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Poor partogram use in Dar-es-Salaam perinatal care study.

WHO's recommendation of the widespread use of the partogram for all women in labour has been adopted by the Ministry of Health of Tanzania, making its use in labour obligatory at all levels of obstetric care. A study in 2004 investigated the quality of the use of the partogram in four public hospitals in Dar-es-Salaam by reviewing and recording the details of 367 partograms used to monitor progress of labour, maternal and fetal condition, and by interviewing 20 midwives. There were no partogram guidelines in any of the labour wards. There were high proportions of unrecorded parameters, coupled with sub-standard monitoring of progress of labour that may have played a role in maternal and fetal health outcomes. Of all partograms, 50% had no records of duration of labour. Although cervical dilation and fetal heart rates were recorded in 97% and 94% of partograms respectively, 63% and 91% of these were judged to be sub-standard. Sub-standard monitoring of fetal heart rate was strongly associated with poor fetal outcome (p<0.001). Blood pressure, temperature and pulse rates were not recorded in 47%-76% of partograms. Although all midwives interviewed had had formal training on how to use a partogram, it was not reflected in their performance. Suboptimal documentation of some parameters could hinder early detection of complications, and partly explain poor outcomes. This study indicates that urgent in-service training in use of the partogram, supervisory mechanisms and regular partogram audits are needed to improve management of labour and reduce maternal and perinatal deaths. (1)

(1.) Nyamtena A, Urassa D, Massawe S, et al. Partogram use in the Dares Salaam perinatal care study. International Journal of Gynecology and Obstetrics 2008;100:37-40.
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Title Annotation:ROUND UP: Maternal Mortality
Publication:Reproductive Health Matters
Article Type:Brief article
Geographic Code:1USA
Date:May 1, 2008
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