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Use of a 2 hour partogram action line instead of a 4 hour action line did not reduce caesarean delivery rate

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 Q In primiparous women in spontaneous labour at term, does the use of a 2 hour partogram action line reduce the risk of caesarean delivery compared with a 4 hour action line?

Clinical impact ratings Obstetrics ★★★★★★★ GP/FP/Obstetrics ★★★★★★☆


Embedded ImageDesign:

randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:


Embedded ImageFollow up period:

2–10 days after delivery.

Embedded ImageSetting:

midwife led unit and physician led delivery suite in a teaching hospital in northwest England, UK.

Embedded ImagePatients:

3000 primigravid women (mean age 25 y) in spontaneous labour at term with an uncomplicated singleton pregnancy in cephalic presentation.

Embedded ImageIntervention:

progress of labour was recorded on a partogram with an action line drawn either 2 hours (n = 1503) or 4 hours (n = 1497) after the alert line. If the plot of cervical dilatation against time crossed the action line, delivery suite guidelines for the management of prolonged labour were followed.

Embedded ImageOutcomes:

caesarean delivery, need for augmentation …

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  • * See glossary.

  • For correspondence: Dr T Lavender, University of Central Lancashire, Preston, UK. Tinalav{at}

  • Source of funding: Liverpool Women’s Foundation Trust.

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