The Role of Partograph in Monitoring of Spontaneous Labour in Primigravidae

Abstract

Background: Partograph is a vital tool to monitor the progression of labour that basically helps to predict the necessary steps that should be taken early for the well-being of both mothers and neonates; specially in poor resource set up. Objectives: To evaluate the role of partograph in monitoring of labour progress in primigravidae. Place of Study: Department of obstetrics and gynaecology of Sylhet M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh. Period of Study: January, 2019 to June, 2019. Study Design: Prospective observational study. Methods: All primigravid women in term attending Obstetrics & Gynecology department, were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 100 cases were finalized. All participants were divided into 2 groups – Group I and Group II. Group I- cervical dilatation and descent curve falling to the left of the alert line. Group II- cervical dilatation and descent curve falling to the right of the alert line. Though Group III with women to right of action line was planned, there were no patients in group III. Group I included 67 cases and Group II included 33 cases A pre-tested, observation based, peer-reviewed data collection sheet was prepared before study. Data regarding clinical, biochemical and surgical profile were recorded. Data were compiled, edited, analyzed. Results: Out of 100 mothers, the highest 48% belonged to age group 21-25 years which was subsequently followed by 23% women in ≤20 years age group. Besides, 22% and 7% came from 26-30 years and >30 years age group. The mean age of the participants was 23.6±4.56 years (age range: 18-35 years). All 100 women were primigravida. The mean gestational age of the respondents was 37.69±0.36 weeks (range: 37-40 weeks). The mean duration of active phase of labour in groups I and II were 226.23±43.39 minutes (range: 182-332 minutes) respectively that is in group I it is almost 4.1 hour revealing the cervical dilatation at the rate of 1.4cm/hour. On the contrary, in Group II, it is almost 6.8 hour revealing cervical dilatation at the rate of 0.8cm/hour. Among 100 cases, 80% underwent NVD, 13% underwent LSCS and 7% underwent instrumental deliveries. Among 67 cases of Group I 64(95.52%) and 3(4.47%) underwent NVD and LSCS respectively. On the contrary, among 33 Group II cases, 16(48.48%), 10(30.30%) and 7(21.21%) underwent NVD, LSCS and instrumental delivery (P=0.03). The highest indication of both instrumental (57.14%) and LSCS (38.46%) is fetal distress. Subsequently, protracted dilatation is the important indication (14.28%) and 23.07% respectively). All the statistics showed significant differences (P=<0.005). Out of 67 Group I neonates only 1(1.49%) required NICU admission and out of 33 Group II neonates 4(12.12%) required the same (P=0.03). Additionally, after 5 minutes of birth APGAR score between the groups respondents were statistically significant (P=0.004). Majority of cases were within alert line (67%) and rest of the cases were outside the alert line (33%) but within the action line. Conclusion: Partograpgh is an extremely useful tool to avoid prospective complications by prediction before specially in resource poor settings. It gives perfect scenario regarding progression of labour.