PARTOGRAM ACTION LINE STUDY - A RANDOMIZED TRIAL

Objective To assess the effect of three different partograms on caesar ean section and maternal satisfaction. Design Prospective randomised c linical trial. Setting Regional teaching hospital in north West of Eng land. Participants Nine hundred and twenty-eight primigravid women wit h uncomplicated pregnancies who presented in spontaneous labour at ter m. Interventions The women were randomised to have their progress of l abour recorded on a partogram with an action line 2, 3 or 4 hours to t he right of the;alert line. If the progress reached the action line, a diagnosis of prolonged labour was made. Prolonged labour was managed according to the standard ward protocol. Main outcome measures Primary : Caesarean section rate and maternal satisfaction; secondary: need fo r augmentation, duration of labour, analgesia, cord blood gas analysis , postpartum haemorrhage, number of vaginal examinations, Apgar score and admission to special care baby unit. Results Caesarean section rat e was lowest when labour was managed using a partogram with a 4-hour a ction line. The difference between the 3- and 4-hour partograms was st atistically significant (OR 1.8, 95% CI 1.1-3.2), but the difference b etween 2 and 4 hours was not (OR 1.4, 95% CI 0.8-2.4). The women in th e 2-hour arm were more satisfied with their labour when compared to th e women in the 3-hour (P < 0.0001) and 3-hour (P < 0.0001) arm. Conclu sion Our data suggest that women prefer active management of labour. I t is possible that partograms which favour earlier intervention are as sociated with higher caesarean section rate. As the evidence on which to base the choice of partograms remains inconclusive further research is required.