Use of the partogram in labor: Analysis of its application in different care models

Cláudia de Azevedo Aguiar, Roselane Gonçalves, Ana Cristina d’Andretta Tanaka

Department of Maternal and Child Health, Faculdade de Saúde Pública, Universidade de Sao Paulo, Sao Paulo, Brazil.
Escola de Artes, Ciências e Humanidades, Universidade de Sao Paulo, SaPaulo, Brazil.
Faculdade de Saúde Pública, Universidade de Sao Paulo, Sao Paulo, Brazil.

DOI: 10.4236/ojog.2013.39A001                

Abstract

Objective: To compare and identify possible differences in the use of the partogram in different models of delivery and birth care. Design/Setting: This was a cross-sectional study performed in two Brazilian hospitals with different models of care: Natural Birth Center (NBC) and Traditional Obstetric Center (TOC). Data were collected from the medical records of 112 mothers with low obstetric risk who underwent an intrapartum cesarean section. Socioeconomic and demographic variables, obstetric history, partogram labor evolution, complications, and indication of cesarean section were included. A significance level of 5% and a confidence interval of 95% were considered. Data were analyzed in accordance with the Brazilian Ministry of Health and World Health Organization recommendations. Findings: In the NBC, the use of the partogram follows the Ministry of Health recommendations for filling-in variables with greater frequency and significance (p < 0.001) beginning with the active phase of labor in the correct column in relation to the lines of alert and action (p = 0.00, OR = 42.2) and continuous records (p = 0.00, OR = 53.3). However, obstetric interventions, such as use of oxytocin, amniotomy and cesarean delivery were concentrated in area 1 of the partogram in both institutions. Conclusions: In this study, the NBC used the instrument most adequately; however there was no difference from the other model (TOC) and regarding the moment of interventions, many of them were early. This finding implies that, regardless of the care model, the partogram has been used bureaucratically and not as a guiding instrument of assistance envisioning safely and timely practices. In other words, aside from a “humanized” physical structure, it is necessary that obstetric practices should be focused on best evidence, thus reducing maternal and perinatal risks.

Keywords

Partogram; Childbirth Care; Birth Center; Obstetrical Surgical Center

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Groeschel, N. and Glover, P. (2001) The partograph. Used daily but rarely questioned. The Australian Journal of Midwifery, 14, 22-27. http://www.sciencedirect.com/science/article/pii/S1445438601 800215 http://dx.doi.org/10.1016/S1445-4386(01)80021-5
[2]	Philpott, R.H. and Castle, W.M. (1972) Cervicographs in the management of labour in primigravidae. BJOG: An International Journal of Obstetrics & Gynecology, 79, 599-602. http://dx.doi.org/10.1111/ j.1471-0528.1972.tb14208.x
[3]	Lavender, T., Tsekiri, E. and Baker L. (2008) Recording labour: A national survey of partogram use. British Journal of Midwifery, 16, 359-362.
[4]	World Health Organization (1994) World Health Organization partograph in management of labour. Lancet, 343, 1399-1404.
[5]	MS. Ministério da Saúde, Secretaria de Políticas de Saúde (2001) Parto, aborto e puerpério: Assistência humanizada à mulher. Brasília, Brazil. http://dtr2001.saude.gov.br/editora/produtos/ livros/popup/01_0420.htm
[6]	Windrim, R., Seaward, G., Hodnett, E., Akoury, H., Kingdom, J., Salenieks, M.E., Fallah, S. and Ryan, G. (2007) A randomized controlled trial of a bedside partogram in the active management of primiparous labour. Journal of Obstetetrics and Gynaecology Canada, 29, 27-34. http://www.sogc.org/jogc/abstracts/full/200701_obstetrics_3.pdf
[7]	Lavender, T., Hart, A. and Smyth, R.M. (2009) Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley. com/doi/10.1002/14651858.CD005461.pub2/full
[8]	Porto, A.M.F., Amorin, M.M.R. and Souza, A.S.R. (2010) Assistência ao primeiro período do trabalho de parto baseada em evidências: [Revis?o]. Femina, 38, 527-537.
[9]	Rocha, I.M.S., Oliveira, S.M.J.V. and Schneck, C.A. (2009) O partograma como instrumento de análise da assistência ao parto. Revista da Escola de Enfermagem da USP, 43, 880-888. http://www.scielo. br/pdf/reeusp/v43n4/a20v43n4.pdf http://dx.doi.org/10.1590/S008062342009 000400020
[10]	Organizacao Mundial de Saúde (1996) Assistência ao Parto Normal: Um guia prático. Brasília, Brazil.
[11]	World Health Organization (1994) Maternal health and safe motherhood programe. Preventing prolonged labour: A pratical guide. The Partograph Part I: principles and strategy. WHO, Geneva.
[12]	Diniz, S.G. and Chacham, A.S. (2004) “The cut above” and “the cut below”: The abuse of caesareans and episiotomy in Sao Paulo, Brazil. Reproductive Health Matters, 12, 100-110. http://www. sciencedirect.com/science/article/pii/S0968808004231123 http://dx.doi.org/10.1016/S0968-8080(04) 23112-3
[13]	Hodnett, E.D., Downe, S., Walsh, D. and Weston, J. (2010) Alternative versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews. http://www2.cochrane. org/reviews/en/ab000012.html
[14]	Clark, S.L., Miller, D.D., Belfort, M.A., Dildy, G.A., Frye, D.K. and Meyers, J.A. (2009) Neonatal and maternal outcomes associated with elective term delivery. American Journal of Obstetrics and Gynecology, 200, 156.e1-156.e4. http://www.sciencedirect.com/science/article/pii/S0002937808010375/pdfft?md5=0f153c9b756e6cd ae3dfd7d75e29373b&pid=1-s2.0-S0002937808010375-main.pdf
[15]	Sakae, T.M., Freitas, P.F. and d’Orsi, E. (2009) Fatores associados a taxas de cesárea em hospital universitário. Revista de Saúde Pública, 43, 472-480. http://www.scielo.br/scielo.php?script=sci_ arttext&pid=S0034-89102009000300011&lng=en http://dx.doi.org/10.1590/S0034-89102009000 300011
[16]	Simkin, P. and O’Hara, M.A. (2002). Nonpharmacologic relief of pain during labor: Systematic reviews of five methods. American Journal of Obstetetrics and Gynecology, 186, S131-S159. ://www.sciencedirect.com/science/article/pii/S0002937802701889
[17]	Enkin, M., Keirse, M.J.N.C., Neilson, J., Crowther, C., Duley, L., Hodnett, E. and Hofmeyr, J. (2005) Guia para atencao efetiva na gravidez e no parto. Guanabara Koogan, Rio de Janeiro, Brazil.
[18]	Mamede, F.V. (2005) O efeito da deambulacao na fase ativa do trabalho de parto. Ph.D. Thesis, Escola de Enfermagem of Universidade de Sao Paulo, Sao Paulo, Brazil. http://www.teses.usp.br/ teses/disponiveis/22/22133/tde-22122005-105613/pt-br.php