A Cochrane review [Abstract] 1 included 11 studies with a total of 9 475 subjects. 3 studies assessed partogram vs no partogram and the remainder assessed different partogram designs. There was no difference between partogram and no partogram in caesarean section (RR 0.77, 95% CI 0.40 to 1.46; n = 1813; instrumental vaginal delivery (RR 1.00, 95% CI 0.85 to 1.17; n=1590) or Apgar score less than seven at five minutes (RR 0.76, 95% CI 0.29 to 2.03; n=1596, I² = 87%) between the groups. However, in both studies the partogram was the experimental arm. When compared to a four-hour action line, women in the two-hour action line group were more likely to require oxytocin augmentation (RR 2.44, 95% CI 1.36 to 4.35; 4 trials, n=4749; I² = 96%). There was no clear difference in caesarean section rates (RR 1.06, 95% CI 0.88 to 1.28; 4 trials, n=4749) or Apgar score less than 7 at five minutes (RR 0.93, 95% CI 0.61 to 1.42; n=4749).
Comment: The quality of evidence is downgraded by study quality (non compliance in completing the partogram, cross contamination of care by staff), by inconsistency (heterogeneity in results in different populations) and by indirectness (differences in studied interventions).
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