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Sinha 2017 (Continued)

the expected rate of progress. However, if cervical dilatation crossed the


allocated action line, a clinical assessment was made and guidelines for the
management of prolonged labour were followed. Where augmentation was
required, this involved oxytocin alone when membranes were ruptured or
amniotomy followed by oxytocin in the presence of intact membranes
Funding: no funding sources
Conflict of interest: none declared

Risk of bias

Bias Authors’ judgement Support for judgement

Random sequence generation (selection High risk Not described - “randomised study” al-
bias) though it states groups were “divided
equally” into 2 groups which describes a
quasi-randomisation process

Allocation concealment (selection bias) High risk No clear information given but “equally di-
vided into two groups” suggests quasi-ran-
domisation

Blinding of participants and personnel High risk Not mentioned, but blinding of staff is not
(performance bias) feasible with this type of intervention
All outcomes

Blinding of outcome assessment (detection High risk Not reported, assumed not due to nature
bias) of intervention. Outcomes likely to be re-
All outcomes ported by unblinded clinicians

Incomplete outcome data (attrition bias) Unclear risk Loss to follow-up was not mentioned. No
All outcomes study flow diagram.

Selective reporting (reporting bias) Unclear risk Duration of labour not reported in this pa-
per. Protocol not available and little infor-
mation on methods

Other bias Unclear risk Baseline characteristics of groups not men-


tioned.

Walss Rodriguez 1987

Methods Prospective study in which women “at random” were distributed in 1 of 2 groups.
Conducted between 15 September to 25 October 1985

Participants 434 women in Mexico, with term pregnancies who presented in labour (cervix 2 cm or
more dilated) with live, singleton, cephalic presentation

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 46
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Walss Rodriguez 1987 (Continued)

Interventions One group had their labour managed according to the Friedman partogram and the
other had labour managed using a non-graphic, descriptive record

Outcomes • Caesarean section


• Forceps delivery
• Normal delivery
• Apgar score

Notes This study was translated into English.


Declarations of interest: not mentioned in translation
Funding source: not mentioned in translation

Risk of bias

Bias Authors’ judgement Support for judgement

Random sequence generation (selection High risk Quasi-randomised study. No information


bias) on how randomisation was achieved

Allocation concealment (selection bias) High risk No information on how women were allo-
cated to groups, not clear that group allo-
cation was truly random

Blinding of participants and personnel High risk Not feasible to blind women or clinical
(performance bias) staff.
All outcomes

Blinding of outcome assessment (detection Unclear risk Not reported.


bias)
All outcomes

Incomplete outcome data (attrition bias) Low risk No apparent loss to follow-up.
All outcomes

Selective reporting (reporting bias) Unclear risk Unable to assess from translation.

Other bias Unclear risk Very little information on study methods


was provided.

Windrim 2006

Methods Prospective randomised clinical trial. Computerised allocation, by telephone. Conducted


between July 1997 and December 1999

Participants 1932 primiparous women, in Toronto, Canada, with uncomplicated pregnancies at term,
with contractions every 3 to 5 minutes and cervix at least 3 cm dilated. Outcomes were
stratified according to whether labour was spontaneous or induced. Only data from
women not induced were included (n = 1156)

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 47
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Windrim 2006 (Continued)

Interventions Women were randomised to 1 of 2 groups: the standard group, who had the progress of
labour charted in written notes, or the partograph group, whose progress in labour was
recorded using a bedside graphical partograph as well as written notes

Outcomes • Rate of caesarean section


• Operative vaginal delivery
• Spontaneous vaginal delivery
• Duration of first stage of labour
• Duration of second stage of labour
• Number of vaginal examinations
• Epidural analgesia use
• Artificial rupture of membranes
• Oxytocin augmentation
• Evaluation for non-reassuring fetal heart tracing
• Maternal and neonatal morbidity

Notes Only data from those in spontaneous labour are included in the review
Declarations of interest: none declared
Funding source: trial was supported by Grant # 96-33 from the Physicians’ Services
Incorporated Foundation, Canada

Risk of bias

Bias Authors’ judgement Support for judgement

Random sequence generation (selection Low risk Stratified randomisation by off-site com-
bias) puterised randomisation service

Allocation concealment (selection bias) Low risk By telephone to off-site service.

Blinding of participants and personnel High risk Not feasible to blind women or clinical
(performance bias) staff. Used bedside charts
All outcomes

Blinding of outcome assessment (detection Unclear risk Not reported.


bias)
All outcomes

Incomplete outcome data (attrition bias) Low risk No missing data apparent.
All outcomes

Selective reporting (reporting bias) Low risk All outcomes prespecified in methods re-
ported.

Other bias Unclear risk No information on the number of women


approached or the numbers of eligible
women declining participation

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 48
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
LSCS: lower segment caesarean section
NICE: National Institute for Health and Care Excellence
NICU: neonatal intensive care unit
WHO: World Health Organization

Characteristics of excluded studies [ordered by study ID]

Study Reason for exclusion

Ajoodani 2011 Both groups had labour monitored by a partograph.

Cartmill 1992 A report of a hypothetical study. No research conducted and no data presented

Fahdhy 2005 This was a cluster-randomised trial in which midwives were randomised to receive training,
alongside using the partograph. The intervention was therefore the training and not the
partograph. There is no description of what midwives in the control group received

Hamilton 2001 This study was presented in abstract form only and lacked detail. It was particularly unclear
whether participants were in spontaneous labour and whether they were at term. We attempted to
contact the trial author, without success

Hamilton 2004 The study intervention was a computerised reference range, not a partograph

Kogovsek 2000 It was unclear from the presentation of data which outcome data were from women in
spontaneous labour. We were unable to contact any of the authors

Mathews 2007 This was a cross-over trial comparing 2 partographs; 1 which included a latent phase and 1 which
did not. In this study all physicians posted to the labour ward used the first partograph (composite
or simplified depending on the random allocation) for 10 days. After 1 week’s break, all physicians
used the second partograph. Study participants were therefore physicians and not women

WHO 1994 This was an observational study, not a randomised controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]

NCT02911272

Methods Randomised controlled trial in a university teaching hospital in Nigeria

Participants Nulliparous women in labour at term


Inclusion criteria
• Healthy nulliparous women at term in spontaneous active phase labour with singleton pregnancies and intact
fetal membranes at first vaginal examination in labour ward
Exclusion criteria
• Multiparous patients
• Multiple pregnancies
• Pre-existing medical conditions complicating pregnancy

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 49
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
NCT02911272 (Continued)

• Non-cephalic presenting fetus at term


• Prelabour rupture of membrane at term
• Preterm labour
• Poor fetal growth in pregnancy

Interventions Partograph with 2-hour action line versus partograph with a 4-hour action line

Outcomes Prolonged labour, mode of birth, neonatal outcome.

