THE PARTOGRAPH: A BIBLIOGRAPHIC REVIEW OFTHE PARTOGRAPH: A BIBLIOGRAPHIC REVIEW OFEVIDENCE OF EFFICACY, PERCEPTIONS ANDEVIDENCE OF EFFICACY, PERCEPTIONS ANDIMPLEMENTATIONS BY HEALTH CARE PROVIDERSIMPLEMENTATIONS BY HEALTH CARE PROVIDERSDR ACHU LORDFREDDR ACHU LORDFREDFacultyFaculty ofof MedicineMedicine andand BiomedicalBiomedical Sciences,Sciences,UniversityUniversity ofof Yaoundé 1 CAMEROONYaoundé 1 CAMEROONTUTORTUTORDR M. BOULVAIN;DR M. BOULVAIN; DepartmentDepartment ofof GynecologyGynecology andandObstetricsObstetrics GENEVA UNIVERSITY HOSPITALGENEVA UNIVERSITY HOSPITALSWITZERLANDSWITZERLAND
INTRODUCTIONINTRODUCTIONMaternal mortality in developing countries is about550/100,000 live birthsIt is 100 times higher than in developed countriesProlonged/obstructed labour and uterine rupturePartographs were developed to differentiate normal fromabnormal labourIn 1998, WHO informal working group in Geneva:• Recommends research into all aspects of the partogram
OBJECTIVESOBJECTIVESReview evidence of efficacy of the partograph inreducing maternal and perinatal morbidity andmortalityEvaluate the perception and implementation byhealth care providers
MaternalMaternal mortalitymortality ratios by country inratios by country in AfricaAfrica,,AsiaAsia andand LatinLatin AmericaAmerica (WHO, 1990)(WHO, 1990)LatinLatin AmericaAmerica AsiaAsia AfricaAfrica0400800120016002000Maternaldeathsper100000livebirths
TheThe higherhigher thethe proportionproportion ofof deliveriesdeliveries attendedattended byby skilledskilledattendant in a country,attendant in a country, thethe lowerlower thethe country’scountry’s maternalmaternalmortalitymortality ratio (WHO)ratio (WHO)R2= 0.7402004006008001000120014001600180020000 10 20 30 40 50 60 70 80 90 100YLogarithmiqu%% skilledskilled attendantattendant atat deliverydeliveryMaternaldeathsper1000000livebirths
PARTOGRAPH: DESIGNPARTOGRAPH: DESIGNPARTOGRAPH: DESIGNPARTOGRAPH: DESIGNWHO model, with alertand action linesOther partographs donot include these lines,or are designed withdifferent delaysEven a round partographhas been developed !
NORMAL AND ABNORMAL LABOURNORMAL AND ABNORMAL LABOURCervical dilatation and effacementDiagnosis and duration of normal labourProgress of labour multigravides vs ordinaryparturiantsProgress of labour → the role of ageProgress of labour in different ethnic groupsProlonged/obstructed labour
EFFICIENCY OF THE PARTOGRAPHEFFICIENCY OF THE PARTOGRAPHTanzania: 1986-1987 compared to 1989(van Roosmalen, Br J Obstet Gynaecol, 1989)Total births: 7523Maternal death: 39Maternal mortality: 520/100 000 livebirthsMajor causes of death:– sepsis following CS– 44% of deaths were referrals for prolonged labourin 1989, perinatal mortality dropped from 71 to 39/1000 birthsafter adoption of the partograph
DETECTION AND REDUCTION OF PROLONGED LABOURDETECTION AND REDUCTION OF PROLONGED LABOURVARIABLE BEFOREPARTOGRAPHAFTERPARTOGRAPHProlonged labour 6.4% 3.4%Augmentation oflabour20.7% 9.1%Emmergency caesareansection9.9% 8.3%(Urrio, East Afr Med J, 1991)
PERCEPTIONS OF THE PARTOGRAPH BY HCPsPERCEPTIONS OF THE PARTOGRAPH BY HCPsA useful tool in the labour wardInfluences obstetric decision-makingA useful training toolImproves quality of maternity services
SOME LIMITATIONS OF THE PARTOGRAPHSOME LIMITATIONS OF THE PARTOGRAPHCervical dilatation assessement is impreciseNo accurate timing of cervical dilatation assessementFrequency of examination variesDeviations from the 1cm/hour dilatation rate may benormalPlotting of curves
CONCLUSIONSCONCLUSIONSEvidence of efficacy of the partograph existsWhen used correctly it improves maternal andperinatal mortality ratesReinforcement of proper usage is encouraged
RECOMMENDATIONSRECOMMENDATIONSThe partograph should become an essential part ofthe documentation of labour in all womenIts proper usage should be encouraged
‘‘THANK YOU VERY MUCHTHANK YOU VERY MUCHFOR YOUR KINDFOR YOUR KINDATTENTION’ATTENTION’
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