A Cochrane review included 6 studies with a total of 7 706 subjects. 2 studies assessed partogram vs no partogram and the remainder assessed different partogram designs. There was no evidence of any difference between partogram and no partogram in caesarean section in 2 trials (RR 0.64, 95% CI 0.24 to 1.70; n=1590); instrumental vaginal delivery (RR 1.00, 95% CI 0.85 to 1.17; n=1590) or Apgar score less than seven at five minutes (RR 0.77, 95% CI 0.29 to 2.06) between the groups. However, in both studies the partogram was the experimental arm. When compared to a four-hour action line, women in the two-hour action line group were more likely to require oxytocin augmentation (RR 1.14, 95% CI 1.05 to 1.22). When the three- and four-hour action line were compared, caesarean section rate was lowest in the four-hour action line group and this difference was statistically significant (RR 1.70, 95% CI 1.07 to 2.70; 1 trials, n = 613). When a partogram with a latent phase (composite) and one without (modified) were compared, the caesarean section rate was lower in the partograph without a latent phase (RR 2.45, 95% CI 1.72 to 3.50, 1 trial, n = 743).
Comment: The quality of evidence is downgraded by study quality (non compliance in completing the partogram, cross contamination of care by staff), by inconsistency (heterogeneity in results in different populations) and by indirectness (differences in studied interventions).