Notes Awaiting more information from authors - contacted 21/04/2017 ’draziken@ubth.org’ as could not locate Dr Orhue’s
personal email

Characteristics of ongoing studies [ordered by study ID]

NCT02714270

Trial name or title A randomised clinical trial of paperless versus modified World Health Organization partograph in management
of first stage of labour

Methods Single-blind, parallel randomised controlled trial

Participants Inclusion criteria


• Age: 18 to 40 years
• Gestational age 38 to 42 weeks
• Singleton pregnancy
• Vertex presentation
• Women who agree to participate in the study
Exclusion criteria
• Malpresentation
• Induced labour
• Multiple pregnancy
• Medical diseases with pregnancy

Interventions Modified partograph versus paperless partograph

Outcomes Vaginal births

Starting date April 2016

Contact information Ahmed Mohamed Abbas, Assiut University


No contact details given

Notes Estimated completion date: August 2017


Trial conducted in Egypt

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 50
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
NCT02741141

Trial name or title A comparative study of the effect of two partographs on the cesarean section rate in women in spontaneous
labour (PARTODYS)

Methods Randomised controlled trial

Participants Inclusion criteria


• Age ≥ 18 years
• Affiliation to a social security insurance
• Written consent given
• Singleton pregnancy
• Cephalic presentation
• ≥ 37 gestational weeks
• Spontaneous onset of labour
Exclusion criteria
• Previous caesarean section
• Induction of labour
• Intrauterine growth restriction
• In utero fetal death
• Congenital malformation
• Chorioamnionitis
• Placenta praevia
• Need for an emergency delivery (fetal heart rate abnormalities at admission)
• Contraindication for vaginal delivery
• Patient under temporary guardianship, guardianship or judicial protection
• Patient included in another study which could interfere with the results of this study

Interventions Classic partograph (labour dystocia is diagnosed when cervical dilation is less than 1 cm per hour or after 3
hours at complete cervical dilation without engagement of the presentation. In this case, active management
of labour is started with introduction of oxytocin, artificial rupture of membranes and supportive therapy)
versus new partograph (the second strategy is based on the partograph developed by Neal and Lowe. An active
management of labour is started when crossing the dystocia line or when there are no cervical modifications
after 4 hours beyond 5 cm of cervical dilation. In this case, active management of labour is started with
introduction of oxytocin, artificial rupture of membranes and supportive therapy.)

Outcomes Primary outcome


• Caesarean section rate
Secondary outcomes
• Total amount of oxytocin used
• Uterine hyperstimulation
• Postpartum haemorrhage
• Uterine rupture
• Retained placenta
• Need for artificial rupture of membranes
• Duration of labour
• Rate of vaginal birth
• Need for epidural
• Transfusion rate
• Maternal fever
• Apgar score < 7 at 5 minutes

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 51
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
NCT02741141 (Continued)

• Neonatal intensive care unit admission


• Neonatal death
• Neonatal infection rate

Starting date January 2016

Contact information Contact: Adrien GAUDINEAU, MD 03 88 12 74 61


adrien.gaudineau@chru-strasbourg.fr

Notes Estimated end date: January 2018


Trial conducted at University Hospital, Strasbourg, France

NTR5543

Trial name or title Randomised controlled trial comparing the currently used Friedman partogram with a 4-hour action line to
the newly developed SIMPLE partogram, based on the 95th percentile normogram of the Consortium on
Safe Labor to evaluate early versus delayed cesarean section (SIMPLE III)

Methods Randomised controlled trial

Participants Inclusion criteria


• Nulliparous
• Singleton pregnancy
• Cephalic presentation
• ≥ 37 weeks of pregnancy
• ≥ 4 cm dilatation
• Non-progressing labour (< 1 cm/hour)
Exclusion criteria
• < 18 years of age
• Unable to read or understand informed consent
• Fetus with relevant congenital malformation
• Planned caesarean section
• Non-reassuring fetal condition
• Inadequate pain medication (as judged by the women herself, no absolute need for epidural, but pain
needs to be considered manageable for continuation of delivery)

Interventions When after all regular interventions for non-progressing labour (amniotomy, oxytocin augmentation, empty
bladder, pain medication) the Friedman partogram action line is crossed, randomisation occurs in which
performing a caesarean section is the regular conduct. Women in the intervention group wait until the Simple
partogram action line is crossed (based on the 95th percentile of the nomogram of the Consortium on Safe
Labor)

Outcomes Primary outcomes


• Mortality and composite morbidity
◦ maternal intensive care unit admittance
◦ Apgar score < 7 after 5 minutes
◦ pH < 7.10
◦ neonatal intensive care unit admittance
Secondary outcomes
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 52
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
NTR5543 (Continued)

• Delivery mode
• Shoulder dystocia
• Anal sphincter lesions
• Blood loss
• Need for blood transfusion
• Maternal infection
• Neonatal infection
• Duration of admission to the hospital
• Total number of caesarean sections in the target population (including non-participating women)
• Cost evaluation
• Budget impact
• Patient preference
• Patient satisfaction

Starting date December 2015

Contact information hcj.scheepers@mumc.nl

Notes Estimated end date: December 2018


Trial website: http://www.studies-obsgyn.nl/simple3

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 53
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DATA AND ANALYSES

Comparison 1. Partograph versus no partograph (studies carried out in high- and low-resource settings)

No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size

1 Caesarean section (overall) 3 1813 Risk Ratio (M-H, Random, 95% CI) 0.77 [0.40, 1.46]
1.1 Low-resource setting 2 657 Risk Ratio (M-H, Random, 95% CI) 0.65 [0.22, 1.91]
1.2 High-resource setting 1 1156 Risk Ratio (M-H, Random, 95% CI) 1.03 [0.82, 1.28]
2 Oxytocin augmentation 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 1.02 [0.95, 1.10]
2.1 High-resource setting 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 1.02 [0.95, 1.10]
3 Duration of first stage of labour 1 1156 Mean Difference (IV, Fixed, 95% CI) 0.80 [-0.06, 1.66]
3.1 High-resource setting 1 1156 Mean Difference (IV, Fixed, 95% CI) 0.80 [-0.06, 1.66]
4 Low Apgar score (less than 7 at 5 2 1596 Risk Ratio (M-H, Fixed, 95% CI) 0.76 [0.29, 2.03]
minutes)
4.1 Low-resource setting 1 440 Risk Ratio (M-H, Fixed, 95% CI) 0.46 [0.04, 5.00]
4.2 High-resource setting 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 0.85 [0.29, 2.52]
5 Instrumental vaginal birth 3 1813 Risk Ratio (M-H, Fixed, 95% CI) 0.99 [0.84, 1.15]
5.1 Low-resource setting 2 657 Risk Ratio (M-H, Fixed, 95% CI) 1.05 [0.75, 1.48]
5.2 High-resource setting 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 0.97 [0.81, 1.15]
6 Regional analgesia - epidural 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 1.01 [0.98, 1.05]
6.1 High-resource setting 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 1.01 [0.98, 1.05]
7 Performance of artificial rupture 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 0.99 [0.88, 1.11]
of membranes during labour
7.1 High-resource setting 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 0.99 [0.88, 1.11]
8 Antibiotic use 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 1.23 [0.88, 1.73]
8.1 High-resource setting 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 1.23 [0.88, 1.73]
9 Duration of second stage of 1 1156 Mean Difference (IV, Fixed, 95% CI) 0.0 [-0.21, 0.21]
labour (hours)
9.1 High-resource setting 1 1156 Mean Difference (IV, Fixed, 95% CI) 0.0 [-0.21, 0.21]
10 Number of vaginal 1 1156 Mean Difference (IV, Fixed, 95% CI) 0.0 [0.0, 0.0]
examinations
10.1 High-resource setting 1 1156 Mean Difference (IV, Fixed, 95% CI) 0.0 [0.0, 0.0]
11 Admission to special care 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 0.94 [0.51, 1.75]
nursery
11.1 High-resource setting 1 1156 Risk Ratio (M-H, Fixed, 95% CI) 0.94 [0.51, 1.75]

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 54
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Comparison 2. Partograph with 2-hour action line versus partograph with 4-hour action line (studies
carried out in a high- and low-resource settings)

