Evaluating progress of labor in nulliparas and multiparas using the modified WHO partograph

OBJECTIVE: To evaluate the progress of labor in nulliparas and multiparas using the modified World Health Organization (WHO) partograph. METHOD: In a prospective study 259 nulliparas and 204 multiparas were compared for rates of normal labor progression in the active phase; of cervical dilatation plots crossing the alert line of the partograph; and of plots reaching or crossing the action line. Outcome measures were total duration of labor, mode of delivery, incidence of labor augmentation, and number of vaginal examinations. RESULTS: Labor duration was similar in the 2 groups and cervical dilatation remained normal for most women. In both groups, the incidence of spontaneous vaginal delivery was highest among women with normal labor progress and the incidence of both labor augmentation and operative intervention increased when labor progress was delayed. CONCLUSION: Labor progress and duration were found similar for nulliparas and multiparas when monitored with the modified WHO partograph. Delay in labor progress increased the need for operative intervention and adversely affected fetal outcome.