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 

METHODS: 

• 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 

RESULTS: 

• 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

CONCLUSION: 

• 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 

Learn More – Primary Sources: 

Management of Spontaneous Labor in Primigravidae: Labor Scale versus WHO Partograph (SLiP Trial) Randomized Controlled Trial

The labour scale–assessment of the validity of a novel labour chart: a pilot study (2014) 

Related ObG Topics:

Does Stopping Oxytocin in Active Phase of Labor Alter Cesarean Section Rates?

Does Epidural Anesthesia Impact the Second Stage of Labor?

Could New Labor Management Guidelines be Doing More Harm than Good?

Electronic Fetal Monitoring vs. Intermittent Auscultation