Partogram use in the Dar es Salaam perinatal care study

Objective: To assess the quality of partograms used to monitor labor in Dar es Salaam hospitals, Tanzania. Methods: The study team reviewed the records of the parameters of labor, and maternal and fetal conditions in 367 partograms, and interviewed 20 midwives. Results: All 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. Conclusion: These 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.