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Breech labor on the WHO partograph
C E Lennox1, B E Kwast, T M Farley
1Law Hospital NHS Trust, Carluke, UK.
Summary
The WHO partograph effectively reduces prolonged labor and Cesarean sections in multigravida breech births, improving fetal outcomes. Cesarean delivery proved safer for babies in this study, irrespective of partograph use.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Management
Background:
- Breech presentation management requires careful labor monitoring.
- The World Health Organization (WHO) partograph is a tool for labor surveillance.
- Assessing the impact of the WHO partograph on breech labor outcomes is crucial.
Purpose of the Study:
- To evaluate the effect of using the WHO partograph in managing breech labor.
- To determine the impact on both fetal and maternal labor outcomes.
Main Methods:
- A multicenter, hospital-based study in South East Asia involving 1,740 breech presentations.
- Before-and-after analysis of labor outcomes after introducing the WHO partograph.
- Comparison of outcomes between 923 pre-partograph and 817 post-partograph breech deliveries.
Main Results:
- The WHO partograph significantly reduced prolonged labor (>18 hours) for both multigravida and primigravida.
- Cesarean section rates decreased among multigravida (27.1% to 19.3%) but not primigravida (38.5% to 38.7%).
- Intrapartum stillbirths showed a non-significant decrease from 1.9% to 1.1%; Cesarean section was associated with better fetal outcomes.
Conclusions:
- The WHO partograph aids in reducing prolonged labor and Cesarean sections in multigravida breech deliveries.
- Improved fetal outcomes were observed with partograph use.
- Cesarean section was identified as a safer delivery method for the fetus in this study context.