PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Ms. MRINAL N. CHOPADE

I YEAR M. Sc NURSING
OBSTETRICS AND GYNECOLOGICAL NURSING
YEAR 2010-2011

TULZA BHAVANI COLLEGE OF NURSING

NO, 899/3, NEAR HAJRAT JUNEEDI DARGA, GYANG BAWADI,

BIJAPUR-586101

0
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATE Ms. MRINAL.N.CHOPADE

AND ADDRESS
1ST YEAR M.Sc. (NURSING),
TULZA BHAVANI COLLEGE OF
NURSING,NEAR GYANG
BOWDI,BIJAPUR DISTRICT
KARANATAKA PIN-586101

2. NAME OF THE INSTITUTE Tulza Bhavani College of Nursing,

No, 899/3, Near Hajrat Juneedi Darga,
Gyang Bawadi, Bijapur-586101.

3. COURSE OF THE STUDY AND 1ST Year M.Sc. (Nursing),

SUBJECT
Obstetrics and Gynaecological Nursing

4. DATE OF ADMISSION TO 21ST May 2010.

THE COURSE

A study to assess the effectiveness of

5. TITLE OF THE STUDY instructional module for nurses on use of
partograph during labor in selected
district hospital at Bijapur, Karnataka
State.

6. BRIEF RESUME OF THE INTENDED WORK

1
6.1 INTRODUCTION:

“Pregnancy is special let us make it safe”.

 WHO (1998)

This was the theme of World health organization in 1998 under the slogan of
safe motherhood. Safe motherhood is women’s right to have a safe and healthy
pregnancy and delivery.1

Pregnancy is seemingly a long journey that is best travelled with support. Labor
is almost an overwhelming experience because it involves sensations and emotions at
such an intense level. Women need supportive persons with them to help them to cope
with their experience of labor. Labor and birth, need all psychological and physical
coping methods available for a woman, no matter, how many child birth preparations
she had nor how many times she had already gone through the experience.2

Labor may be defined as the rhythmic contraction and relaxation of the uterine
muscles with progressive effacement and dilatation of the cervix leading to expulsion
of the products of conception. (Clausen, et al 1973). Labor is described as the process
by which the fetus, placenta and membranes are expelled through the birth canal.
(Cassidy, 1999).3

A considerable number of women suffer complications resulting from Labor

and childbirth and some of these complications result in maternal or infant mortality.
While this problem can be significantly reduced through the use of the Partograph to
monitor Labor, it is uncertain whether midwives in most of the hospitals are
knowledgeable about its use to monitor Labor. 4

The partograph is an effective tool for monitoring labor, and when used
effectively, will prevent prolonged or obstructed labor, which accounts for about 8%
of maternal deaths.5 The partograph thus serves as an ‘early warning system’ and
assists in early decision on transfer, intervention decisions in hospitals and ongoing
evaluation of the effect of interventions. The partograph as a tool for intra-partum
management is a mandatory component of care in all health facilities providing
maternity services.6

6.2 NEED FOR THE STUDY

2
 Pregnancy is a normal physiological process and not a disease, but it is
associated with certain risks to the health and survival both of the woman and for the
infant she bears. These risks are common in every setting, but in developed countries
these risks have been largely overcome because every pregnant woman has access to
special care during pregnancy and child birth. Whereas such is not the case in many
developing countries where each pregnancy represents a journey into the unknown
from which too many woman never return alive.1

The tragedies of obstructed labor and rupture of the uterus comprise one of the
five major causes of maternal mortality and morbidity in developing countries. The
partograph serves as an “early warning system” and assists in early decision on
transfer augmentation and termination of labor. WHO has modified to make it simpler
and easier to use. Studies have shown that using partograph can be highly effective in
reducing complications from prolonged labor for the mother and for the newborn.2

A partograph is a graphical record of the observations made of women in labor

for progress of labor and salient conditions of the mother and fetus .It was developed
and extensively tested by the world health organization WHO. 7

Maternal mortality ratio continues to be the major index of the widening

discrepancy in the level of care and the outcome of reproductive health between the
advanced and developing countries.

