Skip to main content
UploadLanguage (EN)Support
BusinessMobileSocial MediaMarketingTechnologyArt & PhotosCareerDesignEducationPresentations & Public SpeakingGovernment & NonprofitHealthcareInternetLawLeadership & ManagementAutomotiveEngineeringSoftwareRecruiting & HRRetailSalesServicesScienceSmall Business & EntrepreneurshipFoodEnvironmentEconomy & FinanceData & AnalyticsInvestor RelationsSportsSpiritualNews & PoliticsTravelSelf ImprovementReal EstateEntertainment & HumorHealth & MedicineDevices & HardwareLifestyle
muhammad al hennawy, profile picture
Uploaded bymuhammad al hennawy
PPSX, PDF65 views

Comprehensive Comparison of WHO Partograph 1994 vs Labour Care Guide 2020

Detailed analysis of WHO's 1994 Partograph and 2020 Labour Care Guide, highlighting changes in labour monitoring, evidence-based practices, woman-centered care, and clinical decision-making in obstetrics.

Health & Medicine◦
Download to read offline
WHO Partograph 1994 vs WHO Labour Care Guide 2020 – Complete Comparison Dr Muhammad M Al Hennawy Senior Consultant of Obestetrics , gynecology, and Infertility https://mmhennawy.github.io https://www.youtube.com/c/mmhennawy https://www.slideshare.net/ muhammadelhennawy5 Old Partogram New Partogram WHO Traditional Partograph WHO Labour Care Guide (LCG) 1994 2020
Partograph • A partograph is a graphical record of the observations made of a women in labour • For progress of labour and salient conditions of the mother and fetus • It was developed and extensively tested by the world health organization WHO
History Of Partogram • Friedman's partogram devised in 1954 was based on observations of cervical dilatation and foetal station against time elapsed in hours from onset of labour. The time onset of labour was based on the patient's subjective perception of her contractility. Plotting cervical dilatation against time yielded the typical sigmoid or 'S' shaped curve and station against time gave rise to the hyperbolic curve. Limits of normal were defined
Philpott and Castle • in 1972 introduced the concept of "ALERT" and "ACTION" lines. The aim of this study was to fulfill the needs of paramedical personnel practising obstetrics in Rhodesian African primigravidae. • The alert line represented the mean rate of progress of the slowest 10% of patients in the African population whom they served. Alert line was drawn at a slope of 1 centimetre/hr for nulliparous women starting at zero time i.e. time of admission . • Action line drawn four hours to the right of the alert line showing that if the patient has crossed the alert line active management should be instituted within 4 hours, enabling the transfer of the patient to a specialised tertiary care centre. • The action line was subsequently drawn two hours to the right of the alert line
Studd's labour stencils • It were introduced in 1972. These stencils predicted the expected pattern of progression of labour based on the extent of dilataton achieved by the time the patient is admitted (zero time). Curves showing the average course of cervical dilatation were constructed for various dilatation on admission. Five separate patterns representing normal labour progression were constructed. The curves were transcribed onto acrylic stencils On admission in labour, the cervical dilatation was assessed and a stencil was used to draw the relevant pencil line of expected progress on the patient's cervicograph which was then completed. Those crossing the nomogram line were found to have a three fold increase in instrumental delivery.
Evolution of Labour Monitoring • 1954 – Friedman • Introduced the classic sigmoid labour curve. • Assumed a relatively constant cervical dilatation rate. • 1972 – Philpott • Developed the first practical Partograph. • Introduced: • Alert Line • Action Line • 1994 – WHO Partograph • Standardized worldwide. • Active labour started at 4 cm. • Action line = 4 hours after alert line. • 2010–2018 • Large observational studies (including Zhang et al.) showed labour progresses more slowly and variably than previously thought. • 2020 – WHO Labour Care Guide • Active labour begins at 5 cm. • Alert Line removed. • Action Line removed. • Evidence-based time limits introduced. • Woman-centered care integrated.
WHO Partograph *Old 1994 and New 2020*
WHO Partograph Old Partogram New Partogram WHO Traditional Partograph WHO Labour Care Guide (LCG) 1994 2020
Overview • The partograph can be used by health workers with adequate training in midwifery who are able to : - observe and conduct normal labour and delivery. - Perform vaginal examination in labour and assess cervical diltation accurately - plot cervical diltation accurately on a graph against time • There is no place for partograph in deliveries at home conducted by attendants other than those trained in midwifery • Whether used in health centers or in hospitals , the partograph must be accompanied by a program of training in its use and by appropriate supervision and follow up
