Analysis of Spontaneous Labour and Nomograms in Labour

INTRODUCTION: Labour is a very important event in a woman’s life. It would turn out to be a memorable and cherishable one in her life time if she delivers a baby, healthy and undamaged. It may turn out to be horror if she has confronted with a labour which was a tardy and prolonged one with an end with a damaged baby. The sorrow may prolong to even a death of a baby, carried all days long in her womb with care and expectations. It may put her to a morbid state for life long with a Vesico Vaginal or Recto Vaginal Fistula (though very very rare these days). Last but not the least complication may bring an end to the life of a young mother which would pose an immense loss both to her family and the society. A maternal death would deprive her children both mentally and physically. In view of the unacceptably high maternal mortality and morbidity and the social impact of a maternal death to the family and children “SAFE MOTHERHOOD INITATIVE” conference was held at Nairobi in Feb. 1987. World Health Organization has conducted a multi centre trial covering over 35000 labouring women. They showed that the use of partograph decreased the LSCS rate, low Apgar scores, need for augmentation and perinatal mortality and morbidity. It was used to decrease prolonged labour from 6.4% to 3.4%. Partogram is a latin Greek hybrid word synonymous with parturition recorded in graphic form . The partographic control of labour has outdated a feeling of normal labour based on arbitrary time limits. It gives a visual display of labour events at a glance. In this study labour patterns of 300 primi gravidae and 300 multigravidae has been analyzed and compared with the aid of WHO partograph. AIMS OF STUDY: • Analysis of labour pattern in uncomplicated cases of Primi & Multi gravida in our institution who went into spontaneous labour. • Detection of dysfunctional labours earlier in Primi & Multi. So intervention can be done at appropriate time. • Record various events of labour graphically in a single sheet so that aberrations of labour can be detected earlier. • Find the value of alert and action line in deciding the mode of delivery. • To construct nomograms in labour for primigravida admitted in this hospital. MATERIALS AND METHODS: This is a prospective study conducted at Government Hospital for Women and Children, Institute of Obstetrics and Gynaecology, Egmore attached to Madras Medical College, Chennai from September 2004 to August 2005. Inclusion Criteria: The study group included singleton pregnancies after 37 weeks of gestational age presenting by vertex who went into spontaneous labour. Patients in early labour were randomly selected for the study. The patients with any medical or obstetric complications which may require immediate intervention were not included in this study. Only multigravidae with previous good obstetric history were included in our study. 300 cases of Primigravidae and 300 cases of mulitgravidae were studied . Exclusion Criteria: • Preterm labour • Antepartum hemorrhage • Pregnancy Induced Hypertension • Severe Anaemia • Major degrees of Cephalo Pelvic Disproportion • Mal presentations and Foetal distress • Post Caesarean Pregnancies • Medical disorders complicating Pregnancies SUMMARY: • 300 primi gravidae and 300 multi gravidae were included in the study. • The mean latent phase was 6.45 hours in primi and 5.01 hours in multi. • The mean active phase was 3.9 hours in primi and 2.7 hours in multi. • The mean duration of first stage of labour was 10.3 hours in primi and 7.14 hours in multi. • The total duration of labour was 10.5 hours in primi and 7.4 hours in multi. • The mean rate of cervical dilatation was 1.012 cm in primi and 2.16 cm in multi. • 260 primi gravidae delivered via labour naturale, 10 had operative vaginal deliveries and 30 had LSCS. • 287 multi gravidae delivered via labour naturale, 1 had operative vaginal deliveries and 12 had LSCS. • The mean birth weight was 2.7 kg in primi and 2.9 kg in multi. • The APGAR scores were good. CONCLUSION: In the majority of cases labour is a normal process which will progress satisfactorily if allowed to do so without intervention. But, patients with delayed first stage will require augmentation. Graphical documentation of labour with partograms and evaluation with reference to nomograms of cervical dilatation will help in selecting the patients for augmentation. Partogram is a simple and inexpensive tool to provide continuous pictorial overview of labour. This study shows that it helps in early detection of prolonged and dysfunctional labours. Thereby effective and timely intervention can be made and thus reducing unnecessary caesarean section while not adversely affecting the perinatal mortality rate. It can be used as a tool for recording observation, clinical significance with the objective of reducing lengthy note taking. The hand over rounds from one doctor to another and one mid wife to another becomes easy because of “at a glance” view of labour progress. The clarity of information of partogram simplifies data collection and encourages research into the dynamics of labour. Partogram is very useful in the hands of paramedical workers conducting deliveries in the outskirts of this country. Where no electronic gadgets are available to monitor and indicates abnormal labour. Thus it goes a long way in detecting abnormal labour and aid in early referral thus reducing maternal morbidity and mortality