Comparison of two WHO partographs: a one year randomized controlled trial

Objective: To compare two World Health Organization (WHO) partographs - a composite partograph including the latent phase with a simplified one without the latent phase in women with uncomplicated pregnancy. Material and Methods: This was a randomized controlled trial conducted at a tertiary hospital at Belgaum, India. 743 women with term, singleton, vertex gestation, in spontaneous labor were included in the study over a period of one year. Either of the partographs was used on laboring women. The following outcomes were compared: labor crossing the alert and action line, augmentation of labor, rate of cesarean section, perinatal outcome, user friendliness and maternal complications. Statistical analysis was done using Chi-square test. Results: Labor values crossed the alert and action lines significantly more often when composite partograph was used (p<0.001) in each, with increased number of augmentations (p<0.001). The number of vaginal deliveries were high (p<0.005) in the simplified group. There was no significant difference in the rate of cesarean deliveries due to non progress of labor in both groups (p=0.68). NICU admissions were higher in the composite group (p=0.035). Most resident doctors (93%) experienced difficulty with the composite partograph, but no resident doctor reported difficulty with the simplified partograph. The mean SD user friendliness score was lower for the composite partograph (2.87 +/- 1.86 vs 10.67 +/- 1.61; p<0.005). Conclusion: The WHO simplified partograph is easier to use and is a better option for both the laboring women and the user, when compared to composite partograph.