Comparative Evaluation of the WHO Labour Care Guide and Modified Partograph in Cesarean Section Frequency, Delivery Outcomes, and Maternal Stress in Tertiary Care Hospitals in Hyderabad : WHO Labour Care Guide and Modified Partograph in Cesarean Section and Maternal Stress

Shua Bano; Fahmida Parveen; Pulwisha Mustafa; Amna Aslam; Afshan Sultan Zia; . Paras

doi:10.54393/pjhs.v7i8.4040

Authors

Shua Bano Department of Gynaecology and Obstetrics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Fahmida Parveen Department of Gynaecology and Obstetrics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Pulwisha Mustafa Department of Gynaecology and Obstetrics, Isra University Hospital, Hyderabad, Pakistan
Amna Aslam Department of Gynaecology and Obstetrics, Isra University Hospital, Hyderabad, Pakistan
Afshan Sultan Zia Department of Gynaecology and Obstetrics, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
. Paras Department of Gynaecology and Obstetrics, Bilawal Medical College, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i8.4040

Keywords:

Labour, Obstetrics, Parturition, Partograph, Cesarean Section, Pregnancy Outcomes, Maternal Stress

Abstract

The global rise in cesarean section (CS) rates has raised concerns due to associated maternal and neonatal risks, increased healthcare costs, and psychological stress. To address this issue, the World Health Organization introduced the Labour Care Guide (LCG) as an updated, evidence-based tool for monitoring labour and improving childbirth outcomes. Objectives: To compare the frequency of cesarean sections among women managed using the WHO Labour Care Guide (LCG) and those managed with the Modified Partograph in tertiary care hospitals of Hyderabad, Sindh. Methods: A comparative cross-sectional study was conducted at Liaquat University Hospital and Khidmat-e-Khalq Foundation Hospital over four months. A total of 430 pregnant women were enrolled, with 215 participants in each group. Maternal stress levels were assessed using the Perceived Stress Scale (PSS). Data were analyzed using SPSS version 26.0, and the Chi-square test was applied to compare categorical variables. Results: Women managed with the LCG had a significantly lower CS rate compared with those monitored using the Modified Partograph (40 vs. 65; p=0.02). The LCG group also demonstrated improved neonatal outcomes, including higher birth weights and better Apgar scores. Additionally, maternal stress levels were significantly lower and satisfaction with care was higher among women in the LCG group (p<0.050). Conclusions: The WHO Labour Care Guide appears to be more effective than the Modified Partograph in reducing cesarean section rates and improving maternal and neonatal outcomes while lowering maternal stress during labour.

References

Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and Projections of Caesarean Section Rates: Global and Regional Estimates. British Medical Journal Global Health. 2021 Jun; 6(6). doi: 10.1136/bmjgh-2021-005671.

Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. Plos One. 2016 Feb; 11(2): e0148343. doi: 10.1371/journal.pone.0148343.

Boerma T, Ronsmans C, Melesse DY, Barros AJ, Barros FC, Juan L et al. Global Epidemiology of Use of and Disparities in Caesarean Sections. The Lancet. 2018 Oct; 392(10155): 1341-8. doi: 10.1016/S0140-6736(18)31928-7.

Antoine C and Young BK. Cesarean Section One Hundred Years 1920–2020: The Good, the Bad and the Ugly. Journal of Perinatal Medicine. 2021 Jan; 49(1): 5-16. doi: 10.1515/jpm-2020-0305.

Baek S, Froese V, Morgenstern B. Risk Profiles and Outcomes of Uterine Rupture: A Retrospective and Comparative Single-Center Study of Complete and Partial Ruptures. Journal of Clinical Medicine. 2025 Jul; 14(14): 4987. doi: 10.3390/jcm14144987.

Miseljic N and Ibrahimovic S. Health Implications of Increased Cesarean Section Rates. Materia Socio-Medica. 2020 Jun; 32(2): 123. doi: 10.5455/msm.2020.32.123-126.

Javed H, Ahmad TI, Adnan B. Cesarean Section Delivery in the Districts of Pakistan: Prevalence, Extent and Correlates. Journal Homepage. 2024; 1(01): 28-37.

Costello EK, DiGiulio DB, Robaczewska A, Symul L, Wong RJ, Shaw GM et al. Abrupt Perturbation and Delayed Recovery of the Vaginal Ecosystem Following Childbirth. Nature Communications. 2023 Jul; 14(1): 4141. doi: 10.1038/s41467-023-39849-9.

Odogwu NM. Role of Short Interpregnancy Interval, Birth Mode, Birth Practices, and the Postpartum Vaginal Microbiome in Preterm Birth. Frontiers in Reproductive Health. 2023 Jan; 4: 1082199. doi: 10.3389/frph.2022.1082199.

Bedaso A, Adams J, Peng W, Sibbritt D. The Relationship Between Social Support and Mental Health Problems During Pregnancy: A Systematic Review and Meta-Analysis. Reproductive Health. 2021 Jul; 18(1): 162. doi: 10.1186/s12978-021-01209-5.

Childs C, Sandy-Hodgetts K, Broad C, Cooper R, Manresa M, Verdú-Soriano J. Birth-Related Wounds: Risk, Prevention and Management of Complications After Vaginal and Caesarean Section Birth. Journal of Wound Care. 2020 Nov; 29(Sup11a): S1-48. doi: 10.12968/jowc.2020.29.Sup11a.S1.