No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size

1 Caesarean section (overall) 4 4749 Risk Ratio (M-H, Fixed, 95% CI) 1.06 [0.88, 1.28]
1.1 Low-resource setting 2 1148 Risk Ratio (M-H, Fixed, 95% CI) 1.09 [0.71, 1.68]
1.2 High-resource setting 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 1.06 [0.86, 1.30]
2 Oxytocin augmentation 4 4749 Risk Ratio (M-H, Random, 95% CI) 2.44 [1.36, 4.35]
2.1 Low-resource setting 2 1148 Risk Ratio (M-H, Random, 95% CI) 7.22 [2.49, 20.91]
2.2 High-resource setting 2 3601 Risk Ratio (M-H, Random, 95% CI) 1.14 [1.05, 1.22]
3 Duration of first stage of labour 1 948 Risk Ratio (M-H, Fixed, 95% CI) 0.81 [0.32, 2.04]
(length of labour greater than
18 hours, length of labour
greater than 12 hours)
4 Maternal experience of 2 2269 Risk Ratio (M-H, Random, 95% CI) 0.61 [0.28, 1.35]
childbirth - negative childbirth
experience
5 Low Apgar score (less than 7 at 5 4 4749 Risk Ratio (M-H, Fixed, 95% CI) 0.93 [0.61, 1.42]
minutes)
5.1 Low-resource setting 2 1148 Risk Ratio (M-H, Fixed, 95% CI) 1.31 [0.58, 2.96]
5.2 High-resource setting 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 0.82 [0.50, 1.35]
6 Serious maternal morbidity or 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 0.0 [0.0, 0.0]
death
7 Caesarean section (distress) 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 1.30 [0.86, 1.96]
8 Caesarean section (delay) 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 0.98 [0.77, 1.25]
9 Instrumental vaginal delivery 3 3801 Risk Ratio (M-H, Fixed, 95% CI) 0.92 [0.81, 1.04]
10 Postpartum haemorrhage - 3 4549 Risk Ratio (M-H, Fixed, 95% CI) 1.06 [0.90, 1.25]
blood loss > 500 mL
10.1 Low-resource setting 1 948 Risk Ratio (M-H, Fixed, 95% CI) 0.85 [0.26, 2.76]
10.2 High-resource setting 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 1.07 [0.90, 1.26]
11 Regional analgesia - epidural 2 3601 Risk Ratio (M-H, Random, 95% CI) 1.06 [0.92, 1.21]
12 Performance of artificial 3 3801 Risk Ratio (M-H, Random, 95% CI) 1.00 [0.84, 1.18]
rupture of the membranes
during labour
13 Number of vaginal 2 3601 Mean Difference (IV, Random, 95% CI) -0.08 [-0.37, 0.21]
examinations in labour
14 Serious neonatal morbidity or 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 0.0 [0.0, 0.0]
perinatal death
15 Admission to special care 3 3801 Risk Ratio (M-H, Fixed, 95% CI) 0.83 [0.51, 1.34]
nursery
15.1 Low-resource setting 1 200 Risk Ratio (M-H, Fixed, 95% CI) 1.33 [0.31, 5.81]
15.2 High-resource setting 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 0.78 [0.46, 1.31]
16 Cord blood arterial pH less 2 3601 Risk Ratio (M-H, Fixed, 95% CI) 0.73 [0.44, 1.22]
than 7.1

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 55
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Comparison 3. Partograph with 2-hour action line versus partograph with 3-hour action line (study carried
out in a high-resource setting)

No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size

1 Caesarean section (overall) 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.78 [0.51, 1.18]
2 Oxytocin augmentation 1 617 Risk Ratio (M-H, Fixed, 95% CI) 1.02 [0.85, 1.21]
3 Maternal experience of 1 348 Risk Ratio (M-H, Fixed, 95% CI) 0.49 [0.27, 0.90]
childbirth - negative childbirth
experience
4 Low Apgar score (less than 7 at 5 1 617 Risk Ratio (M-H, Fixed, 95% CI) 1.44 [0.41, 5.05]
minutes)
5 Serious maternal morbidity or 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.0 [0.0, 0.0]
death
6 Caesarean section (distress) 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.96 [0.44, 2.10]
7 Caesarean section (delay) 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.71 [0.42, 1.19]
8 Instrumental vaginal delivery 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.93 [0.69, 1.26]
9 Postpartum haemorrhage - blood 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.96 [0.63, 1.45]
loss > 500 mL
10 Regional analgesia - epidural 1 617 Risk Ratio (M-H, Fixed, 95% CI) 1.16 [0.94, 1.44]
11 Performance of artificial 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.94 [0.77, 1.15]
rupture of membranes during
labour
12 Vaginal examinations 1 617 Mean Difference (IV, Fixed, 95% CI) 0.0 [-0.29, 0.29]
13 Serious neonatal morbidity or 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.0 [0.0, 0.0]
perinatal death
14 Admission to special care 1 617 Risk Ratio (M-H, Fixed, 95% CI) 3.83 [0.43, 34.12]
nursery
15 Cord blood arterial pH less 1 617 Risk Ratio (M-H, Fixed, 95% CI) 0.38 [0.07, 1.96]
than 7.1

Comparison 4. Partograph with 3-hour action line versus partograph with 4-hour action line (study carried
out in a high-resource setting)

No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size

1 Caesarean section (overall) 1 613 Risk Ratio (M-H, Fixed, 95% CI) 1.70 [1.07, 2.70]
2 Oxytocin augmentation 1 613 Risk Ratio (M-H, Fixed, 95% CI) 1.09 [0.91, 1.30]
3 Maternal experience of 1 340 Risk Ratio (M-H, Fixed, 95% CI) 0.80 [0.51, 1.27]
childbirth - negative childbirth
experience
4 Low Apgar score (less than 7 at 5 1 613 Risk Ratio (M-H, Fixed, 95% CI) 0.82 [0.22, 3.04]
minutes)
5 Serious maternal morbidity or 1 613 Risk Ratio (M-H, Fixed, 95% CI) 0.0 [0.0, 0.0]
death
6 Caesarean section (distress) 1 613 Risk Ratio (M-H, Fixed, 95% CI) 1.77 [0.70, 4.42]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 56
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
7 Caesarean section (delay) 1 613 Risk Ratio (M-H, Fixed, 95% CI) 1.68 [0.97, 2.91]
8 Instrumental vaginal delivery 1 613 Risk Ratio (M-H, Fixed, 95% CI) 0.96 [0.72, 1.28]
9 Postpartum haemorrhage - blood 1 613 Risk Ratio (M-H, Fixed, 95% CI) 1.03 [0.68, 1.56]
loss > 500 mL
10 Regional analgesia - epidural 1 613 Risk Ratio (M-H, Fixed, 95% CI) 1.01 [0.80, 1.27]
11 Performance of artificial 1 613 Risk Ratio (M-H, Fixed, 95% CI) 1.04 [0.85, 1.26]
rupture of membranes during
labour
12 Number of vaginal 1 613 Mean Difference (IV, Fixed, 95% CI) 0.10 [-0.19, 0.39]
examinations in labour
13 Serious neonatal morbidity or 1 613 Risk Ratio (M-H, Fixed, 95% CI) 0.0 [0.0, 0.0]
perinatal death
14 Admission to special care 1 613 Risk Ratio (M-H, Fixed, 95% CI) 0.51 [0.05, 5.65]
nursery
15 Cord blood arterial pH less 1 613 Risk Ratio (M-H, Fixed, 95% CI) 2.57 [0.50, 13.17]
than 7.1

