MATERIALS AND METHODOLOGY
This prospective observational study was conducted at a tertiary
referral centre between January 2015 to May 2016. The study was started
after approval from clinical research ethics committee of institute.
Nulliparas attending labor room were screened for the study, inclusion
criteria were: 37-41 weeks of gestation, singleton viable intrauterine
pregnancy, and vertex presentation in the first stage of labor with
cervical dilatation of ≤ 4 cm with reassuring fetal heart rate.
Exclusion criteria were; any contraindications for vaginal delivery,
evidences of fetal malformations, intrauterine growth retardation and
chronic maternal medical or surgical illness. A total of 500 nulliparas
were recruited.
Informed written consent was taken from women after explaining detailed
plan, purpose and duration of study. After taking a detailed history and
clinical examination, participants were randomized into two groups A and
B according to computer generated table.
A graphical record of cervical dilatation and descent was made on the
WHO modified partograph. In group A, 250 women were marked on the alert
line at 4 cm and then progress was documented. In group B, 250 women
were also marked on the alert line at 4 cm and again shifted back to
alert line at 6 cm (assuming commencement of active phase from 6 cm) if
they the crossed alert line. Between 4 and 6cm, Group B women were
considered in latent phase. They were only monitored with supportive
care without any intervention provided maternal and fetal status were
reassuring. Labor pattern in both groups was evaluated. Time taken for
dilatation of the cervix from 4 to 6cm was noted in all women. The rate
of dilatation was calculated retrospectively in all women who underwent
vaginal delivery. Outcome was to study, the average labor pattern curve
of all parturients, and to see the labor duration using the modified WHO
partogram. The results were considered to be statistically significant
when p<0.05. Data analysis was performed using SPSS version.