Zacharias NA, Panda A, Elmahdy A, Revzin MV, Aswani Y. Early and Delayed Post-Cesarean Complications: An Imaging Review. Abdominal Radiology. 2026 Mar; 51(3): 1489-505. doi: 10.1007/s00261-025-05118-0.

Ramya R and Sharma N. Effectiveness of the WHO Labour Care Guide in Reducing Primary Caesarean Delivery: A Randomized Controlled Trial. Journal of the Neonatal Surgery. 2025 May; 14(25S): 96-105.

Vogel JP, Pujar Y, Vernekar SS, Armari E, Pingray V, Althabe F et al. Effects of the WHO Labour Care Guide on Cesarean Section in India: A Pragmatic, Stepped-Wedge, Cluster-Randomized Pilot Trial. Nature Medicine. 2024 Feb; 30(2): 463-9. doi: 10.1038/s41591-023-02751-4.

Pandey D, Bharti R, Dabral A, Khanam Z. Impact of WHO Labor Care Guide on Reducing Cesarean Sections at a Tertiary Center: An Open-Label Randomized Controlled Trial. American Journal of Obstetrics and Gynecology Global Reports. 2022 Aug; 2(3): 100075. doi: 10.1016/j.xagr.2022.100075.

Katus L, Foley S, Murray AL, Luong-Thanh BY, Taut D, Baban A et al. Perceived Stress During the Prenatal Period: Assessing Measurement Invariance of the Perceived Stress Scale (PSS-10) Across Cultures and Birth Parity: Katus et al. Archives of Women's Mental Health. 2022 Jun; 25(3): 633-40. doi: 10.1007/s00737-022-01229-5.

Sharif-Nia H, Froelicher ES, Hoseinzadeh E, Kaveh O, Fatehi R, Nowrozi P. Assessing the Validity and Reliability of the 10-Item Persian Version of the Perceived Stress Scale in Post-Surgery Patients. Frontiers in Psychiatry. 2024 Jun; 15: 1402122. doi: 10.3389/fpsyt.2024.1402122.

Boluarte-Carbajal A, Salazar-Conde M, Alata Vasquez S, Zegarra-López A. Psychometric Review of the Perceived Stress Scale Under CFA and Rasch Models in Lima, Peru. Frontiers in Psychology. 2023 May 23; 14: 1160466. doi: 10.3389/fpsyg.2023.1160466.

Vogel JP, Pingray V, Althabe F, Gibbons L, Berrueta M, Pujar Y et al. Implementing the WHO Labour Care Guide to Reduce the Use of Caesarean Section in Four Hospitals in India: Protocol and Statistical Analysis Plan for A Pragmatic, Stepped-Wedge, Cluster-Randomized Pilot Trial. Reproductive Health. 2023 Jan; 20(1): 18. doi: 10.1186/s12978-022-01525-4.

Midhet F, Khalid SN, Baqai S, Khan SA. Trends in the Levels, Causes, and Risk Factors of Maternal Mortality in Pakistan: A Comparative Analysis of National Surveys of 2007 and 2019. Plos One. 2025 Jan; 20(1): e0311730. doi: 10.1371/journal.pone.0311730.

Angolile CM, Max BL, Mushemba J, Mashauri HL. Global Increased Cesarean Section Rates and Public Health Implications: A Call to Action. Health Science Reports. 2023 May; 6(5): e1274. doi: 10.1002/hsr2.1274.

Akram M, Afzal M. Driving Factors Influencing the Women's Preference and Decision-Making for Non-Medically Indicated Caesarean Section. Global Social Sciences Review. 2023 Mar; 8(1): 107-15. doi: 10.31703/gssr.2023(VIII-I).10.

Orovou E, Antoniou E, Zervas I, Sarantaki A. Prevalence and Correlates of Postpartum PTSD Following Emergency Cesarean Sections: Implications for Perinatal Mental Health Care: A Systematic Review and Meta-Analysis. BioMed Central Psychology. 2025 Jan; 13(1): 26. doi: 10.1186/s40359-025-02344-5.

Benton M, Salter A, Tape N, Wilkinson C, Turnbull D. Women’s Psychosocial Outcomes Following an Emergency Caesarean Section: A Systematic Literature Review. BioMed Central Pregnancy and Childbirth. 2019 Dec; 19(1): 535. doi: 10.1186/s12884-019-2687-7.

Mugyenyi GR, Atukunda EC, Tumuhimbise W, Farjardo YF, Byamugisha J. Exploring Potential Opportunities and Strategies of Using the New WHO Labour Care Guide to Improve Labour Monitoring and Health Outcomes among Health Care Providers in Uganda: A Qualitative Study. 2023. doi: 10.21203/rs.3.rs-3374008/v1.

Seth S. Strategies for Cesarean Section Rate Reduction. In Labour and Delivery: An Updated Guide. Singapore: Springer Nature Singapore. 2023 Aug: 549-561. doi: 10.1007/978-981-19-6145-8_38.

Le HN, Gold L, Mensah FK, Cook F, Bayer JK, Hiscock H. Health Service Use and Costs for Infant Behaviour Problems and Maternal Stress. Journal of Pediatrics and Child Health. 2016 Apr; 52(4): 402-9. doi: 10.1111/jpc.13095.