Comparison 5. Partograph with alert line only versus partograph with alert and action line (study carried
out in a low-resource setting)

No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size

1 Caesarean section (overall) 1 694 Risk Ratio (M-H, Fixed, 95% CI) 0.68 [0.50, 0.93]
2 Oxytocin augmentation 1 694 Risk Ratio (M-H, Fixed, 95% CI) 0.81 [0.62, 1.05]
3 Low Apgar score (less than 7 at 5 1 694 Risk Ratio (M-H, Fixed, 95% CI) 7.12 [0.37, 137.36]
minutes)
4 Instrumental vaginal delivery 1 694 Risk Ratio (M-H, Fixed, 95% CI) 0.87 [0.66, 1.15]
5 Serious neonatal morbidity or 1 694 Risk Ratio (M-H, Fixed, 95% CI) 7.12 [0.37, 137.36]
perinatal death

Comparison 6. Partograph with latent phase versus partograph without latent phase (study carried out in a
low-resource setting)

No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size

1 Caesarean section (overall) 1 743 Risk Ratio (M-H, Fixed, 95% CI) 2.45 [1.72, 3.50]
2 Oxytocin augmentation 1 743 Risk Ratio (M-H, Fixed, 95% CI) 2.18 [1.67, 2.83]
3 Low Apgar score (less than 7 at 5 1 743 Risk Ratio (M-H, Fixed, 95% CI) 0.75 [0.21, 2.63]
minutes)
4 Caesarean section (distress) 1 743 Risk Ratio (M-H, Fixed, 95% CI) 4.87 [2.83, 8.37]
5 Caesarean section (delay) 1 743 Risk Ratio (M-H, Fixed, 95% CI) 1.35 [0.59, 3.08]
6 Instrumental vaginal delivery 1 743 Risk Ratio (M-H, Fixed, 95% CI) 1.04 [0.61, 1.77]
7 Admission to special care nursery 1 743 Risk Ratio (M-H, Fixed, 95% CI) 1.84 [1.29, 2.63]
8 Usability: user-friendliness score 1 743 Mean Difference (IV, Fixed, 95% CI) -7.89 [-8.14, -7.64]

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 57
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Comparison 7. Partograph with 2-hour action line versus partograph with stepped dystocia line

No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size

1 Caesarean section 1 99 Risk Ratio (M-H, Fixed, 95% CI) 1.10 [0.46, 2.62]
2 Oxytocin augmentation 1 99 Risk Ratio (M-H, Fixed, 95% CI) 0.62 [0.39, 0.98]
3 Duration of first stage of labour 1 99 Risk Ratio (M-H, Fixed, 95% CI) 0.76 [0.31, 1.89]
(labour longer than 12 hours)
4 Maternal experience of 1 90 Mean Difference (IV, Fixed, 95% CI) 0.0 [-3.58, 3.58]
childbirth (BSS-R score)
5 Low Apgar score (less than 4 at 4 1 99 Risk Ratio (M-H, Fixed, 95% CI) 0.98 [0.06, 15.23]
min)
6 Instrumental vaginal birth 1 99 Risk Ratio (M-H, Fixed, 95% CI) 0.75 [0.37, 1.56]
7 Postpartum haemorrhage (> 500 1 99 Risk Ratio (M-H, Fixed, 95% CI) 1.57 [0.55, 4.46]
mL)
8 Regional analgesia 1 99 Risk Ratio (M-H, Fixed, 95% CI) 0.86 [0.56, 1.32]
9 Opioid use 1 99 Risk Ratio (M-H, Fixed, 95% CI) 0.98 [0.45, 2.14]
10 Need for intubation at birth 1 99 Risk Ratio (M-H, Fixed, 95% CI) 0.44 [0.14, 1.32]

Comparison 8. Partograph versus labour scale (study carried out in a low-resource setting)

No. of No. of
Outcome or subgroup title studies participants Statistical method Effect size

1 Caesarean section (overall) 1 122 Risk Ratio (M-H, Fixed, 95% CI) 0.42 [0.16, 1.11]
2 Oxytocin augmentation 1 122 Risk Ratio (M-H, Fixed, 95% CI) 0.32 [0.18, 0.54]
3 Duration of first stage of labour 1 110 Mean Difference (IV, Fixed, 95% CI) 0.44 [-0.40, 1.28]
4 Low Apgar score (less than 7 at 5 1 110 Risk Ratio (M-H, Fixed, 95% CI) 0.0 [0.0, 0.0]
minutes)
5 Caesarean section (delay) 1 122 Risk Ratio (M-H, Fixed, 95% CI) 0.2 [0.05, 0.88]
6 Stillbirth, neonatal death or 1 110 Risk Ratio (M-H, Fixed, 95% CI) 0.0 [0.0, 0.0]
neonatal morbidity
7 Birth injuries and PPH 1 122 Risk Ratio (M-H, Fixed, 95% CI) 3.0 [0.32, 28.04]
(non-prespecified outcome)

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 58
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Analysis 1.1. Comparison 1 Partograph versus no partograph (studies carried out in
high- and low-resource settings), Outcome 1 Caesarean section (overall).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 1 Caesarean section (overall)

Study or subgroup Par tograph No par tograph Risk Ratio Weight Risk Ratio
M- M-
H,Random,95% H,Random,95%
n/N n/N CI CI

1 Low-resource setting
Rani 2015 21/110 19/113 30.2 % 1.14 [ 0.65, 1.99 ]

Walss Rodriguez 1987 21/224 52/210 32.4 % 0.38 [ 0.24, 0.61 ]

Subtotal (95% CI) 334 323 62.6 % 0.65 [ 0.22, 1.91 ]


Total events: 42 (Par tograph), 71 (No par tograph)
2 2 2
Heterogeneity: Tau = 0.54; Chi = 8.66, df = 1 (P = 0.003); I =88%
Test for overall effect: Z = 0.79 (P = 0.43)
2 High-resource setting
Windrim 2006 125/580 121/576 37.4 % 1.03 [ 0.82, 1.28 ]

Subtotal (95% CI) 580 576 37.4 % 1.03 [ 0.82, 1.28 ]


Total events: 125 (Par tograph), 121 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 0.23 (P = 0.82)
Total (95% CI) 914 899 100.0 % 0.77 [ 0.40, 1.46 ]
Total events: 167 (Par tograph), 192 (No par tograph)
2 2 2
Heterogeneity: Tau = 0.28; Chi = 15.07, df = 2 (P = 0.00053); I =87%
Test for overall effect: Z = 0.81 (P = 0.42)
2 2
Test for subgroup differences: Chi = 0.67, df = 1 (P = 0.41), I =0.0%

0.1 0.2 0.5 1 2 5 10


Favours par tograph Favours no par tograph

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Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 1.2. Comparison 1 Partograph versus no partograph (studies carried out in
high- and low-resource settings), Outcome 2 Oxytocin augmentation.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 2 Oxytocin augmentation

Study or subgroup Par tograph No par tograph Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI

1 High-resource setting
Windrim 2006 423/580 412/576 100.0 % 1.02 [ 0.95, 1.10 ]

Total (95% CI) 580 576 100.0 % 1.02 [ 0.95, 1.10 ]


Total events: 423 (Par tograph), 412 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 0.53 (P = 0.59)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours par tograph Favours no par tograph

Analysis 1.3. Comparison 1 Partograph versus no partograph (studies carried out in


high- and low-resource settings), Outcome 3 Duration of first stage of labour.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 3 Duration of first stage of labour

