The Role of Partograph in Monitoring of Spontaneous Labour in Primigravidae

Sabina Akhter *

Sylhet M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh.

Nasima Akther

Sylhet M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh.

Ayesha Siddika

Shaheed Taj Uddin Ahmad Medical College Hospital, Gazipur, Bangladesh.

Mosst. Khadiga Akter

Mugda Medical College Hospital, Dhaka, Bangladesh.

Taslima Akter

Shaheed Taj Uddin Ahmad Medical College Hospital, Gazipur, Bangladesh.

Nafisa Anwar Mariana

Shaheed Taj Uddin Ahmad Medical College Hospital, Gazipur, Bangladesh.

*Author to whom correspondence should be addressed.


Background: Partograph is a vital tool to monitor the progression of labour that basically helps to predict the necessary steps that should be taken early for the well-being of both mothers and neonates; specially in poor resource set up.

Objectives: To evaluate the role of partograph in monitoring of labour progress in primigravidae. Place of Study: Department of obstetrics and gynaecology of Sylhet M.A.G Osmani Medical College Hospital, Sylhet, Bangladesh.

Period of Study: January, 2019 to June, 2019.

Study Design: Prospective observational study.

Methods: All primigravid women in term attending Obstetrics & Gynecology department, were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 100 cases were finalized. All participants were divided into 2 groups – Group I and Group II. Group I- cervical dilatation and descent curve falling to the left of the alert line. Group II- cervical dilatation and descent curve falling to the right of the alert line. Though Group III with women to right of action line was planned, there were no patients in group III. Group I included 67 cases and Group II included 33 cases A pre-tested, observation based, peer-reviewed data collection sheet was prepared before study. Data regarding clinical, biochemical and surgical profile were recorded. Data were compiled, edited, analyzed.

Results: Out of 100 mothers, the highest 48% belonged to age group 21-25 years which was subsequently followed by 23% women in ≤20 years age group. Besides, 22% and 7% came from 26-30 years and >30 years age group. The mean age of the participants was 23.6±4.56 years (age range: 18-35 years). All 100 women were primigravida. The mean gestational age of the respondents was 37.69±0.36 weeks (range: 37-40 weeks). The mean duration of active phase of labour in groups I and II were 226.23±43.39 minutes (range: 182-332 minutes) respectively that is in group I it is almost 4.1 hour revealing the cervical dilatation at the rate of 1.4cm/hour. On the contrary, in Group II, it is almost 6.8 hour revealing cervical dilatation at the rate of 0.8cm/hour. Among 100 cases, 80% underwent NVD, 13% underwent LSCS and 7% underwent instrumental deliveries. Among 67 cases of Group I 64(95.52%) and 3(4.47%) underwent NVD and LSCS respectively. On the contrary, among 33 Group II cases, 16(48.48%), 10(30.30%) and 7(21.21%) underwent NVD, LSCS and instrumental delivery (P=0.03). The highest indication of both instrumental (57.14%) and LSCS (38.46%) is fetal distress. Subsequently, protracted dilatation is the important indication (14.28%) and 23.07% respectively). All the statistics showed significant differences (P=<0.005). Out of 67 Group I neonates only 1(1.49%) required NICU admission and out of 33 Group II neonates 4(12.12%) required the same (P=0.03). Additionally, after 5 minutes of birth APGAR score between the groups respondents were statistically significant (P=0.004). Majority of cases were within alert line (67%) and rest of the cases were outside the alert line (33%) but within the action line.

Conclusion: Partograpgh is an extremely useful tool to avoid prospective complications by prediction before specially in resource poor settings. It gives perfect scenario regarding progression of labour.

Keywords: Partograph, monitoring, spontaneous labour, primigravidae

How to Cite

Akhter, S., Akther, N., Siddika, A., Akter, M. K., Akter, T., & Mariana, N. A. (2022). The Role of Partograph in Monitoring of Spontaneous Labour in Primigravidae. Asian Research Journal of Gynaecology and Obstetrics, 5(1), 212–221. Retrieved from


National Institute of Population Research and Training (NIPORT). Measure Evaluation., icddr b. Bangladesh Maternal Mortality Survey 2010. Dhaka, Bangladesh: NIPORT, MEASURE Evaluation, icddr,b; 2012.

Ministry of Health and Family Welfare (MOHFW). Project Implementation Plan for Health, Population and Nutrition Sector Program (HPNSP) 2017–2022. Bangladesh: Ministry of Health and Family Welfare; 2017.

Campbell OM, Graham WJ, group LMSSs. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006; 368(9543):1284–99.

Ministry of Health and Family Welfare (MOHFW). Bangladesh Health Bulletin 2013. Bangladesh: Management Information System: Directorate General of Health Services; 2014.

Chowdhury M, Roy L, Biswas T, Rahman M, Akther S, Al-Sabir A. A needs assessment study for emergency obstetric and newborn care (EmONC) services in 24 districts of Bangladesh. Dhaka, Bangladesh: icddr,b. 2014.

