Partogram use in the Dar es Salaam perinatal care study

ObjectiveTo assess the quality of partograms used to monitor labor in Dar es Salaam hospitals, Tanzania.MethodsThe study team reviewed the records of the parameters of labor, and maternal and fetal conditions in 367 partograms, and interviewed 20 midwives.ResultsAll midwives interviewed had been previously trained to use the partogram. Of all partograms reviewed, 50% had no records of duration of labor. Although cervical dilation and fetal heart rates were recorded in 97% and 94% of the partograms respectively, 63% and 91% of these were judged to be substandard. Substandard monitoring of fetal heart rates was strongly associated with poor fetal outcome (P < 0.001). Blood pressure, temperature, and pulse rates were not recorded in 47%–76% of partograms.ConclusionThese findings reflect poor management of labor and indicate urgent in-service training to address the importance of documentation and regular partogram audit in order to reduce maternal and perinatal deaths.