A Comparative Observational Study on the WHO Labour Care Guide Versus the WHO Modified Partograph on Labour Outcome

TL;DR

This study compares two labor monitoring tools and finds that the WHO Labour Care Guide improves labor outcomes and reduces cesarean sections compared to the older WHO Modified Partograph.

Contribution

The study provides empirical evidence supporting the effectiveness of the WHO Labour Care Guide over the Modified Partograph in improving maternal labor outcomes.

Findings

Women using the WHO Labour Care Guide had shorter active and second stage labor durations and lower cesarean section rates.

Vaginal delivery rates were higher and hospital stays shorter with the Labour Care Guide compared to the Modified Partograph.

Neonatal outcomes were comparable between the two groups, indicating no compromise in neonatal safety.

Abstract

Introduction: Labour is a critical physiological process requiring close monitoring to ensure optimal maternal and neonatal outcomes. Traditional labour monitoring using the WHO Modified Partograph has been widely adopted; however, concerns regarding rigid time thresholds and unnecessary interventions have prompted the development of the WHO Labour Care Guide (LCG), a more individualized and woman-centred tool aligned with contemporary evidence. Comparative data between these two tools remain limited. The study aimed to compare the effectiveness of the WHO LCG with the WHO Modified Partograph in terms of maternal labour outcomes and caesarean section rates among primigravida women at term.

Methods: This comparative observational study was conducted at a tertiary care teaching hospital in South India. A total of 146 primigravida women in spontaneous labour with singleton, cephalic pregnancies at 37-40 weeks of gestation were enrolled. Participants were equally allocated to monitoring with either the WHO LCG (n = 73) or the WHO Modified Partograph (n = 73). Maternal labour parameters, mode of delivery, hospital stay, and neonatal outcomes were recorded.

Results: Women monitored using the WHO LCG had significantly shorter durations of the active phase and the second stage of labour and a markedly lower caesarean section rate compared with those monitored using the Modified Partograph (p < 0.001). Vaginal delivery rates were significantly higher, and hospital stays were shorter in the LCG group. Neonatal outcomes, including APGAR (appearance, pulse, grimace, activity, respiration) scores, birth weight, NICU admissions, and NICU stay duration, were comparable between the two groups.

Conclusion: The WHO LCG is a more effective intrapartum monitoring tool than the WHO Modified Partograph, improving maternal labour outcomes without compromising neonatal safety. Its adoption may enhance labour efficiency, reduce unnecessary caesarean deliveries, and support woman-centred obstetric care.