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.