O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 3 | 19 A retrospective descriptive study on the use of the partogram in a high-risk referral hospital in the Eastern Cape M Madaha, M S Mabenge Department of Obstetrics & Gynaecology, Dora Nginza Hospital, Walter Sisulu University, Eastern Cape, South Africa Introduction Many complications that occur during labour and childbirth can cause maternal death, neonatal death or stillbirth. ese mortality rates are particularly high in low to middle-income countries, 1 and there is a global commitment to reduce the unacceptably high maternal and neonatal death rates, also In South Africa. 2 Adverse birth outcomes can be prevented by closely monitoring the process of labour and childbirth. e partogram is a graphic representation of labour progress, maternal and fetal condition in relation to time. It is a simple, low-cost monitoring tool for intrapartum care, ensuring early detection and intervention in abnormal labour. 3,4 e partogramcanempower healthworkers in labourmanagement, preventing prolonged and or obstructed labour, thereby reducing maternal and perinatal morbidity andmortality. 3 Prolonged labour is a common cause of obstetric haemorrhage. During 2014 – 2016, 16.9% of maternal mortality in South Africa was caused by obstetric haemorrhage, making it the third most common cause of maternal death. 5 Low and or inadequate use of the partogram in South Africa 6-9 and other African countries 10-12 has been reported. Barriers to partogram use include lack of knowledge, awareness and training, regarding the completion as complex and tedious, and underrating the partogram. 13 is study aimed to describe the utilization of the partogram use and its in uence on the immediate birth outcomes at Dora Nginza Hospital. Methods is retrospective descriptive study was conducted at Dora Nginza Hospital, a regional hospital in Zwinde township, Gqeberha. An average of 3671 deliveries per six-month period was recorded between January 2018 and December 2019, translating to our estimated adequate sample size of 348. Our sample sizewas calculatedusing the parameters: population size of 3 923, with 95% con dence level and 5%margin of error. e labour ward birth register was reviewed for the six-month period between July and December 2019, retrieving the rst alternate 60 patients’ records for each of six months Sixty-one les ( %) met exclusion criteria, 36 patients had elective caesarean section, 12 had obstetric emergencies such as abruption abruptio placentae, fetal distress, imminent uterine rupture, and were not in labour, nine patients were referrals from other units with previously plotted partograms, and four patients were emergencies in the antenatal ward. e nal data set included 301 patient les. Maternal characteristics, fetal and maternal outcomes, and partogram use were collected from patient les. In cases where a partogram was not used, clinical notes were reviewed to obtain data. Descriptive statistics analysis was done using frequency or proportion for categorical variables and for continuous variables means with their standard deviations or median with their interquartile range (IQR) depending on the skewness of the data. Bivariate analysis was conducted using Wilcoxon rank sumtest and Fisher’s exact test. e signi cance level was set at p-value < 0.05. To assess fetal outcomes, we dichotomized the Apgar into low (< 7/10) and normal scores (>= 7/10), then compared low and normal Apgar ratings when Abstract Background: High maternal and neonatal mortality rates can be reduced by closely monitoring the process of labour and childbirth. The partogram is a simple, low-cost monitoring tool for intrapartum care, ensuring early detection and intervention in abnormal labour. Aim: To describe the utilization of the partogram use and its influence on the immediate birth outcomes at Dora Nginza Hospital. Methods: This was a retrospective descriptive study including maternity file records from July to December 2019. Maternal characteristics, fetal and maternal outcomes, and partogram use were collected. In cases where a partogram was not used, clinical notes were reviewed to obtain data. Simple descriptive statistics were used to analyse data. Results: Three hundred-and-one maternal files were reviewed. Mean age of mothers was 27.1 years [12 – 47 years], 54.2% (163/301) were in the age group 21 – 30 years and 28.1% (175/301) were multiparous women. In 82.4% (248/301) of cases the partogram was used, but only 19.4% were completed correctly. Common errors were: duration of labour in 23.0% (57/28) cases, maternal vitals 21.0% (52/248) and fetal position 20.2% (50/248). In 56/80 caesarean sections the partogram was used versus partogram not used in 24/80 caesarean sections. Conclusion: Our study showed a high utilization of partogram in a tertiary and teaching hospital, and supported the recent Cochrane systemic review where utilization of the partogram had no statistically significant association with immediate neonatal outcome. In our study the majority of caesarean sections were associated with partogram use versus no partogram use. No association was however found between partogram use and postpartum haemorrhage. Correspondence Prof Mfundo Mabenge email: mfundo@netactive.co.za O&G Forum 2021; 31: 19 - 21 ORIGINAL RESEARCH