Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Risk of bias
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
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
Risk of bias
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
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.
Windrim 2006
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
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
Random sequence generation (selection Low risk Stratified randomisation by off-site com-
bias) puterised randomisation service
Blinding of participants and personnel High risk Not feasible to blind women or clinical
(performance bias) staff. Used bedside charts
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.
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
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
NCT02911272
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)
Interventions Partograph with 2-hour action line versus partograph with a 4-hour action line
Notes Awaiting more information from authors - contacted 21/04/2017 ’draziken@ubth.org’ as could not locate Dr Orhue’s
personal email
NCT02714270
Trial name or title A randomised clinical trial of paperless versus modified World Health Organization partograph in management
of first stage of labour
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)
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.)
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)
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)
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)
• 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
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
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 59
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)
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 ]
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)
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 ]
-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) 60
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
(1) Duration in 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)
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 ]
2 High-resource setting
Windrim 2006 6/580 7/576 77.1 % 0.85 [ 0.29, 2.52 ]
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)
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 ]
2 High-resource setting
Windrim 2006 173/580 178/576 77.1 % 0.97 [ 0.81, 1.15 ]
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)
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 ]
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 63
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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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 64
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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)
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 ]
-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)
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
-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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 66
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 67
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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)
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 ]
0.02 0.1 1 10 50
Favours 2-hour Favours 4-hour
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 68
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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 ]
0.02 0.1 1 10 50
Favours 2-hour Favours 4-hour
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 69
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 70
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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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 71
Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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)
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
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 72
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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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 73
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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)
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 ]
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 75
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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)
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 ]
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)
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 ]
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 78
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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)
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
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 79
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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)
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 ]
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
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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)
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 ]
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 81
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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)
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 ]
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 82
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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)
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 ]
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)
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
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
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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)
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 ]
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 84
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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)
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 ]
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)
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 ]
Effect of partograph use on outcomes for women in spontaneous labour at term and their babies (Review) 85
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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)
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 ]
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)
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 ]
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.