Comparing Different Partograph Designs for Use in Standard Labor Care: A Pilot Randomized Trial
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Comparing Different Partograph Designs for Use in Standard Labor Care: A Pilot Randomized Trial Nigel J. Lee1,2 · Jeremy Neal3 · Nancy K. Lowe4 · Sue V. Kildea1,2
Published online: 21 September 2017 © Springer Science+Business Media, LLC 2017
Abstract Backgound Partographs are used in many labour settings to provide a pictorial overview of a woman’s cervical dilation pattern in the first stage of labor and to alert clinicians to slow progress possibly requiring intervention. Recent reviews called for large trials to establish the efficacy of partographs to improve birth outcomes whilst highlighting issues of clinician compliance with use. Previous studies have also reported issues with participant recruitment related to concerns regarding the possibility of a longer labour. Objectives We sought to compare a standard partograph with an action line, to a newly designed partograph with a stepped line, to determine the feasibility of recruitment to a larger clinical trial. Methods A pragmatic, single-blind randomised trial wherein low-risk, nulliparous women in spontaneous labour at term were randomized to an action-line or stepped-line partograph. First stage labour management was guided by the allocated partograph. Primary outcomes included the proportion of eligible women recruited, reasons for failed recruitment and compliance with partograph use. Secondary outcomes included rates of intervention, mode of birth, maternal and neonatal outcomes. Results Of the 384 potentially eligible participants, 38% (149/384) were * Nigel J. Lee [email protected] 1
Midwifery Research Unit, School of Nursing, Midwifery and Social Work, The University of Queensland (UQ), Brisbane, QLD, Australia
2
Mater Research Institute – UQ, Mater Health Services, Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia
3
School of Nursing, Vanderbilt University, Nashville, TN, USA
4
College of Nursing, University of Colorado, Aurora, CO, USA
approached. Of these 77% (116/149) consented, with 85% (99/116) randomized, only nine women approached (6%) declined to participate. A further 9% (14/149) who were consented antenatally were not eligible at onset of labor and 7% (10/149) of women approached in the birth suite but did not meet the inclusion criteria. Compliance with partograph completion was 65% (action) versus 84% (dystocia line). Conclusions for Practice Participant recruitment to a larger randomized controlled trial comparing new labour management guidelines to standard care is feasible. Effective strategies to improve partograph completion compliance would be required to maintain trial fidelity. Keywords Action line partograph · First stage labor · Labor dystocia · Partograph · Stepped line partograph · Partogram
Significance What is already known on this subject Although the use of Partographs has been advocated by the World Health Organisation they have not been demonstrated to be of benefit in developed health systems. Although larger trials have been recommended, issues with compliance and recruitment
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