O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2021 | ISSUE 3 | 21 cardiotocogram, health care providers’ awareness, interpretation of abnormal clinical ndings during labour and availability of obstetrician or advanced midwives. In our setting, labour is monitored and managed by advanced midwives under the supervision of obstetrician and gynaecologist registrars and an obstetrician consultant. Our study results are similar to other published data, that showed reduced caesarean section rate with the use of the partogram. 10,16 e Cochrane systemic review and data from high resource settings however demonstrated that partogramuse had no statistical signi cance onmode of delivery. 15,17 e possible explanation of this discrepancy might be due to hospital settings, labourward protocols, availability of theatre for caesarean sections and labour augmentation agents. e association between augmentation use and the use of a partogram (~97%) compared to when no augmentation was used (~82%) were similar to reported data were the two-hour action line partogram utilization was associated with increased oxytocin augmentation in labour. 18 No statistically signi cant di erence could be demonstrated in the proportion of post-partum haemorrhage occurrences when a partogram was used versus when it was not used in our study. e results detected a signi cant association between stage of labour and mode of delivery (p < 0.001), signi cant association between the proportion of normal vertex deliveries to caesarian section deliveries for the active vs latent phase of labour (p < 0.001), showing that the women presenting in the active phase of labour weremore likely to have a normal vertex delivery than those presenting in the latent phase of labour. Compared to women presenting in the latent phase, the women in the active phase weremore also likely to have assisted deliveries (p = 0.009). ese results are similar to the Cochrane systemic review were use of the partogram in active phase of labour was associated with lower caesarean section compared to the partogramuse in the latent phase. 15 Study limitations, conclusion and recommendations Limitations of the current study include the fact that it was conducted in a single institution, a tertiary and teaching hospital where high use of the partogram is expected. For better representative data on the utilization of partogram in the western region of the Eastern Cape Province, the referring district hospitals and midwives’ obstetric units should be included. e sample size of the study was small, a bigger sample would be ideal to measure the association between partogram utilization with maternal and neonatal outcomes. Data collection were dependent on proper documentation of the clinical notes and some missing data could not be recovered. e neonatal Apgar score assessment and criteria for neonatal admission was not standardized and this might vary depending on the experience of the assessing healthcare provider (intern doctor or midwife compare to pediatrics registrar or pediatrician). In line with the published data, our study showed a high utilization of partogram in a tertiary and teaching hospital, but the correct utilization of the partogram remained poor. e results of this study supported the recent Cochrane systemic review where utilization of the partogram had no statistically signi cant associationwith immediate neonatal outcome. 15 In our study the use of the partogram was associated with lower caesarean section compared to no partogram use, increase use of analgesia and augmentation during labour. No association was however found between partogram use and postpartumhaemorrhage. ere is a need for followup studies with larger sample sizes and including the referring district hospitals and midwives’ obstetrics units, and also follow up studies to assess the role of the partogram use in intrapartum care. Inservice training on correct partogram plotting should be performed. As the shortage of labour ward sta is one of the main problems of intrapartum care, employment of more midwives can improve the correct partogram utilization. Establishment of new labour monitoring methods could improve neonatal andmaternal outcomes. References 1. Trends inmaternal mortality 2000 to 2017: estimates byWHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. Geneva: World Health Organization; 2019. Available at: https://apps.who.int/iris/bitstream/handle/10665/327596/ WHO-RHR-19.23-eng.pdf?sequence=13&isAllowed=y 2. Guidelines for Maternal Care in South Africa: a manual for clinics, community health centres and district hospitals. 