Publication:

Evaluation of labor progression in induced and spontaneous labor using modified WHO partograph in term primigravida: a hospital-based comparative study

Background Induction of labor is commonly performed to improve maternal and neonatal outcomes; however, its effectiveness compared to spontaneous labor remains debated. Monitoring labor progress using the modified WHO partograph provides an objective way to assess outcomes. To compare the progress and outcomes of induced labor with spontaneous labor among primigravida women at term.

Methods This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Chattogram Medical College Hospital, Bangladesh, from March 2018 to February 2019. A total of 130 primigravida women at term (41⁰⁄₇–41⁶⁄₇ weeks) were selected using purposive sampling and divided equally into spontaneous labor (n=65) and induced labor (n=65) groups. Inclusion and exclusion criteria were applied to ensure comparability. Labor was monitored using the modified WHO partograph. Data on socio-demographic variables, labor progression, mode of delivery, maternal and neonatal outcomes were collected and analyzed using SPSS version 23. Statistical significance was set at p<0.05.

Results There was no significant difference in socio-demographic characteristics between the groups. The induced group had significantly higher mean gestational age (41.61±0.48 vs 41.21±0.01 weeks; p<0.001) and BMI (24.07±1.32 vs 22.63±1.55 kg/m²; p<0.001). The rate of normal vaginal delivery was slightly higher in the spontaneous group (86.2%) compared to the induced group (78.5%), though not statistically significant. Caesarean section rates were comparable (9.2% vs 12.3%). Labor progression assessed by partograph showed no significant difference between groups, with most women remaining within the alert line. However, the duration of labor was significantly shorter in the induced group, with a reduced first stage (7.59±0.85 vs 10.53±1.04 hours; p<0.001) and second stage (45.05±8.28 vs 49.10±7.99 minutes; p=0.001). Maternal complications were minimal and comparable between groups. Neonatal outcomes, including Apgar scores, birth asphyxia, meconium aspiration and NICU admission, showed no statistically significant differences.

Conclusions Induced labor is comparable to spontaneous labor in terms of maternal and neonatal outcomes among primigravida at term. Although induction shortens the duration of labor, it does not significantly increase adverse outcomes or operative delivery rates.