Mean Mean
Study or subgroup Par tograph No par tograph Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Fixed,95% CI IV,Fixed,95% CI

1 High-resource setting
Windrim 2006 (1) 580 16.8 (7.3) 576 16 (7.6) 100.0 % 0.80 [ -0.06, 1.66 ]

Total (95% CI) 580 576 100.0 % 0.80 [ -0.06, 1.66 ]


Heterogeneity: not applicable
Test for overall effect: Z = 1.82 (P = 0.068)
Test for subgroup differences: Not applicable

-10 -5 0 5 10
Favours par tograph Favours no par tograph

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Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
(1) Duration in hours

Analysis 1.4. Comparison 1 Partograph versus no partograph (studies carried out in


high- and low-resource settings), Outcome 4 Low Apgar score (less than 7 at 5 minutes).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 4 Low Apgar score (less than 7 at 5 minutes)

Study or subgroup Par tograph No par tograph Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI

1 Low-resource setting
Walss Rodriguez 1987 1/230 2/210 22.9 % 0.46 [ 0.04, 5.00 ]

Subtotal (95% CI) 230 210 22.9 % 0.46 [ 0.04, 5.00 ]


Total events: 1 (Par tograph), 2 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 0.64 (P = 0.52)

2 High-resource setting
Windrim 2006 6/580 7/576 77.1 % 0.85 [ 0.29, 2.52 ]

Subtotal (95% CI) 580 576 77.1 % 0.85 [ 0.29, 2.52 ]


Total events: 6 (Par tograph), 7 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 0.29 (P = 0.77)
Total (95% CI) 810 786 100.0 % 0.76 [ 0.29, 2.03 ]
Total events: 7 (Par tograph), 9 (No par tograph)
2 2
Heterogeneity: Chi = 0.22, df = 1 (P = 0.64); I =0.0%
Test for overall effect: Z = 0.55 (P = 0.58)
2 2
Test for subgroup differences: Chi = 0.22, df = 1 (P = 0.64), I =0.0%

0.05 0.2 1 5 20
Favours par tograph Favours no par tograph

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 61
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 1.5. Comparison 1 Partograph versus no partograph (studies carried out in
high- and low-resource settings), Outcome 5 Instrumental vaginal birth.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 5 Instrumental vaginal bir th

Study or subgroup Par tograph No par tograph Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI

1 Low-resource setting
Rani 2015 12/110 16/113 6.8 % 0.77 [ 0.38, 1.55 ]

Walss Rodriguez 1987 45/224 36/210 16.0 % 1.17 [ 0.79, 1.74 ]

Subtotal (95% CI) 334 323 22.9 % 1.05 [ 0.75, 1.48 ]


Total events: 57 (Par tograph), 52 (No par tograph)
2 2
Heterogeneity: Chi = 1.04, df = 1 (P = 0.31); I =4%
Test for overall effect: Z = 0.29 (P = 0.77)

2 High-resource setting
Windrim 2006 173/580 178/576 77.1 % 0.97 [ 0.81, 1.15 ]

Subtotal (95% CI) 580 576 77.1 % 0.97 [ 0.81, 1.15 ]


Total events: 173 (Par tograph), 178 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 0.40 (P = 0.69)
Total (95% CI) 914 899 100.0 % 0.99 [ 0.84, 1.15 ]
Total events: 230 (Par tograph), 230 (No par tograph)
2 2
Heterogeneity: Chi = 1.26, df = 2 (P = 0.53); I =0.0%
Test for overall effect: Z = 0.19 (P = 0.85)
2 2
Test for subgroup differences: Chi = 0.19, df = 1 (P = 0.66), I =0.0%

0.1 0.2 0.5 1 2 5 10


Favours par tograph Favours no par tograph

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 62
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 1.6. Comparison 1 Partograph versus no partograph (studies carried out in
high- and low-resource settings), Outcome 6 Regional analgesia - epidural.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 6 Regional analgesia - epidural

Study or subgroup Par tograph No par tograph Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI

1 High-resource setting
Windrim 2006 532/580 521/576 100.0 % 1.01 [ 0.98, 1.05 ]

Total (95% CI) 580 576 100.0 % 1.01 [ 0.98, 1.05 ]


Total events: 532 (Par tograph), 521 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 0.76 (P = 0.45)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours par tograph Favours no par tograph

Analysis 1.7. Comparison 1 Partograph versus no partograph (studies carried out in high- and low-
resource settings), Outcome 7 Performance of artificial rupture of membranes during labour.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 7 Performance of ar tificial rupture of membranes during labour

Study or subgroup Par tograph No par tograph Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI

1 High-resource setting
Windrim 2006 283/580 284/576 100.0 % 0.99 [ 0.88, 1.11 ]

Total (95% CI) 580 576 100.0 % 0.99 [ 0.88, 1.11 ]


Total events: 283 (Par tograph), 284 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 0.17 (P = 0.86)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours par tograph Favours no par tograph

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Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 1.8. Comparison 1 Partograph versus no partograph (studies carried out in
high- and low-resource settings), Outcome 8 Antibiotic use.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 8 Antibiotic use

Study or subgroup Par tograph No par tograph Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI

1 High-resource setting
Windrim 2006 67/580 54/576 100.0 % 1.23 [ 0.88, 1.73 ]

Total (95% CI) 580 576 100.0 % 1.23 [ 0.88, 1.73 ]


Total events: 67 (Par tograph), 54 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 1.21 (P = 0.23)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours par tograph Favours no par tograph

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 64
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 1.9. Comparison 1 Partograph versus no partograph (studies carried out in
high- and low-resource settings), Outcome 9 Duration of second stage of labour (hours).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 9 Duration of second stage of labour (hours)

Mean Mean
Study or subgroup Par tograph No par tograph Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Fixed,95% CI IV,Fixed,95% CI

1 High-resource setting
Windrim 2006 580 2.4 (1.8) 576 2.4 (1.9) 100.0 % 0.0 [ -0.21, 0.21 ]

Total (95% CI) 580 576 100.0 % 0.0 [ -0.21, 0.21 ]


Heterogeneity: not applicable
Test for overall effect: Z = 0.0 (P = 1.0)
Test for subgroup differences: Not applicable

-10 -5 0 5 10
Favours par tograph Favours no par tograph

Analysis 1.10. Comparison 1 Partograph versus no partograph (studies carried out in high- and
low-resource settings), Outcome 10 Number of vaginal examinations.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 10 Number of vaginal examinations

Mean Mean
Study or subgroup Par tograph No par tograph Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Fixed,95% CI IV,Fixed,95% CI

1 High-resource setting
Windrim 2006 580 4 (0) 576 4 (0) Not estimable

Total (95% CI) 580 576 Not estimable


Heterogeneity: not applicable
Test for overall effect: not applicable
2 2
Test for subgroup differences: Chi = 0.0, df = -1 (P = 0.0), I =0.0%

-10 -5 0 5 10
Favours par tograph Favours no par tograph

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 65
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Analysis 1.11. Comparison 1 Partograph versus no partograph (studies carried out in high- and
low-resource settings), Outcome 11 Admission to special care nursery.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 1 Par tograph versus no par tograph (studies carried out in high- and low-resource settings)

Outcome: 11 Admission to special care nursery

Study or subgroup Par tograph No par tograph Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI

1 High-resource setting
Windrim 2006 19/580 20/576 100.0 % 0.94 [ 0.51, 1.75 ]

Total (95% CI) 580 576 100.0 % 0.94 [ 0.51, 1.75 ]


