus 4 hours on the partograph

To evaluate whether treatment of slow labor progress among term nulliparous women using a 2-hour partograph action line reduces the incidence of prolonged labor versus a 4-hour action line.

Randomized controlled trial of nulliparous women with a term singleton, non-macrosomic, cephalic fetus in labor attending a university hospital in Nigeria (2008-2015). For labor supervision, women were randomly assigned to the 2-hour (n=320) or 4-hour (n=320) partograph action line group. slow labor progress was treated with oxytocin augmentation The primary outcome was incidence of prolonged labor (>12 hours). Delivery mode, neonatal outcomes, and maternal satisfaction with treatment were secondary outcomes.

Prolonged labor rate did not significantly differ between the 2-hour (7/320, 2.2%) and 4-hour (8/320, 2.5%) action line groups. Secondary outcomes did not differ significantly. Oxytocin augmentation to treat slow labor progress was needed for 87 (27.2%) and 61 (19.1%) women in the respective 2- and 4-hour groups (P=0.025). Mean duration of first and second labor stages differed significantly between the groups (P<0.05).

The 2-hour partograph action line did not reduce incidence of prolonged labor relative to the 4-hour action line. Partograph with a 4-hour action line is recommended for labor supervision in all facilities.

Registered at ClinicalTrials.gov as (https://clinicaltrialsgov/show/NCT02911272).