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Partogram action line study: a randomised trial

T Lavender1, Z Alfirevic, S Walkinshaw

  • 1Liverpool Women's Hospital, UK.

British Journal of Obstetrics and Gynaecology
|October 8, 1998
PubMed
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A study on partograms found that a 4-hour action line resulted in the lowest caesarean section rate. However, women preferred earlier intervention, indicating a preference for active labor management.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal Health
  • Clinical Trials

Background:

  • Partogram use is standard in labor management.
  • The optimal timing of the partogram action line remains debated.
  • Different partogram action line timings may influence obstetric outcomes and maternal experience.

Purpose of the Study:

  • To evaluate the impact of three distinct partogram action line timings (2, 3, and 4 hours) on caesarean section rates.
  • To assess maternal satisfaction with labor management under different partogram protocols.
  • To explore secondary outcomes including labor duration and augmentation needs.

Main Methods:

  • A prospective randomized clinical trial involving 928 primigravid women with uncomplicated pregnancies.
  • Women were randomized to partogram groups with action lines set at 2, 3, or 4 hours past the alert line.

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  • Labor progress was monitored, and prolonged labor was managed per standard protocol.

    • Main Results:

    • The caesarean section rate was lowest with a 4-hour action line, significantly lower than the 3-hour group.
    • Maternal satisfaction was highest in the 2-hour action line group, with women preferring earlier intervention.
    • No significant difference in caesarean rates was observed between the 2-hour and 4-hour groups.

    Conclusions:

    • Women appear to prefer active labor management, favoring earlier intervention.
    • Partograms that encourage earlier intervention may be associated with increased caesarean section rates.
    • Further research is needed to establish definitive evidence for partogram choice and labor management strategies.