Total events: 19 (Par tograph), 20 (No par tograph)
Heterogeneity: not applicable
Test for overall effect: Z = 0.18 (P = 0.85)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours par tograph Favours no par tograph

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Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.1. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action
line (studies carried out in a high- and low-resource settings), Outcome 1 Caesarean section
(overall).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 1 Caesarean section (overall)

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI

1 Low-resource setting
Orhue 2013 29/470 28/478 14.0 % 1.05 [ 0.64, 1.74 ]

Sinha 2017 11/100 9/100 4.5 % 1.22 [ 0.53, 2.82 ]

Subtotal (95% CI) 570 578 18.6 % 1.09 [ 0.71, 1.68 ]


Total events: 40 (2-hour action line), 37 (4-hour action line)
2 2
Heterogeneity: Chi = 0.09, df = 1 (P = 0.77); I =0.0%
Test for overall effect: Z = 0.41 (P = 0.68)
2 High-resource setting
Lavender 1998a 35/315 26/311 13.2 % 1.33 [ 0.82, 2.15 ]

Lavender 2006 136/1490 135/1485 68.2 % 1.00 [ 0.80, 1.26 ]

Subtotal (95% CI) 1805 1796 81.4 % 1.06 [ 0.86, 1.30 ]


Total events: 171 (2-hour action line), 161 (4-hour action line)
2 2
Heterogeneity: Chi = 1.06, df = 1 (P = 0.30); I =6%
Test for overall effect: Z = 0.53 (P = 0.60)
Total (95% CI) 2375 2374 100.0 % 1.06 [ 0.88, 1.28 ]
Total events: 211 (2-hour action line), 198 (4-hour action line)
2 2
Heterogeneity: Chi = 1.17, df = 3 (P = 0.76); I =0.0%
Test for overall effect: Z = 0.65 (P = 0.51)
2 2
Test for subgroup differences: Chi = 0.02, df = 1 (P = 0.88), I =0.0%

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

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Analysis 2.2. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action
line (studies carried out in a high- and low-resource settings), Outcome 2 Oxytocin augmentation.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 2 Oxytocin augmentation

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
M- M-
H,Random,95% H,Random,95%
n/N n/N CI CI

1 Low-resource setting
Orhue 2013 118/470 10/478 22.0 % 12.00 [ 6.37, 22.60 ]

Sinha 2017 29/100 7/100 19.4 % 4.14 [ 1.90, 9.01 ]

Subtotal (95% CI) 570 578 41.4 % 7.22 [ 2.49, 20.91 ]


Total events: 147 (2-hour action line), 17 (4-hour action line)
2 2 2
Heterogeneity: Tau = 0.46; Chi = 4.51, df = 1 (P = 0.03); I =78%
Test for overall effect: Z = 3.64 (P = 0.00027)
2 High-resource setting
Lavender 1998a 144/315 129/311 29.0 % 1.10 [ 0.92, 1.32 ]

Lavender 2006 696/1490 607/1485 29.6 % 1.14 [ 1.05, 1.24 ]

Subtotal (95% CI) 1805 1796 58.6 % 1.14 [ 1.05, 1.22 ]


Total events: 840 (2-hour action line), 736 (4-hour action line)
2 2 2
Heterogeneity: Tau = 0.0; Chi = 0.13, df = 1 (P = 0.72); I =0.0%
Test for overall effect: Z = 3.35 (P = 0.00080)
Total (95% CI) 2375 2374 100.0 % 2.44 [ 1.36, 4.35 ]
Total events: 987 (2-hour action line), 753 (4-hour action line)
2 2 2
Heterogeneity: Tau = 0.29; Chi = 69.40, df = 3 (P<0.00001); I =96%
Test for overall effect: Z = 3.01 (P = 0.0026)
2 2
Test for subgroup differences: Chi = 11.57, df = 1 (P = 0.00), I =91%

0.02 0.1 1 10 50
Favours 2-hour Favours 4-hour

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Analysis 2.3. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 3 Duration of first stage of labour (length
of labour greater than 18 hours, length of labour greater than 12 hours).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 3 Duration of first stage of labour (length of labour greater than 18 hours, length of labour greater than 12 hours)

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Orhue 2013 (1) 8/470 10/478 100.0 % 0.81 [ 0.32, 2.04 ]

Total (95% CI) 470 478 100.0 % 0.81 [ 0.32, 2.04 ]


Total events: 8 (2-hour action line), 10 (4-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.44 (P = 0.66)
Test for subgroup differences: Not applicable

0.02 0.1 1 10 50
Favours 2-hour Favours 4-hour

(1) Described as ”prolonged labour”.

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Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.4. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 4 Maternal experience of childbirth -
negative childbirth experience.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 4 Maternal experience of childbir th - negative childbir th experience

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
M- M-
H,Random,95% H,Random,95%
n/N n/N CI CI
Lavender 1998a 14/179 34/171 45.0 % 0.39 [ 0.22, 0.71 ]

Lavender 2006 72/962 81/957 55.0 % 0.88 [ 0.65, 1.20 ]

Total (95% CI) 1141 1128 100.0 % 0.61 [ 0.28, 1.35 ]


Total events: 86 (2-hour action line), 115 (4-hour action line)
2 2 2
Heterogeneity: Tau = 0.27; Chi = 5.78, df = 1 (P = 0.02); I =83%
Test for overall effect: Z = 1.21 (P = 0.23)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

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Analysis 2.5. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action
line (studies carried out in a high- and low-resource settings), Outcome 5 Low Apgar score (less than 7
at 5
minutes).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 5 Low Apgar score (less than 7 at 5 minutes)

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
1 Low-resource setting
Orhue 2013 (1) 7/470 6/478 13.5 % 1.19 [ 0.40, 3.50 ]

Sinha 2017 6/100 4/100 9.1 % 1.50 [ 0.44, 5.15 ]

Subtotal (95% CI) 570 578 22.6 % 1.31 [ 0.58, 2.96 ]


Total events: 13 (2-hour action line), 10 (4-hour action line)
2 2
Heterogeneity: Chi = 0.08, df = 1 (P = 0.78); I =0.0%
Test for overall effect: Z = 0.66 (P = 0.51)
2 High-resource setting
Lavender 1998a 6/315 5/311 11.4 % 1.18 [ 0.37, 3.84 ]

Lavender 2006 22/1490 29/1485 66.0 % 0.76 [ 0.44, 1.31 ]

Subtotal (95% CI) 1805 1796 77.4 % 0.82 [ 0.50, 1.35 ]


Total events: 28 (2-hour action line), 34 (4-hour action line)
2 2
Heterogeneity: Chi = 0.46, df = 1 (P = 0.50); I =0.0%
Test for overall effect: Z = 0.79 (P = 0.43)
Total (95% CI) 2375 2374 100.0 % 0.93 [ 0.61, 1.42 ]
Total events: 41 (2-hour action line), 44 (4-hour action line)
2 2
Heterogeneity: Chi = 1.48, df = 3 (P = 0.69); I =0.0%
Test for overall effect: Z = 0.33 (P = 0.74)
2 2
Test for subgroup differences: Chi = 0.94, df = 1 (P = 0.33), I =0.0%

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

(1) Described as ”neonatal asphyxia at 5 minutes”.

