Evaluation of the alert line of partogram in recognizing the need for neonatal resuscitation

Abstract

Background:A major problem of the first moments of childbirth, especially in “prolonged labor,” is perinatal asphyxia which necessitates neonatal resuscitation. This study aimed at evaluating the alert line of the partogram in recognizing the need for neonatal resuscitation 20–30 s after delivery.Materials and Methods:140 full-term pregnant women were kept under surveillance through using a partogram. In order to decide on the onset of resuscitation, the three indicators of fetal respiration, heart rate, and skin color were used 20–30 s after delivery. The findings from the evaluation of fetal conditions were compared to the position of the ultimate cervical dilatation graph to the alert line of the partogram, and through using appropriate statistical procedures, sensitivity, specificity, and positive and negative prediction values of the alert line to recognize the need for neonatal resuscitation were computed.Results:There was a significant relationship between the need for neonatal resuscitation within 20–30 seconds after delivery and the graph of the cervical dilatations on the partogram (P = 0.001). The indices of the alert line for predicting the need for resuscitation 20–30 s after birth had a sensitivity of 97.5%, specificity of 80.2%, positive prediction value of 97.2%, and negative prediction value of 98.7%.Conclusions:In mothers who had normal vaginal delivery, with normal fetal heart rate, and with no oxytocin administration or omniotomy, the alert line showed appropriate sensitivity, specificity, and negative prediction value. So, it can assist in predicting the necessity of action for neonatal resuscitation 20–30 s after delivery.

Strategies for intrapartum foetal surveillance in low- and middle-income countries: A systematic review

“…Many studies were from urban settings (urban: n = 16, rural: n = 1, both: 2), for 18 studies this could not be determined. Studies were on: admission tests and early intrapartum (CTG, n = 7, IA: 1, other methods, n = 6) [ 32 – 35 , 44 , 48 , 51 , 56 , 57 , 59 , 61 ], ongoing intrapartum FHR monitoring (IA, n = 8; CTG, n = 11) [ 26 – 28 , 30 , 31 , 36 – 39 , 41 , 43 , 45 – 47 , 50 , 53 , 58 ], adjunctive tests (n = 9) [ 39 , 41 – 43 , 45 , 46 , 49 , 52 , 58 ] and partograph (n = 5) [ 24 , 25 , 29 , 40 , 54 , 55 ] (Tables 1 – 3 ).…”

“…Training midwives to use the partograph reduced low Apgar scores at 1 minute but no improvement in other perinatal outcomes [ 29 ]. Observational studies showed that crossing the alert and action lines on the partograph was associated with a higher incidence of neonatal resuscitation and fresh stillbirths [ 54 , 55 ]. Substandard use of partograph was associated with low Apgar score [ 40 ].…”

“…Strengths of the partograph were its low-cost, pictorial overview of labour allowing timely recognition for complications and action [ 25 , 29 , 40 , 54 , 55 ]. A major threat was an underuse of partograph due to a shortage of staff, lack of knowledge, training, and guidelines, unavailability of copies and hesitant attitudes of staff [ 29 , 40 , 54 ].…”

“…However, their effectiveness is not known and should be tested in future studies. Contrary to a Cochrane review, which did not include the large study in South East Asia [ 69 ], the partograph was useful for monitoring and decision-making for the intrapartum care of the mother, foetus and labour progress, and was associated with reduced intrapartum stillbirths in low-resource settings [ 25 , 29 , 40 , 54 , 55 ]. The BOLD initiative and WHO guidelines stress the importance of supportive, person-centred care during labour and childbirth rather than focus on cervical dilatation only [ 70 – 72 ].…”

The correctness and completeness of documentation of parameters on the partographs used by midwives in primary healthcare facilities in midwestern Uganda: A retrospective descriptive study

“…In this study, correctness and completeness of recordings of parameters on partographs was determined by appropriate documentation of 13 (Mandiwa & Zamawe, 2017 ) variables. These were; assessment of the mother for potential risk factors, recording of foetal heart rates every half hour, recording of the intactness or rupture of membranes, recording of colour of liquor upon rupture of membranes, recording of foetal head moulding, recording of cervical dilation every four (Bolbol‐Haghighi et al, 2015 ) hourly, recording of uterine contractions every half hourly, recording of foetal descent every two hourly, recording of maternal temperature every 4‐hourly, recording of maternal pulse rate every half hourly, recording of maternal blood pressure every 4‐hourly, urine testing for proteins and a recording of actions taken when needed. All the 13 variables were scored with either Yes (1) or No (0).…”