Percent of deliveries in which a partogram is correctly used
The percent of deliveries correctly monitored with a partogram (sometimes known as a partograph).
A partogram is a simple chart that clinical staff can use to monitor labor and identify when it is not progressing satisfactorily.
Correct use is defined as: (1) starting the monitoring process only after the woman begins labor and (2) measuring the essential parameters, such as cervical dilation, descent of fetal head, and uterine contractions.
The indicator is calculated for a specific reference period as:
# of deliveries correctly monitored with a partogram x 100
Total # of deliveries
Number of facility-based deliveries monitored with a partogram; evidence of correct use of the partogram; number of deliveries at the facility during the reference period (e.g., 3 months, 12 months)
Review of medical records; direct observation by supervisor or external evaluator (regarding correct use); and review of the partogram
In a pictorial overview, the partogram graphically displays the dynamics of labor during the first stage of delivery. It records fetal condition, labor progress, and maternal condition with the aim of alerting health professionals to any problems with the mother or baby. In this way, the partogram acts as an “early warning system” that detects insufficient uterine action and/or cephalopelvic disproportion leading to obstructed labor (WHO, 1991a).
If properly used, the partogram helps reduce prolonged labor and its sequelae through earlier referral. Midwives, physicians, and nurses at all levels can learn to use and interpret partograms correctly, and thus can reduce cases of prolonged labor, maternal morbidity, and perinatal mortality (Schwarcz, Díaz, and Nieto, 1990).
A low score on this indicator may reveal a need for additional interventions, such as on-the-job training or refresher tutorials for staff.
There is no one partogram template; different health facilities may use different versions, with varying degrees of usefulness and simplicity. The WHO still recommends partograms as a method of diagnosing obstructed labor, with the focus being on low-resource settings. However, a systematic Cochrane review concluded, “On the basis of the findings of this review, we cannot recommend routine use of the partogram as part of standard labour management and care. Given the fact that the partogram is currently in widespread use and generally accepted, it appears reasonable, until stronger evidence is available, that partogram use should be locally determined. Further trial evidence is required to establish the efficacy of partogram use” (Lavender et al., 2012).
Particularly in a hospital setting where there are several people looking at the labor notes, a partogram is helpful for a quick, consistent review and is a useful tool for good decision making. However, in settings where there are one or two people monitoring the labor, there are other ways to appropriately and efficiently document labor notes apart from using a partogram. Furthermore, knowledgeable and experienced health providers need not rely on a partogram to identify when a woman’s labor is not progressing well.
Therefore, use of this indicator as a proxy measure of quality of care should be interpreted with caution.
newborn (NB), quality
Schwarcz R., A. Diaz, and F. Nieto. 1990. “Guía para la vigilancia del parto. Partograma con curvas de alerta.” Montevideo, Uruguay: Centro Latinoamericano de Perinatología.
WHO. 1991a. Essential Elements of Obstetrical Care at First Referral Level. Geneva: WHO.
Lavender T, Hart A, Smyth RMD. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD005461. DOI: 10.1002/14651858.CD005461.pub3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005461.pub4/pdf