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Breech labor on the WHO partograph
Author(s) -
Lennox C.E,
Kwast B.E,
Farley T.M.M
Publication year - 1998
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/s0020-7292(98)00083-6
Subject(s) - medicine , breech presentation , obstetrics , apgar score , childbirth , pregnancy , cervical dilatation , fetus , cervix , genetics , cancer , biology
Objectives : To assess the impact of breech labor management using the WHO partograph on fetal and maternal outcomes of labor. Method : All 1,740 breech presentations in a larger multicentre hospital‐based study in South East Asia of the use of the WHO partograph in labor management were studied. The partograph was introduced into each hospital during the study and a before and after analysis of various outcomes was conducted. Results : There were 923 breech presentations prior to implementation of the partograph and 817 after. The overall Cesarean section rate was 29.7% (21.6% emergency and 7.6% elective). Introducing the partograph reduced Cesarean sections for multigravida from 27.1% to 19.3% (non‐significant) but had no impact on the rate for primigravida (38.5% to 38.7%). Prolonged labor (>18 hours) was reduced significantly among multigravida and primigravida ( P <0.05), despite a reduced use of oxytocin. Intrapartum stillbirths fell (non‐significantly) from 1.9% to 11.1% (all parties combined). Fetal outcome, as measured by intrapartum deaths and Apgar scores <7 at 1 minute, was significantly better ( P <0.05) when delivery was by Cesarean section rather than vaginally, regardless of use of the partograph. Conclusion : The use of the WHO partograph in the management of breech labor reduces prolonged labor and (among multigravida) Cesarean sections and improves fetal outcome. In this study, however, Casarean section was a safer method of delivery for the baby, regardless of use of the partograph.