India tops the world with 26 million births every year, maternal mortality is
alarming high (400-600/100,000 live births) with majority of deaths due to
preventable causes like ante partum hemorrhage, puerperal sepsis, toxemia,
postpartum hemorrhage and obstructed labor.8

Maternal mortality rate in Karnataka is 460 per 100,000 live births. Important
contributing causes are anemia, poverty, ignorance, malnutrition, inter current
infections, haemoglobinopathies.Haemorrhage(25.6%) ranks first as the cause of
maternal death followed by sepsis(13%), Toxemia of pregnancy (11.9%),
abortion(8.5%), obstructed labor(6.2%) while other causes together total 35.3%.9

Oladapo OT, Daniel OJ, Olatunji AO.(2006) A questionnaire-based survey of

396 maternity care-providers from 66 randomly selected peripheral delivery units in
Ogun State, Nigeria was conducted over a 2-month period, to evaluate their

3
knowledge and use of the partograph. The majority of the personnel were
nurses/midwives (45.5%) and community health extension workers (CHEW) (42.7%).
Of the 216 personnel (54.5%) who were aware of the partograph, 36 (16.7%), 119
(55.5%) and 61 (28.2%) demonstrated poor, fair and good levels of knowledge,
respectively. No junior CHEW had a satisfactory knowledge of the partograph. Only
39 (9.8%) of all the personnel routinely employed the partograph for labor
management and almost half of these individuals had a poor level of knowledge.
Efforts to limit the frequency of referred cases of established obstructed labor to the
State's referral hospital should include training of care-providers at the peripheral
delivery units, especially junior personnel in the effective use of the partograph, in
addition to employing quality assurance measures to check inappropriate use.10

Fahdhy M, Chongsuvivatwong V. (2005) A study was done in Indonesia with

the objective to assess the effectiveness of promoting the use of the World Health
Organization (WHO) partograph by midwives for labor in a maternity home by
comparing outcomes after birth. 20 midwives, who regularly conducted births in
maternity homes, were randomly allocated into two equal groups. The design of the
study was cluster randomized-control trial. Under supervision from a team of
obstetricians, midwives in the intervention group were introduced to the WHO
partograph, trained in its use and instructed to use it in subsequent labors. There were
304 eligible women with vertex presentations among 358 laboring women in the
intervention group and 322 among 363 in the control group. Among the intervention
group, 304 (92.4%) partographs were correctly completed. From 71 women with the
graph beyond the alert line, 42 (65%) were referred to hospital. Introducing the
partograph significantly increased referral rate, and reduced the number of vaginal
examinations, oxytocin use and obstructed labor. The proportions of caesarean
sections and prolonged labor were not significantly reduced. Apgar scores of less than
7 at 1min were reduced significantly, whereas Apgar scores at 5mins and requirement
for neonatal resuscitation were not significantly different. Fetal death and early
neonatal death rates were too low to compare. A training programme with follow-up
supervision and monitoring may be of use when introducing the WHO partograph in
other similar settings, and the findings of this study suggest that the appropriate time
of referral needs more emphasis in continuing education. The study concluded that the

4
WHO partograph should be promoted for use by midwives who care for laboring
women in a maternity home.11
On the basis of above literature, it is clear that knowledge of nurses regarding
use of partograph during labor is inadequate. Although a considerable amount of
experience and information on the use of the partograph has been accumulated in the
past 15-20 years it is not in use in many great countries and there are significant gaps
in our knowledge.
Considering all the above factors the investigator felt that there is a need to
assess the knowledge of staff nurses regarding use of partograph and to provide them
with instructional module that will help them to give efficient care to women during
labor.

