TITLE:
Using Alert and Action Expected Times of Delivery in Prevention of Prolonged Labor
AUTHORS:
N. F. B. Tandu-Umba, G. Kalombo Muamba
KEYWORDS:
Management of Labor, Alert and Action Times of Delivery, Paperless Partogram
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.5 No.14,
December
1,
2015
ABSTRACT: Background and Objective: Although globally admitted as the most valuable
tool to prevent prolongation of labor, the partogram has failed to be commonly
used. This is due to its alleged complexity. Based on the simplified model
proposed by Debdas, the so called paperless partogram, we aimed at evaluating
the ability of only using the alert and action lines to prevent prolongation of
labor. Methods: This was a cross-sectional study including labor records of
women delivered at King Baudouin Hospital of Kinshasa (secondary level) from
01/01 till 31/12/2013. The study was approved by the Faculty Ethical Committee.
Inclusion criteria were: 1) live singleton pregnancy, 2) cephalic fetal
presentation, 3) lack of uterine scar, 4) monitoring in labor ward by 4 cm of
cervical dilation, and 5) delivery at term. For every record, the expected time
of delivery (ETD = 6 hours after 4 cm of cervical dilation) was considered “Alert
EDT” to which 4 hours were added to obtain the “Action EDT”. Irrespective of
other fetal and maternal features contained in the traditional partogram Alert
and Action ETD were checked a posteriori on Debdas’s model to derive the appropriate
outcome of labor. Results: The study included 357 participants, of which 219
primiparous and 138 multiparous. Vaginal delivery took place in 91% of cases.
Full cervical dilation was achieved after 8 - 9 hours (9.5 ± 1.8 hours for
primiparous and 8.4 ± 1.7 hours for multiparous women), namely 2 - 3 hours
following Alert ETD). This duration is close to the Action ETD. For 32 cesarean
sections (9%) final decision took place within the Alert ETD. Conclusion: Using
only Alert and Action ETD was found convenient to derive appropriate measures
for the outcome of labor. So, the paperless partogram is a simplified method to
manage the active stage of labor that could prevent prolongation of labor in
our setting.