Paperless partogram – a simple and acceptable alternative to who modified partograph in resource poor setting

Background: labour is a natural process of child birth. The partograph is a graphical representation used to monitor labour. Close monitoring of labour and early detection of prolonged and obstructed labour can prevent disastrous complications. WHO modified partograph is universally adopted for monitoring labour. However, inspite of its universal recommendation it is rarely used. The major drawback for its non compliance is its complex nature of graph and shortage of doctors and nurses. Dr Debdas introduced paperless partogram for monitoring labour which is graph less, simple, non time consuming, and two step calculation. It calculates alert ETD (Estimated Time of delivery) and Action ETD to arrive at accurate time to intervene for ensuring a safe delivery. Objective: The present study was done to evaluate the simplicity, acceptability, user friendliness and also to determine overall use of paperless partograph in comparison to WHO modified Partograph. Methods: 400 pregnant women with singleton uncomplicated term pregnancy with cephalic presentation were included and divided into two groups of 200 each and their progress of labour and outcome were followed . Group A was followed using Paperless partogram and Group B using WHO modified Partograph. 16 resident working in Labour room in shifts were asked to fill either of partographs for monitoring labour and outcome. A total of 200 partograph were randomly checked for completeness. A structured questionnaire with score from 1 to 10 was used to analyze preference of residents for using either of the two partograph. Results: It was found that maternal and perinatal outcome were similar in group A and B (p>0.05). However, paperless partograph was more acceptable, simple and user friendly than WHO modified partograph (p<0.0001) and the difference was highly significant. Conclusion: The paperless partograph was found to be equally effective in monitoring and management of low risk labour as WHO modified partograph. However it was more acceptable and user friendly among residents and nurses. Thus paperless partograph may be a good alternative to WHO modified partograph to monitor labour in a facility with less staff and high patient load.