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Analysis 2.6. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 6 Serious maternal morbidity or death.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 6 Serious maternal morbidity or death

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 0/315 0/311 Not estimable

Lavender 2006 0/1490 0/1485 Not estimable

Total (95% CI) 1805 1796 Not estimable


Total events: 0 (2-hour action line), 0 (4-hour action line)
Heterogeneity: not applicable
Test for overall effect: not applicable
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

Analysis 2.7. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action
line (studies carried out in a high- and low-resource settings), Outcome 7 Caesarean section
(distress).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 7 Caesarean section (distress)

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 12/315 7/311 18.0 % 1.69 [ 0.68, 4.24 ]

Lavender 2006 39/1490 32/1485 82.0 % 1.21 [ 0.77, 1.93 ]

Total (95% CI) 1805 1796 100.0 % 1.30 [ 0.86, 1.96 ]


Total events: 51 (2-hour action line), 39 (4-hour action line)
2 2
Heterogeneity: Chi = 0.40, df = 1 (P = 0.53); I =0.0%
Test for overall effect: Z = 1.25 (P = 0.21)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 72
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.8. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action
line (studies carried out in a high- and low-resource settings), Outcome 8 Caesarean section
(delay).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 8 Caesarean section (delay)

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 23/315 19/311 15.6 % 1.20 [ 0.66, 2.15 ]

Lavender 2006 97/1490 103/1485 84.4 % 0.94 [ 0.72, 1.23 ]

Total (95% CI) 1805 1796 100.0 % 0.98 [ 0.77, 1.25 ]


Total events: 120 (2-hour action line), 122 (4-hour action line)
2 2
Heterogeneity: Chi = 0.54, df = 1 (P = 0.46); I =0.0%
Test for overall effect: Z = 0.17 (P = 0.86)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 73
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.9. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action
line (studies carried out in a high- and low-resource settings), Outcome 9 Instrumental vaginal
delivery.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 9 Instrumental vaginal delivery

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 66/315 73/311 18.3 % 0.89 [ 0.67, 1.20 ]

Lavender 2006 294/1490 320/1485 79.7 % 0.92 [ 0.80, 1.05 ]

Sinha 2017 9/100 8/100 2.0 % 1.13 [ 0.45, 2.80 ]

Total (95% CI) 1905 1896 100.0 % 0.92 [ 0.81, 1.04 ]


Total events: 369 (2-hour action line), 401 (4-hour action line)
2 2
Heterogeneity: Chi = 0.23, df = 2 (P = 0.89); I =0.0%
Test for overall effect: Z = 1.37 (P = 0.17)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 74
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.10. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 10 Postpartum haemorrhage - blood loss >
500 mL.
Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 10 Postpar tum haemorrhage - blood loss > 500 mL

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
1 Low-resource setting
Orhue 2013 5/470 6/478 2.6 % 0.85 [ 0.26, 2.76 ]

Subtotal (95% CI) 470 478 2.6 % 0.85 [ 0.26, 2.76 ]


Total events: 5 (2-hour action line), 6 (4-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.27 (P = 0.78)
2 High-resource setting
Lavender 1998a 39/315 39/311 17.0 % 0.99 [ 0.65, 1.50 ]

Lavender 2006 201/1490 185/1485 80.4 % 1.08 [ 0.90, 1.30 ]

Subtotal (95% CI) 1805 1796 97.4 % 1.07 [ 0.90, 1.26 ]


Total events: 240 (2-hour action line), 224 (4-hour action line)
2 2
Heterogeneity: Chi = 0.16, df = 1 (P = 0.69); I =0.0%
Test for overall effect: Z = 0.74 (P = 0.46)
Total (95% CI) 2275 2274 100.0 % 1.06 [ 0.90, 1.25 ]
Total events: 245 (2-hour action line), 230 (4-hour action line)
2 2
Heterogeneity: Chi = 0.30, df = 2 (P = 0.86); I =0.0%
Test for overall effect: Z = 0.68 (P = 0.49)
2 2
Test for subgroup differences: Chi = 0.14, df = 1 (P = 0.71), I =0.0%

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 75
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.11. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action
line (studies carried out in a high- and low-resource settings), Outcome 11 Regional analgesia -
epidural.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 11 Regional analgesia - epidural

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
M- M-
H,Random,95% H,Random,95%
n/N n/N CI CI
Lavender 1998a 120/315 101/311 30.1 % 1.17 [ 0.95, 1.45 ]

Lavender 2006 479/1490 473/1485 69.9 % 1.01 [ 0.91, 1.12 ]

Total (95% CI) 1805 1796 100.0 % 1.06 [ 0.92, 1.21 ]


Total events: 599 (2-hour action line), 574 (4-hour action line)
2 2 2
Heterogeneity: Tau = 0.00; Chi = 1.54, df = 1 (P = 0.21); I =35%
Test for overall effect: Z = 0.79 (P = 0.43)
Test for subgroup differences: Not applicable

0.5 0.7 1 1.5 2


Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 76
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.12. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 12 Performance of artificial rupture of the
membranes during labour.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 12 Performance of ar tificial rupture of the membranes during labour

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
M- M-
H,Random,95% H,Random,95%
n/N n/N CI CI
Lavender 1998a 120/315 121/311 34.5 % 0.98 [ 0.80, 1.19 ]

Lavender 2006 715/1490 657/1485 55.7 % 1.08 [ 1.00, 1.17 ]

Sinha 2017 19/100 29/100 9.8 % 0.66 [ 0.39, 1.09 ]

Total (95% CI) 1905 1896 100.0 % 1.00 [ 0.84, 1.18 ]


Total events: 854 (2-hour action line), 807 (4-hour action line)
2 2 2
Heterogeneity: Tau = 0.01; Chi = 4.43, df = 2 (P = 0.11); I =55%
Test for overall effect: Z = 0.04 (P = 0.97)
Test for subgroup differences: Not applicable

0.5 0.7 1 1.5 2


Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 77
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.13. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 13 Number of vaginal examinations in
labour.
Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 13 Number of vaginal examinations in labour

Mean Mean
Study or subgroup 2-hour action line 4-hour action line Difference Weight Difference
N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

Lavender 1998a 315 4 (1.9) 311 3.9 (1.8) 40.7 % 0.10 [ -0.19, 0.39 ]

Lavender 2006 1490 3.2 (1.9) 1485 3.4 (2) 59.3 % -0.20 [ -0.34, -0.06 ]

Total (95% CI) 1805 1796 100.0 % -0.08 [ -0.37, 0.21 ]


2 2 2
Heterogeneity: Tau = 0.03; Chi = 3.33, df = 1 (P = 0.07); I =70%
Test for overall effect: Z = 0.53 (P = 0.60)
Test for subgroup differences: Not applicable

-0.5 -0.25 0 0.25 0.5


Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 78
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.14. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 14 Serious neonatal morbidity or perinatal
death.
Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 14 Serious neonatal morbidity or perinatal death

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 0/315 0/311 Not estimable

Lavender 2006 0/1490 0/1485 Not estimable

Total (95% CI) 1805 1796 Not estimable


Total events: 0 (2-hour action line), 0 (4-hour action line)
Heterogeneity: not applicable
Test for overall effect: not applicable
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 79
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.15. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 15 Admission to special care nursery.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 15 Admission to special care nursery

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
1 Low-resource setting
Sinha 2017 4/100 3/100 8.6 % 1.33 [ 0.31, 5.81 ]

Subtotal (95% CI) 100 100 8.6 % 1.33 [ 0.31, 5.81 ]


Total events: 4 (2-hour action line), 3 (4-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.38 (P = 0.70)
2 High-resource setting
Lavender 1998a 4/315 2/311 5.7 % 1.97 [ 0.36, 10.70 ]

