World Health Organization : Year 1993 ; World Health Organization, Family Health, Maternal and Newborn Health-Safe Motherhood, No. 93.8: Preventing Prolonged Labour ; A Practical Guide the Partograph Part I ; Principles and Strategy

By Christopher E. Lennox

Book Id: WPLBN0000101640
Format Type: PDF eBook:
File Size: 1.06 MB
Reproduction Date: 2005

Title:	World Health Organization : Year 1993 ; World Health Organization, Family Health, Maternal and Newborn Health-Safe Motherhood, No. 93.8: Preventing Prolonged Labour ; A Practical Guide the Partograph Part I ; Principles and Strategy
Author:	Christopher E. Lennox
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago E. Lenno, B. C. (n.d.). World Health Organization : Year 1993 ; World Health Organization, Family Health, Maternal and Newborn Health-Safe Motherhood, No. 93.8. Retrieved from http://gutenberg.cc/

Description
Medical Reference Publication

Excerpt
PREFACE Of the estimated annual toll of half a million maternal deaths, some 99 per cent occur in developing countries. An unknown proportion of these follow prolonged labour, due mainly to cephalopelvic disproportion which may result in obstructed labour, matemal dehydration, ruptured uterus and obstetric fistulae (and also, but less directly, in postpartum haemorrhage and neonatal infection). In the infant, prolonged obstructed labour may cause asphyxia, brain damage, infection and death. Obstructed labour, with or without ruptured uterus, features among the five major causes of maternal death in almost every developing country, although its relative importance varies from region to region. Nevertheless, it can be said with certainty that abnormally prolonged labour and its effects are important contributors to maternal and perinatal mortality and morbidity worldwide. There are many constraints - geographical, economic, political and sociocultural - which lead to either the non-availability or non-utilisation of the basic obstetric care which is required to manage obstructed labour satisfactorily. The aim of safe motherhood interventions is to address, directly or indirectly, these constraints. Early detection of abnormal progress and prevention of prolonged labour would help reduce matemal and perinatal mortality. The partograph, which is a graphic recording of the progress of labour and the condition of the mother and fetus, has been in use for over 20 years, but not so widely as the reported results of its use would suggest is appropriate. In order to promote its wider and more rapid adoption, WHO held consultations which produced an agreed standard format. This has been the subject of a WHO multicentre trial conducted in Indonesia, Malaysia and Thailand (I). The repon of the trial (2) confirms what had been found in earlier studies concerning its effectiveness, low cost and feasibility. In this trial, the proportion of labours which lasted over 18 hours was almost halved after introducing the partograph. The rate of caesarean section among normal women (i.e. without serious complications or high risk already on admission) was reduced from 5.2 to 3.7 per cent; and the percentage requiring augmentation of labour was more than halved. There were not the dramatic improvements in neonatal outcome which earlier mals, e.g. in Zimbabwe and Malawi, had shown. However, a study in Assiut in Egypt, at the same time as the multicentre trial but not part of it, did show a marked fall in the percentage of Apgar scores less than 7 at five minutes, and in per-natal mortality (3).

Table of Contents
TABLE OF CONTENTS PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i 1 . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . HISTORY OF THE PARTOGRAPH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 THE PARTOGRAPH: THE WHO MODEL . . . . . . . . . . . . . . . . . . . . . . . . 4 4.1 Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 4.2 Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4.2.1 The progress of labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 4.2.2 The fetal condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 4.2.3 The maternal condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 STRATEGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10