Quality of partogram recordings and perinatal outcomes at muhimbili national hospital, Tanzania.

Abstract

Introduction; The management of labor using partogram is the standard way of improving both maternal and perinatal outcomes. The partogram increases the quality and regularity of all observations on the fetus and the mother in labor and aids early recognition of problems in both mother and fetus. Correct recording of labor parameters in the partogram is a reliable tool to estimate midwives’ operation. Tanzania has high maternal and perinatal mortality rates. One third of stillbirths takes place during delivery and is largely avoidable. It is estimated that 40% of stillbirths are associated with substandard fetal heart monitoring during labor. Objective; This study aimed at assessing the quality of partogram recordings and compare with fetal outcomes among women delivering at Muhimbili National Hospital. Methodology; It was a crossectional study in which partograms of women whose labor was monitored using partogram delivered in the hospital were reviewed immediately after delivery. The study was conducted from 1st September to 30th November 2011. Using a checklist, recordings of parameters of labor in partogram, fetal outcomes (Apgar score at 5 minute, still birth and admission to neonatal ward for special care) and immediate maternal outcomes (PPH, perineal tear, visceral injuries following cesarean section) were assessed. Partogram recordings of labor parameters were judged as standard if standard recorded or substandard if not recorded as per standard protocols. Results; Partogram was used in all women who were admitted in labor ward with spontaneous labor. A total of 1,051 partograms were reviewed during the study time. Only 8.9% of partograms had all parameters with standard recordings. The most unrecorded parameter was x maternal pulse rate. Most (81.4%) of partograms had substandard recordings of uterine contraction. There were 53 newborns with Apgar score less than 7 at 5 minutes and 17 fresh stillbirths. Substandard fetal heart rate recording in the partogram is significantly associated with Apgar score less than 7 at 5 minute and stillbirths. (P-value<0.001, Chi-square 15.92). Majority (79.5%) had spontaneous vaginal delivery and 18.6% delivered by cesarean section. Though there were a trend of association but statistically substandard partogram recordings were not associated with immediate adverse maternal outcomes. Conclusion: This study as other studies conducted as where found high proportion of substandard partogram recordings. Substandard recordings of fetal heart rate and uterine contractions were significantly associated with adverse fetal outcomes. Supervisory mechanisms and on job training on partogram use are recommended as a way of improving labor monitoring and standard recordings. This will improve both fetal and maternal outcomes.