4th ed. 2016. Pretoria: Department of Health Republic of South Africa. Available at: https:// www.knowledgehub.org.za/system/ les/elibdownloads/2020-08/ CompleteMaternalBook.pdf 3. Bedwell C, Levin K, Pett C, Lavender DT. A realist review of the partograph: when and how does it work for labour monitoring? BMC Pregnancy Childbirth. 2017;17(1):31. doi: 10.1186/s12884-016-1213-4. 4. Khan ANS, Billah SM, Mannan I, Mannan II, BegumT, KhanMA, et al. A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh. PLoS One. 2018;13(9):e0203617. doi: 10.1371/journal. pone.0203617. 5. Saving Mothers 2014–2016: seventh triennial report on con dential enquiries into maternal deaths in South Africa: short report. Pretoria: National Committee for the Con dential Enquiries into Maternal Deaths; 2018. Available from: https://www.westerncape.gov.za/assets/ departments/health/saving_mothers_2014-16_-_short_report.pdf 6. Maphasha OM, Govender I, Motloba DP, Barua C. Use of the partogram by doctors and midwives at Odi District Hospital, Gauteng, South Africa. S Afr Fam Pract 2017; 59(2): 82-86. Doi: 10.1080/20786190.2017.1280899 7. Yazbek M, Jomeen J. Use of the partogram in a private hospital in South Africa. Midwifery 2019; 69: 128-134. Doi: 10.1016/j.midw.2018.11.009. 8. Basu JK, Hoosain S, Leballo G, Leistner E, Masango D, Mercer M, Mohapi M, Petkar S, Tshiovhe NA. e partogram: a missed opportunity. S Afr Med J 2009; 99(8): 578. 9. Brits H, Joubert G, Mudzwari F, Ramashamole M, Nthimo M, amae N, Pilenyane M, Mamabolo M. e completion of partograms: knowledge, attitudes and practices of midwives in a public health obstetric unit in Bloemfontein, South Africa. Pan Afr Med J 2020; 36: 301. doi: 10.11604/pamj.2020.36.301.24880. 10. Kitila SB, GmariamA, Molla A, Nemera G. Utilization of partograph during labour and birth outcomes at Jimma University. J Preg Child Health. 2014;1:101. doi: 10.4172/2376-127X.1000101 11. Ogwang S, Karyabakabo Z, Rutebemberwa E. Assessment of partogram use during labour in Rujumbura Health Sub District, Rukungiri District, Uganda. Afr Health Sci. 2009;9 Suppl 1(Suppl 1):S27-S34. 12. Bedada KE, Huluka TK, Bulto GA, Roga EY. Low utilization of partograph and its associated factors among obstetric care providers in governmental health facilities at West Shoa Zone, Central Ethiopia. Int J ReprodMed 2020, Article ID 3738673, 9 pages. Doi: 10.1155/2020/3738673 13. Ollerhead E, Osrin D. Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2014;14:281. doi: 10.1186/1471-2393-14-281. 14. Neal JL, Lowe NK, Nacht AS, Koschoreck K, Anderson J. Pilot study of physiologic partograph use among low-risk, nulliparous women with spontaneous labor onset. J MidwiferyWomens Health. 2016;61(2):235- 241. doi: 10.1111/jmwh.12442. 15. Lavender T, Cuthbert A, Smyth RM. E ect of partograph use on outcomes for women in spontaneous labour at term and their babies. Cochrane Database Syst Rev. 2018;8(8):CD005461. doi: 10.1002/14651858.CD005461.pub5. 16. Kenchaveeriah SM, Patil KP, Singh TG. Comparison of twoWHO partographs: a one year randomized controlled trial. J Turk Ger Gynecol Assoc. 2011;12(1):31-34. doi: 10.5152/jtgga.2011.07. 17. WindrimR, Seaward PG, Hodnett E, Akoury H, Kingdom J, Salenieks ME, et al. A randomized controlled trial of a bedside partogram in the active management of primiparous labour. J Obstet Gynaecol Can. 2007;29(1):27-34. doi: 10.1016/s1701-2163(16)32367-2. 18. Oladapo OT, Souza JP, Fawole B, Mugerwa K, Perdoná G, Alves D, et al. Progression of the rst stage of spontaneous labour: a prospective cohort study in two sub-Saharan African countries. PLoS Med. 2018;15(1):e1002492. doi: 10.1371/journal.pmed.1002492. O&G Forum 2021; 31: 19 - 21 ORIGINAL RESEARCH