Partograph and labour care by Dr Igbodike Emeka Philip

Consultant Obstetrician and Gynecologist
Partographs
WHO Labour ward Care guide

1. Partograph Dr Emeka Igbodike, MBBS, FWACS, FMCOG Consultant Obstetrician & Gynecologist Kisoll Richards Healthcare Foundation

2. No conflict of interest to declare WHO labour care guide user manual New WHO partograph Respectful maternity care (New Ribbon Alliance) Tuesday, November 16, 2021 Igbodike EP 2

3. Brief history Freidman (1954) Hendriks (1969) Philpott & Castle (1972) WHO composite (1994) WHO new (2000) 3 Tuesday, November 16, 2021 Igbodike EP

4. Indication & Contraindications Indications Established labour (spontaneous or induced) Dead fetuses Contraindication Obstructed labour Contracted pelvis 8cm cervical os dilatation Need for Caesarean delivery 4 Tuesday, November 16, 2021 Igbodike EP

5. Advantages Easy hand over Gives information on single sheet of paper at a glance Record keeping of labour events Prevents unnecessary interventions Indicates when transfer is imminent in primary care centres Early prediction of deviation from normal progress of labour 5 Tuesday, November 16, 2021 Igbodike EP

6. Demerits Requires skilled staff for interpretation Some studies have shown that cervical dilatation over is a poor predictor of severe adverse birth outcomes. (how important is alert line?). JP Souza et al BMJ 2017. Accessed the accuracy of alert line in WHO partograph in 13 maternity hospital in Nigeria and Uganda, total of 9995 women with at <= 6cm . Concluded that the validity of alert line at 1cm per hr should be re-evaluated and that assessment of cervical diltation is a poor predictor of severe adverse birth outcome. Relevance as regards improving perinatal morbidity and mortality is not clear 6 Tuesday, November 16, 2021 Igbodike EP

7. Types Composite partograph (WHO 1994) Modified partograph (WHO 2000) Others ( eg : Digital partograph, Colour partograph, Paperless partograph etc ) Based on alert line ( 1hr , 2hr , 3hr , 4hr alert line partograph) 7 Tuesday, November 16, 2021 Igbodike EP

8. Igbodike EP 8 Tuesday, November 16, 2021

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10. 10 Composite partograph ( 1994) Tuesday, November 16, 2021 Igbodike EP

11. New WHO partograph modified (2000) 11 Tuesday, November 16, 2021 Igbodike EP

12. New WHO partograph 12 Tuesday, November 16, 2021 Igbodike EP

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17. Why LCG To monitor the well-being of women and babies during labour through regular assessments to identify any deviation from normality. To stimulate shared decision-making by health-care providers and women To promote women- centred care. To ensure quality evidence-based care , with a special emphasis on ensuring safety , avoiding unnecessary interventions , and providing supportive care 17 Tuesday, November 16, 2021 Igbodike EP

18. WHO Labour Ward Care Guide 2020 – modification Tuesday, November 16, 2021 Igbodike EP

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23. Research Tina Lavender et al 2018, The Cochrane Database of Systematic review included 11 studies , involving 9475 women Assessed: 1. Effectiveness and safety of partograph use on perinatal and maternal morbidity and mortality 2. To determine which partograph design was the most effective for perinatal and maternal morbidity and mortality outcomes 23 Tuesday, November 16, 2021 Igbodike EP

24. 24 Tina Lavender et al 2018, The Cochrane Database of Systematic review included 11 studies , involving 9475 women Concluded: 1. Not certain of the effects of routine use of the partograph as part of standard labour management and care 2. Not certain which design if any are most effective 3. Recommended further trial Tuesday, November 16, 2021 Igbodike EP

25. 25 Intrapartum care : care of healthy women and their babies during childbirth. NICE guidelines [ CG190 ].December 2014. Last updated 21 February 2017 Recommendation: 1. Use of partogram once labour is established Tuesday, November 16, 2021 Igbodike EP

26. Thank You Dr Emeka Philip Igbodike , MBBS, FWACS, FMCOG Igbodike.philip@npmcn,edu.ng LinkedIn: Dr. Emeka Philip Igbodike 26 Tuesday, November 16, 2021 Igbodike EP

27. References WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018 Standards for improving quality of maternal and newborn care in health facilities. Geneva: World Health Organization; 2016. WHO, UNFPA, UNICEF. Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice. Geneva: World Health Organization; 2015. Liabsuetrakula T. Algorithm of intrapartum care for abnormal vaginal loss: liquor abnormalities, blood and purulent discharge. BJOG 2020. (in press). WHO Labour Ward Care Guide 2020 27 Tuesday, November 16, 2021 Igbodike EP

28. Hands on… 28 Tuesday, November 16, 2021 Igbodike EP