Abstract

WHO partogram,is cumbersome and time consuming procedure for overburdened Indian labour room setup very few clinicians use it. To circumvent the above problem Debdas (2006) introduced a very simple almost timeless mental method called ‘Paperless Partogram’ which is based on Friedman’s rule.

Objectives: Assessment of procedural  difference, predictability of ‘time’ of delivery, user friendliness and fetal outcome between WHO and Paperless partogram

Material: Any uncomplicated patient irrespective of age and parity in spontaneous onset labour with cephalic presentation who is at least 4cm dilated carrying pregnancy of 37 completed week

Method: In paperless group, right at first PV the Expected TIME of delivery (ETD) was calculated by mentally adding to the time-point of PV - the number cm left to full dilatation using Friedman’s formula of cervical dilatation of 1cm/hour. Birth attendant has to add 4 hours to the alert ETD to get ‘Action ETD’. Both the ETDs were written in the front of case sheet for everybody’s attention. In WHO group PV was done 2 hourly and plotted on graph in usual way.

Results: Around 75% of cases of both group wereage ranged between 25-30 years, primipara and of gestation between 38-40 weeks. Vaginal delivery occurred in: WHO-87%, Paperless-89%. One minute Apgar: WHO-97%, Paperless-96% - highly comparable. Even the augmentation rate (74% in Paperless, 77% in WHO group) and NICU admission rate (1.4% in paperless, 1.62%) were also comparable.

The only difference found was in ‘user friendliness’. While in Paperless group 100% became fan of the method, 96% of WHO group expressed that they would like to switch to paperless method, only 4% were not sure.

Conclusion: Paperless Partogram is 1) equally effective and efficient as the WHO method as a labour management tool, 2) The great point about it is-it is highly user friendly and hence ideal for resource poor situations.