UTILITY OF ALERT AND ACTION LINES ON PARTOGRAMS IN MANAGEMENT OF LABOUR IN PRIMIGRAVIDA FOR IMPROVING PRENATAL OUTCOME

Dr. Ajay Kumar Sharma; Dr. Kanti Yadav; Dr. Suchitra Narayan; Dr Jaiprakash Narayan

Volume : VI, Issue : VII, July - 2016

UTILITY OF ALERT AND ACTION LINES ON PARTOGRAMS IN MANAGEMENT OF LABOUR IN PRIMIGRAVIDA FOR IMPROVING PRENATAL OUTCOME

Dr. Ajay Kumar Sharma, Dr. Kanti Yadav, Dr. Suchitra Narayan, Dr Jaiprakash Narayan

Abstract :

Background and objectives : Labour is a simple natural process; which can take a turn producing it ‘lethal‘ and most dangerous for any patient. Partograph serves as a simple and inexpensive tool to monitor labour and provide early recognition of any deviation from normal progress of labour. The objective of this study is to recognize at an early stage, the abnormal labour and to assess management option for different abnormal labours detected to reduce perinatal morbidity and to study utility of alert and action lines. Methodology : In this prospective cohort study conducted in Department of Obstetricts and Gynecology, J.L.N. Medical College, Ajmer. 250 patients within a span of 6 months (January 2012 to July 2012) were studied. Term primigravidae patients were choosen with cephalic presentation and vertex as the presenting part were choosen and with no obstetrics and medical complications.Results and Summary : This was a prospective study of 250 patients where all patients were primigravide with progress of labour depicted on WHO Partogram. The study divides patients into 3 groups and the partogram into 3 zones. Group A : Safe zone – Patients who deliver before the alert line reached. Group B : Observation Zone – Patients who deliver after alert but before the action line. Group C : Intervention zone – Patients who deliver after action line has crossed. In the present study, the mean age of the patients was 21.4 years. Mean rate of cervical dilatation was 1.78 cm/hr. Most of cases went into spontaneous onset of labour. Maximum numbers of deliveries were FTND; LSCS rate was 6%. Patient crossing the Alert line had longer duration of labour and required augmentation. Perinatal mortality was 0.8%. Mean total duration of labour was 3.9+1.5 hrs. Patients with a favourable partogram i.e., patients in Group A had high FTND rate, Group B required intervention, Group C were at risk & had LSCS. Majority of babies delivered were at term; had APGAR at 1 min in between 7–8 and 94% had no complications. Conclusion : Labour is a natural phenomenon; few tends to become dystocic and go in for prolonged labour. From this study, it‘s evident that routine use of partogram is helpful to detect abnormalities in the progress of labour and it permits early corrective therapy. Partogram management with 3 zones increase quality & regularity of observation and act of early warning systems for detection of abnormal progress; enabling early decision for referral; intervention; or termination of that labour, thus improving maternal & fotal outcome and so should be routinely used.