Khan ANS, Billah SM, Mannar I, Mannar II, Begum T, Khan MA, et al. A cross sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh. Public library of science. 2018;13(9):1-18.

Dutta DC. Prolonged labour, obstructed labour, dystocia caused by fetal anomalies, Safe motherhood, Epidemiology of obstetrics. In: Dutta, DC. ed. DC Dutta’s text book of obstetrics, 9th ed. New Delhi, India: Jaypee Brothers the health sciences publisher (P) Ltd: (376-379, 561); 2018.

Kadikar GK, Manoj Kumar JB, Karari K, Shah S. Comparison of normal and abnormal labour by using modified WHO partograph. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2018;7(4):1440-5.

Javed I, Bhutta S, Shoaib T. Role of partogram in preventing prolonged labour. Journal of Pakistan Medical Association. 2007;57(8):408-11.

Elizabeth SG. Disfunctional labour. Manual of High Risk Pregnancy and Delivery, 5th edition, Elsevier, a division of Reed Elsevier India Private Limited; 610.

Urmi S, Goswami S, Mukhopadhaya P. The Role of partograph in the outcome of spontaneous labour. Nepal Journal of Obstetrics and Gynaecology. 2014;9(17): 52-7.

Kathuria TS, Sapkal Rekha. Audit of caesarean section for non-progress of labour. International journal of Reproduction contraception Obstetric and Gynecology. 2016;5(4):1002-5.

Penumadu KM, Hariharan C. Role of partogram in the management of spontaneous labour in primigravida and multigravida. International journal of Reproduction, Contraception, Obstetrics and Gynecology. 2014;3(4):1043-9.

Indra Usharai N, Mumtaz B. A study on clinical outcome of obstructed labour. International Journal of Reproduction, Contraception, Obstretic and Gynaecology. 2017;6(2):439-42.

Begum T, Rahman Nababas H, Haque DME, Khan F Ali. Indication and determinants of caesarean section delivery: Evidence from a population based study in Matlab, Bangladesh. Public Library of science. 2017;12(11):1-16.

Hashim N, Naqvi S, Kharam M, Jafry HF. Prim parity as an intrapartum obstetric risk factor. Journal of Pakistan Medical Association. 2012;62(7):694-8.

Sinha D, Shrivastava S, Shrivastava S. Management of labour in primigravidae with who modified partograph. Scholars journal of applied medical science. 2016; 4(91):3457-61.

Anjuman Begum. Conference paper: Third global symposium on health system research, At Cape Town, South Africa, October 2014, barriers in use of partograph in different health facilities in Bangladesh. [accessed on 26.09.2018.]

Sanyal U, Goswami S, Mukhopadhyay P. The Role of Partograph in the Outcome of Spontaneous Labor. NJOG. 2014;17(1): 52-57.

World Heal Organization. World Health Organization partograph in management of labour. Lancet. 1994;343:1399-1404.

Kavitha G Pujar, Shruthi V Salian, Sunanda R Kulkarni. Partographic analysis of labour by modified who partograph in primigravidae: a prospective observational study. Int J Reprod Contracept Obstet Gynecol. 2016;5(1):166-9.

Mahfuza Rahman. Use of partograph in obstetric care [Dissertation]. Bangladesh College of Physicians & surgeons; 2004.

Nazlima Nargis. Partographic assessment of labour in DMCH [Dissertation]. Bangladesh College of Physician and Surgeons; 2003.

Khan KS, Rizvi A. The partograph in the management of labor following caesarean section. International Journal of Gynecology and Obstetrics. 1995;50(2): 151-7.

Manjulatha Anitha, Shivalingiah N. Partogram: Clinical study to assess the role of parogram in primigravidae in labour. International Journal of Reproduction, Contraception, Obstetrics & Gynaecology. 2016;5(4):10412-25.

Philpott RH. Obstructed labour, lin obstet gynaecol. 1982;9(3):625-40.

Daftary SN, Mhatre PN. Cervicograph in the management of labour in primigravidae. J Obstet Gynecol. 1977; 27:687–91.

Zhang J, Troendle JF, Yancey MK. Reassesing the labour curves in nulliporous woman. Mosby-Yearbook Inc. 2002;187(4):824–8.

Impey L, Hobson J, O’Herlihy C. Graphic analysis of actively managed labor: Prospective computation of labour progress in 500 consecutive primigravida women in spontaneous labor at term. Am J Obstet Gynecol. 2000;183(2):438–43.

Gifford DS, Morton SC, Fiske Mary, et al. Lack of progress in labour as a reason for cesarean. Am Coll Obstet Gynecol. 2000; 95(4):589–95.

Surekha Tayade. The impact of modified WHO partogram on maternal and perinatal outcome. International Journal of Biomedical and Advance Research IJBAR. 2012;03(04).

Dujardin B, Boutsenb, Hampheleire D, Kulkerd R, Manshenale JP. Oxtocic in developing countires, International Journal of Gynae and Obstetric. 1995;50: 243-51.