Effectiveness Of Who Labour Care Guide in Reducing Primary Caesarean Delivery: A Randomized Controlled Trial
Keywords:
WHO Labour Care Guide, primary caesarean section, labor management, maternal outcomes, randomized controlled trialAbstract
Background: The rising global caesarean delivery rate, particularly primary caesarean sections, remains a significant public health concern. The WHO Labour Care Guide (LCG) was developed as an evidence-based tool to improve labor monitoring and reduce unnecessary interventions, though robust evidence of its effectiveness remains limited.
Objective: To evaluate the effectiveness of the WHO LCG in reducing primary caesarean deliveries among low-risk pregnant women compared to WHO partograph carelabor management protocols.
Methods: A randomized controlled trial was conducted at a tertiary care hospital over 6 months, enrolling 100 low-risk pregnant women (50 per group). Participants were randomly allocated to either WHO LCG-guided care or standard labor management. Primary outcome was incidence of primary caesarean delivery. Secondary outcomes included maternal complications (postpartum hemorrhage, puerperal sepsis), neonatal outcomes (APGAR scores, NICU admissions), labor duration, and provider satisfaction.
Results: The LCG group had significantly lower primary caesarean rates (16% vs 32%; RR 0.50, 95% CI 0.28-0.89; p=0.021). Reduced maternal complications: Postpartum hemorrhage (6% vs 16%; p=0.048). Puerperal sepsis (2% vs 10%; p=0.042). Shorter active labor duration (mean difference -1.3 hours; p=0.018). Comparable neonatal outcomes between groups. High provider satisfaction (85%) and adherence (92%)
Conclusion: The WHO Labour Care Guide significantly reduces primary caesarean deliveries and improves maternal outcomes without compromising neonatal safety. These findings support its implementation in routine obstetric practice, particularly in settings with high caesarean rates.
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Bernitz S, Dalbye R, Zhang J, et al. The frequency of intrapartum caesarean section use with the WHO Labour Care Guide: a multicentre, randomized controlled trial. Lancet Glob Health. 2023;11(4):e567-75.
Oladapo OT, Diaz V, Bonet M, et al. Cervical dilatation patterns of ‘low-risk’ women with spontaneous labour and normal perinatal outcomes: a systematic review. BJOG. 2018;125(8):944-54.
Tilden EL, Phillippi JC, Snowden JM, et al. Randomized trial of labour monitoring in low-risk women. Obstet Gynecol. 2019;133(6):1171-9.
Vogel JP, Souza JP, Gülmezoglu AM. Patterns and outcomes of induction of labour in Africa and Asia: a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. PLoS One. 2013;8(6):e65612.
Lavender T, Hart A, Smyth RM. Effect of partograph use on outcomes for women in spontaneous labour at term. Cochrane Database Syst Rev. 2013;(7):CD005461.
Neal JL, Lowe NK, Ahijevych KL, et al. "Active labor" duration and dilation rates among low-risk, nulliparous women with spontaneous labor onset: a systematic review. J Midwifery Womens Health. 2010;55(4):308-18.
World Health Organization. WHO Labour Care Guide: User’s Manual. Geneva: WHO; 2020.
Boerma T, Ronsmans C, Melesse DY, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341-8.
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