Grand Rounds

Results from the SLiP Pregnancy Monitoring Trial: The Ongoing Partograph Wars

BACKGROUND AND PURPOSE:

Cochrane Review did not find an advantage to the use of the WHO partograph
In 2014, a novel “labor scale”, using more conservative parameters, was described in a pilot study (see “Learn More – Primary Sources”)
Tolba et al. (Amer J Perinatol, 2018) sought to compare this novel labor scale to the WHO partograph

Single center, double blinded, randomized controlled trial (RCT)
SLiP (Spontaneous Labor in Primigravidae) trial
Eligibility: Nulliparous | Spontaneous onset of labor | 38 to 41 weeks | Singleton viable fetus, and vertex | EFW between 2,500 and 3,800 g.
Exclusion: Medical and obstetric co-morbidities | Fetal abnormalities
Patients were randomized into arms for labor management
- Labor scale
- WHO partograph
Primary outcome
- Successful vaginal delivery
Secondary outcome
- Low APGAR scores
- Birth injuries
- Postpartum hemorrhage
- Infection

Data were pooled from 110 patients (55 per group)
Comparing the labor scale to WHO partograph
- Lower cesarean section rate
  - 3.6% versus 18.2%; P=0.03
- Reduced rate and duration of oxytocin administration
  - 21.8% versus 69.1%; P < 0.0001
- Increased in average 1 minute APGAR score (statistically but not clinically significant)
Active phase was comparable between the 2 groups
- 4.84 ± 2.51 hours vs 4.40 ± 1.96 hours
There was no significant differences in maternal complications and no neonatal complications were reported

The labor scale was associated with fewer cesarean sections and reduced oxytocin use for induction
The authors recommend that labor monitoring should begin at ≥5 cm or more to avoid erroneous diagnosis of labor dystocia

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