Redefining Active Labor: Comparing Maternal and Foetal Outcomes Using 4 Cm Versus 6 Cm Cervical Dilatation Thresholds on The Who Partograph

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Introduction: This study aimed to compare labor outcomes using the existing World Health Organization (WHO) partograph guideline (active phase at 4 cm cervical dilatation) versus a proposed guideline (6 cm) in low-risk women with spontaneous labor, assessing maternal and fetal outcomes and intervention rates. Methods: A prospective observational study was conducted from December 2019 to November 2021 at Krishna Institute of Medical Sciences, Karad, India. A total of 300 women with singleton, cephalic pregnancies were equally randomized into two groups: Group A (partograph initiated at 4 cm, n=150) and Group B (6 cm, n=150). Exclusion criteria included high-risk pregnancies and emergency delivery needs. Outcomes measured included active phase duration, cervical dilatation rate, mode of delivery, and neonatal intensive care unit (NICU) admissions. Data were analyzed using t-tests and chi-square tests, with significance at P<0.05. Results: Group B exhibited a shorter mean active phase duration (3.22±1.23 hours vs. 4.64±1.78 hours, P<0.001) and faster dilatation rate (2.42±0.80 cm/hour vs. 1.49±0.42 cm/hour, P<0.001). Normal labor progression was higher in Group B (74.67% vs. 46.00%, P<0.001), with fewer crossing the action line (10.00% vs. 16.67%, P=0.089). Cesarean rates (14.00% vs. 22.00%, P=0.240) and NICU admissions (4.00% vs. 6.00%, P=0.426) were lower in Group B, though not significantly. Conclusion: Initiating partograph monitoring at 6 cm enhances labor progression and reduces intervention tendencies without compromising outcomes, supporting its adoption in low-risk pregnancies.

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