Our Summary

This research paper looks at the use of a tool called a partogram, which is used to track the progress of labor. The aim was to see if using this tool can help reduce the rate of cesarean (or C-section) births and to see which version of the partogram is most effective.

The researchers looked at studies that compared using the partogram to not using it, and also studies that compared different types of partograms. They found that using the partogram didn’t significantly reduce the rate of C-sections, especially in countries where the rate of C-sections is already low.

However, they found that a newer version of the partogram, developed by the World Health Organization, which doesn’t include the initial phase of labor, seemed to be more effective than the older 1994 version, with a lower rate of C-sections.

Even though the partogram didn’t show a big impact on reducing C-sections, it’s still a useful tool for tracking labor progress, which could help with making clinical decisions.

In Chile, where the rate of C-sections is around 45%, it’s suggested that using the newer partogram could be helpful. But more local studies are needed to confirm if it could actually help reduce C-sections there.

FAQs

  1. What is the purpose of the partogram tool in labor?
  2. Did the use of a partogram significantly lower the rate of cesarean sections according to the research?
  3. Which version of the partogram was found to be more effective in reducing the rate of C-sections?

Doctor’s Tip

A helpful tip a doctor might tell a patient about cesarean section is to discuss the possibility of a C-section during prenatal care appointments and to be aware of the signs that may indicate the need for a C-section, such as a lack of progress in labor or fetal distress. It’s important for patients to have open communication with their healthcare provider and to ask any questions they may have about the procedure. Additionally, following post-operative care instructions carefully can help with a smooth recovery process after a C-section.

Suitable For

In general, patients who may be recommended for a cesarean section include:

  1. Prolonged labor: If labor is not progressing as expected or if there are concerns about the health of the mother or baby, a cesarean section may be recommended.

  2. Fetal distress: If the baby is showing signs of distress during labor, such as an abnormal heart rate, a cesarean section may be necessary to deliver the baby quickly and safely.

  3. Breech presentation: If the baby is in a breech position (feet or buttocks first) rather than head first, a cesarean section is usually recommended to reduce the risk of complications during delivery.

  4. Placenta previa: If the placenta is covering the cervix, a vaginal delivery may not be possible, and a cesarean section may be necessary to prevent bleeding and other complications.

  5. Multiple pregnancies: If a woman is carrying twins, triplets, or more, a cesarean section may be recommended to reduce the risk of complications during delivery.

  6. Previous cesarean section: If a woman has had a previous cesarean section, there may be concerns about the risk of uterine rupture during a vaginal delivery, so a repeat cesarean section may be recommended.

  7. Maternal health conditions: If the mother has certain health conditions, such as high blood pressure, diabetes, or heart disease, a cesarean section may be recommended to reduce the risk of complications during delivery.

Overall, the decision to recommend a cesarean section is made on a case-by-case basis, taking into account the individual circumstances and health of both the mother and baby.

Timeline

Before a cesarean section:

  1. Patient goes through prenatal care and attends regular check-ups with their healthcare provider.
  2. Patient goes into labor and is admitted to the hospital.
  3. Healthcare provider monitors the progress of labor using tools such as the partogram.
  4. If labor stalls or complications arise, the decision for a C-section may be made.

After a cesarean section:

  1. Patient undergoes the surgical procedure in the operating room.
  2. Patient is closely monitored in the recovery room.
  3. Patient may experience pain and discomfort post-surgery.
  4. Patient receives post-operative care and is advised on how to care for themselves and their newborn.
  5. Patient may have a longer recovery period compared to vaginal delivery.
  6. Patient may have follow-up appointments with their healthcare provider to monitor their recovery and healing process.

What to Ask Your Doctor

  1. What are the potential risks and benefits of having a cesarean section compared to a vaginal delivery?
  2. How will my recovery be different after a cesarean section compared to a vaginal delivery?
  3. What factors would make me a candidate for a cesarean section?
  4. What is the process of a cesarean section and what can I expect during the procedure?
  5. How will a cesarean section affect my future pregnancies and deliveries?
  6. Are there any long-term implications or risks associated with having a cesarean section?
  7. What are the alternatives to a cesarean section and under what circumstances might they be considered?
  8. How can I best prepare for a cesarean section and what can I do to ensure a smooth recovery?
  9. What is the hospital’s policy on cesarean sections and what are their success rates and complications rates?
  10. Are there any specific questions or concerns I should discuss with my obstetrician before making a decision about a cesarean section?

Reference

Authors: Rojas Cedeño L, Carvajal JA. Journal: Medwave. 2024 Dec 9;24(11):e2966. doi: 10.5867/medwave.2024.11.2966. PMID: 39652743