Lavender 2006 21/1490 30/1485 85.7 % 0.70 [ 0.40, 1.21 ]

Subtotal (95% CI) 1805 1796 91.4 % 0.78 [ 0.46, 1.31 ]


Total events: 25 (2-hour action line), 32 (4-hour action line)
2 2
Heterogeneity: Chi = 1.32, df = 1 (P = 0.25); I =24%
Test for overall effect: Z = 0.95 (P = 0.34)
Total (95% CI) 1905 1896 100.0 % 0.83 [ 0.51, 1.34 ]
Total events: 29 (2-hour action line), 35 (4-hour action line)
2 2
Heterogeneity: Chi = 1.79, df = 2 (P = 0.41); I =0.0%
Test for overall effect: Z = 0.77 (P = 0.44)
2 2
Test for subgroup differences: Chi = 0.46, df = 1 (P = 0.50), I =0.0%

0.05 0.2 1 5 20
Favours 2-hour Favours 4-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 80
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 2.16. Comparison 2 Partograph with 2-hour action line versus partograph with 4-hour action line
(studies carried out in a high- and low-resource settings), Outcome 16 Cord blood arterial pH less than 7.1.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 2 Par tograph with 2-hour action line versus partograph with 4-hour action line (studies carried out in a high- and low-resource settings)

Outcome: 16 Cord blood ar terial pH less than 7.1

Study or subgroup 2-hour action line 4-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 2/315 2/311 5.9 % 0.99 [ 0.14, 6.97 ]

Lavender 2006 23/1490 32/1485 94.1 % 0.72 [ 0.42, 1.22 ]

Total (95% CI) 1805 1796 100.0 % 0.73 [ 0.44, 1.22 ]


Total events: 25 (2-hour action line), 34 (4-hour action line)
2 2
Heterogeneity: Chi = 0.10, df = 1 (P = 0.76); I =0.0%
Test for overall effect: Z = 1.19 (P = 0.23)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 4-hour

Analysis 3.1. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action
line (study carried out in a high-resource setting), Outcome 1 Caesarean section (overall).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 1 Caesarean section (overall)

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 35/315 43/302 100.0 % 0.78 [ 0.51, 1.18 ]

Total (95% CI) 315 302 100.0 % 0.78 [ 0.51, 1.18 ]


Total events: 35 (2-hour action line), 43 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 1.16 (P = 0.24)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

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Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 3.2. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action
line (study carried out in a high-resource setting), Outcome 2 Oxytocin augmentation.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 2 Oxytocin augmentation

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 144/315 136/302 100.0 % 1.02 [ 0.85, 1.21 ]

Total (95% CI) 315 302 100.0 % 1.02 [ 0.85, 1.21 ]


Total events: 144 (2-hour action line), 136 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.17 (P = 0.87)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Analysis 3.3. Comparison 3 Partograph with 2-hour action line versus partograph with
3-hour action line (study carried out in a high-resource setting), Outcome 3 Maternal
experience of childbirth - negative childbirth experience.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 3 Maternal experience of childbir th - negative childbir th experience

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 14/179 27/169 100.0 % 0.49 [ 0.27, 0.90 ]

Total (95% CI) 179 169 100.0 % 0.49 [ 0.27, 0.90 ]


Total events: 14 (2-hour action line), 27 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 2.29 (P = 0.022)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 82
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 3.4. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action
line (study carried out in a high-resource setting), Outcome 4 Low Apgar score (less than 7 at 5
minutes).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 4 Low Apgar score (less than 7 at 5 minutes)

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 6/315 4/302 100.0 % 1.44 [ 0.41, 5.05 ]

Total (95% CI) 315 302 100.0 % 1.44 [ 0.41, 5.05 ]


Total events: 6 (2-hour action line), 4 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.57 (P = 0.57)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Analysis 3.5. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action
line (study carried out in a high-resource setting), Outcome 5 Serious maternal morbidity or death.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 5 Serious maternal morbidity or death

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 0/315 0/302 Not estimable

Total (95% CI) 315 302 Not estimable


Total events: 0 (2-hour action line), 0 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: not applicable
Test for subgroup differences: Not applicable

0.1 0.2 0. 5 1 2 5 10
Favours 2-hour Favours 3-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 83
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 3.6. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action
line (study carried out in a high-resource setting), Outcome 6 Caesarean section (distress).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 6 Caesarean section (distress)

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 12/315 12/302 100.0 % 0.96 [ 0.44, 2.10 ]

Total (95% CI) 315 302 100.0 % 0.96 [ 0.44, 2.10 ]


Total events: 12 (2-hour action line), 12 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.11 (P = 0.92)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Analysis 3.7. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action
line (study carried out in a high-resource setting), Outcome 7 Caesarean section (delay).

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 7 Caesarean section (delay)

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 23/315 31/302 100.0 % 0.71 [ 0.42, 1.19 ]

Total (95% CI) 315 302 100.0 % 0.71 [ 0.42, 1.19 ]


Total events: 23 (2-hour action line), 31 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 1.29 (P = 0.20)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 84
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 3.8. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action
line (study carried out in a high-resource setting), Outcome 8 Instrumental vaginal delivery.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 8 Instrumental vaginal delivery

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 66/315 68/302 100.0 % 0.93 [ 0.69, 1.26 ]

Total (95% CI) 315 302 100.0 % 0.93 [ 0.69, 1.26 ]


Total events: 66 (2-hour action line), 68 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.47 (P = 0.64)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Analysis 3.9. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action line
(study carried out in a high-resource setting), Outcome 9 Postpartum haemorrhage - blood loss > 500 mL.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 9 Postpar tum haemorrhage - blood loss > 500 mL

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 39/315 39/302 100.0 % 0.96 [ 0.63, 1.45 ]

Total (95% CI) 315 302 100.0 % 0.96 [ 0.63, 1.45 ]


Total events: 39 (2-hour action line), 39 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.20 (P = 0.84)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 85
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 3.10. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action
line (study carried out in a high-resource setting), Outcome 10 Regional analgesia - epidural.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 10 Regional analgesia - epidural

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 120/315 99/302 100.0 % 1.16 [ 0.94, 1.44 ]

Total (95% CI) 315 302 100.0 % 1.16 [ 0.94, 1.44 ]


Total events: 120 (2-hour action line), 99 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 1.37 (P = 0.17)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Analysis 3.11. Comparison 3 Partograph with 2-hour action line versus partograph with 3-hour action line
(study carried out in a high-resource setting), Outcome 11 Performance of artificial rupture of membranes
during labour.

Review: Effect of par tograph use on outcomes for women in spontaneous labour at term and their babies

Comparison: 3 Par tograph with 2-hour action line versus partograph with 3-hour action line (study carried out in a high-resource setting)

Outcome: 11 Performance of ar tificial rupture of membranes during labour

Study or subgroup 2-hour action line 3-hour action line Risk Ratio Weight Risk Ratio
n/N n/N M-H,Fixed,95% CI M-H,Fixed,95% CI
Lavender 1998a 120/315 122/302 100.0 % 0.94 [ 0.77, 1.15 ]

Total (95% CI) 315 302 100.0 % 0.94 [ 0.77, 1.15 ]


Total events: 120 (2-hour action line), 122 (3-hour action line)
Heterogeneity: not applicable
Test for overall effect: Z = 0.59 (P = 0.56)
Test for subgroup differences: Not applicable

0.1 0.2 0.5 1 2 5 10


Favours 2-hour Favours 3-hour

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 86
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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