6.3 REVIEW OF LITERATURE:

5
 Review of literature refers to the activities involved in identifying and
searching for information on a topic and developing an understanding of the state of
knowledge on that topic.(Polit).12

Gao Y, Barclay L. (2010).The study was done with the objective to

investigate the availability and quality of emergency obstetric care (EmOC) received
by women in a rural Chinese province. The study was conducted in 7 rural counties
and townships in Shanxi Province, China. Data sources included interviews with 7
hospital leaders, 5 maternal and child health workers, and 7 obstetricians; 118 records
of complicated delivery were audited, 21 Maternal and Child Health Annual Reports
analyzed, and observations conducted of facilities and advanced labor care. The study
resulted that the number of comprehensive EmOC facilities was adequate in all
counties. Three counties had fewer basic EmOC facilities than recommended and only
4 counties reached the recommended level. Most of the existing township hospitals
did not provide birthing services. All the county hospitals could perform cesarean
deliveries with rates from 6.8%-40.8%. The management of complications was not
evidence-based. For example, women with pre-eclampsia and eclampsia were given
too little magnesium sulfate; women were not closely monitored for hemorrhage after
birth and the partograph was used incorrectly with consequences for obstructed labor.
The study concluded that the Basic EmOC facilities are not adequate and township
hospitals should be upgraded to provide birthing services. The quality of EmOC is
poor and needs improvement.13

Fawole AO, Adekanle DA, Hunyinbo KI. (2010 June) A study was conducted
with the objective to assess knowledge about the partograph and its utilization among
maternity care providers in primary health care in southwestern Nigeria. Two hundred
and seventy-five maternity care providers comprising of 64 CHEWS (23.3%), 74
Auxiliary midwives (26.9%), 123 Nurses/midwives (44.7%) and 14 medical doctors
(5.1%) were interviewed in primary health centers and private hospitals in three states
in southwestern Nigeria using a multi-stage sampling strategy. Knowledge about the
partograph and assessment of labor were assessed with an interviewer-administered

6
questionnaire. The study resulted that about a quarter of respondents, 75 (27.3%) had
received prior training on the partograph. Only 25 (9.1%) reported that the partograph
was available in their labor wards. Knowledge about the partograph was poor; only 18
(16.0%) of all respondents correctly mentioned at least one component part of the
partograph, 21 (7.6%) correctly explained function of the alert line and 30 (10.9%)
correctly explained function of the action line. Prior training significantly influenced
knowledge about the partograph (gamma2 = 49.2; p < 0.05). Knowledge about
assessment of labor was also poor: less than 50% of all respondents knew the normal
duration of labor and just about 50% understood assessment for progress of labor. The
study concluded that the partograph is not utilized for labor management in Nigeria.
Knowledge about partograph and assessment during labor is grossly deficient.
Findings suggest poor quality intrapartum care. Effective interventions to improve
labor supervision skills and partograph utilization are urgently required.14

Lavender T, Hart A, Smyth RM (2008) : A study was done with the objective
to determine the effect of use of partogram on perinatal and maternal morbidity and
mortality. The study was done on 6187 women; two studies assessed partogram versus
no partogram and the remainder assessed different partogram designs. There was no
evidence of any difference between partogram and no partogram in caesarean section
(risk ratio (RR) 0.64, 95% confidence interval (CI) 0.24 to 1.70); instrumental vaginal
delivery (RR 1.00, 95% CI 0.85 to 1.17) or Apgar score less than seven at five
minutes (RR 0.77, 95% CI 0.29 to 2.06) between the groups. 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, n = 613 , one trial). The study concluded that on the basis of the
findings of this review, we cannot recommend routine use of the partogram as part of
standard labor management and care. We do recommend that the evidence presented
should be used as a basis for discussion between clinicians and women. Further trial
evidence is required to establish the efficacy of partogram use.15

7
 Orji E. (2008 Sep): The study was done in Nigeria with the objective to
evaluate the progress of labor in nulliparas and multiparas using the modified World
Health Organization (WHO) partograph. In a prospective study 259 nulliparas and
204 multiparas were compared for rates of normal labor progression in the active
phase; of cervical dilatation plots crossing the alert line of the partograph; and of plots
reaching or crossing the action line. Outcome measures were total duration of labor,
mode of delivery, incidence of labor augmentation, and number of vaginal
examinations. The study resulted that labor duration was similar in the 2 groups and
cervical dilatation remained normal for most women. In both groups, the incidence of
spontaneous vaginal delivery was highest among women with normal labor progress
and the incidence of both labor augmentation and operative intervention increased
when labor progress was delayed. The study concluded that Labor progress and
duration were found similar for nulliparas and multiparas when monitored with the
modified WHO partograph. Delay in labor progress increased the need for operative
intervention and adversely affected fetal outcome.16