Objectives • early detection of abnormal progress of a labour • prevention of prolonged labour • recognize cephalopelvic disproportion long before obstructed labour • assist in early decision on transfer , augmentation , or terminjation of labour • increase the quality and regularity of all observations of mother and fetus • early recognition of maternal or fetal problems • the partograph can be highly effective in reducing complications from prolonged labor for the mother (postpartum hemorrhage, sepsis, uterine rupture and its sequelae) and for the newborn (death, anoxia, infections, etc.).
Why Did WHO Change? • Labour is highly variable • 1 cm/hour is not universal • Active labour begins at 5 cm • Reduce unnecessary interventions • Promote woman-centred care
Advantages of the LCG • Evidence-based • Individualized care • Better documentation • Respectful maternity care • Appropriate interventions
1 identifying informarions and labour characters at admission
2 Supportive care
Record Supportive Care (New in LCG) • Birth companion • Pain score • Pain relief • Oral fluids • Mobility • Position • Emotional support
3 Care of the baby
Fetal heart rate Basal fetal heart rate? • < 160 beats/mi =tachycardia • > 120 beats/min = bradycardia • >100 beats/min = severe bradycardia Decelerations? yes/no Relation to contractions? n Early n Variable n Late – -----Auscultation - return to baseline > 30 sec  contraction ----- Electronic monitoring peak and trough (nadir)  > 30 sec
Membranes and liquor
Moulding the fetal skull bones
4 Care of the woman
Maternal condition Name / DOB /Gestation Medical / Obstetrical issues Assess maternal condition regularly by monitoring : • drugs , IV fluids , and oxytocin , if labour is augmented • pulse every 30 minutes , blood pressure every 4 hour • Temperature every 2 hour • Urine volume , analysis for protein and acetone
1996 2020 Oxytocin use Recorded Recorded with dose changes Other medications Limited Comprehensive Maternal pulse Recorded Recorded Blood pressure Recorded Recorded Temperature Recorded Recorded Respiratory rate Not routinely May be recorded if indicated Urine volume Recorded When indicated Proteinuria Recorded When indicated Ketonuria Recorded When indicated Pain assessment Not included Included Pain relief Not documented Documente
1994 2020 albour companionl Not included Included Maternal position Not included Included Oral fluids Not included Included Mobility Not included Encouraged and documented Emotional support Not included Included Respectful maternity care Minimal Core component Shared decision-making No Yes Documentation of interventions Limited Detailed Reassessment after intervention Limited Mandatory Trigger for intervention Crossing Alert/Action Line Any abnormal maternal, fetal or labour finding Overall goal Detect prolonged labour Improve maternal and neonatal outcomes with
5 Labour progress •Cervical dilatation •Descent of the fetal head •Uterine contractions •Frequency •Duration
Uterine Contractions
Recording of uterine contraction
latent phase
Second Stage
Cervical Diltation
Descent of the fetal head • It should be assessed • by abdominal examination • immediately before doing a vaginal examination, using the rule of fifth to assess engagement • The rule of fifth means the palpable fifth of the fetal head are felt by abdominal examination to be above the level of symphysis pubis • When 2/5 or less of fetal head is felt above the level of symphysis pubis , this means that the head is engage , and by vaginal examination , the lowest part of vertex has passed or is at the level
Assessing descent of the fetal head by vaginal examination; 0 station is at the level of the ischial spine (Sp).
Occiput transverse positions Occiput anterior positions Fetal position
6 medication
7 Shared Decision making
Decisions Should Be Based on the Whole Clinical Picture • Management should depend on: • Maternal condition • Fetal condition • Uterine activity • Labour progress • Clinical judgement • —not solely on cervical dilatation.
Make an Individualized Decision • Continue observation • ARM • Oxytocin augmentation • Referral • Operative vaginal delivery • Caesarean section
Approach to labour problems
Management to labour problems
• The Labour Care Guide (LCG) follows the principle: • Observe Assess Decide Document → → → • NOT: • Observe Cross the Alert/Action Line Intervene → → • Golden Rule • LCG = Reassess Think Decide → → • NOT: • Delay = Intervention •Partograph 1994 Depends on Lines (Alert & Action). •Labour Care Guide 2020 Depends on Evidence-based thresholds + Clinical judgment + Woman-centered car The Key Message of This Slide
Major Changes in 2020 (Key Messages) 1.Active labour starts at 5 cm, not 4 cm. 2.Alert Line and Action Line have been eliminated. 3.The 1 cm/hour rule is no longer recommended. 4.Labour progress is assessed using evidence-based time limits for each centimetre of cervical dilatation. 5.Continuous documentation of supportive and respectful maternity care. 6.Shared decision-making with the woman is encouraged. 7.Dedicated monitoring of the second stage of labour. 8.Clinical actions are triggered by any abnormal maternal, fetal, or labour finding, not only slow cervical dilatation.
Thank You From Monitoring Labour… To Caring for Women "The greatest advance in modern obstetrics is not performing more interventions— it is knowing when intervention is truly needed."