A.O.Fatusi (2008 Jan) A study was done with the objective to assess the
impact of training on use of the partogram for labor monitoring among various
categories of primary health care workers. Fifty-six health workers offering delivery
services in primary health care facilities were trained to use the partogram and were
evaluated after 7 months.The study resulted that total of 242 partograms of women in
labor were plotted over a 1-year period; 76.9% of them were correctly plotted.
Community health extension workers (CHEWs) plotted 193 (79.8%) partograms and
nurse/midwives plotted 49 (20.2%). Inappropriate action based on the partogram
occurred in 6.6%. No statistically significant difference was recorded in the rate of
correct plotting and consequent decision-making between nurse/midwives and the
CHEWs.The study concluded that Lower cadres of primary health care workers can
be effectively trained to use the partogram with satisfactory results, and thus
contribute towards improved maternal outcomes in developing countries with scarcity
of skilled attendants.17

8
 Mathews JE, Rajaratnam A, George A, Mathai M. (Feb. 2007) A study
was done with the objective to compare two World Health Organization (WHO)
partographs - a composite partograph including latent phase with a simplified one
without the latent phase. The method used was Comparison of the two partographs in
a crossover trial. The study resulted that eighteen physicians participated in this trial.
One or the other partograph was used in 658 parturients. The mean (S.D.) user-
friendliness score was lower for the composite partograph (6.2 (0.9) vs. 8.6 (1.0);
P=0.002). Most participants (84%) experienced difficulty "sometimes" with the
composite partograph, but no participant reported difficulty with the simplified
partograph. While most maternal and perinatal outcomes were similar, labor values
crossed the action line significantly more often when the composite partograph was
used, and the women were more likely to undergo cesarean deliveries. The study
concluded that the simplified WHO partograph was more user-friendly, was more to
be completed than the composite partograph, and was associated with better labor
outcomes.18

Chalumeau M, et al (2002 Jun) they tested the hypothesis that the risk
factors for late stillbirth in West Africa are detectable principally shortly before or
during labor. Data came from a prospective population-based study (the MOMA
survey) that collected information about 20 326 pregnant women in seven areas,
primarily urban, in West Africa. The study resulted that there were 19 870 singleton
births. The stillbirth rate was 25.9 per 1000 total births (95% CI: 23.7-28.1). In the
crude analysis, after adjustment and consideration of prevalence, the principal risk
factors for late stillbirth were: late antenatal or intrapartum vaginal bleeding,
intrapartum hypertension, dystocia, and infection. Other risk factors were: maternal
height (<150 cm), maternal age (>35 years), previous stillbirths, hypertension at the 8-
month antenatal visit and number of antenatal visits (<2). The study concludes that the
principle risk factors for late stillbirth observed in our study could be detected only in
the late antenatal and intrapartum period. These results highlight the potential benefits
of partograph use. They need to be confirmed by studies incorporating continuous
intrapartum fetal monitoring.19

9
 Sizer AR, Evans J, Bailey SM, Wiener J.(2000Nov) A study was done in
U.K with the objective to describe a second-stage partogram based on a system of
scoring the descent and position of the fetal head and to use this system for studying
progress in the second stage of labor and predicting mode of delivery and obstetric
outcome. A prospective observational study of 1,413 women at term with a singleton,
cephalic presentation. The position and station of the fetal head were observed and
scored at diagnosis of the second stage of labor, 1 hour later, and then at 30 minute
intervals until delivery was achieved. The score at diagnosis of the second stage of
labor was assessed for its ability to predict eventual mode of delivery and duration of
labor. A normogram was defined for nulliparas and multiparas and was used to define
normal and abnormal progress in the second stage, associated factors in the first stage
of labor, and mode of delivery. The study resulted that increasing total score at the
start of the second stage of labor is associated with increasing chance of spontaneous
vaginal delivery (odds ratio [OR] 1.68 for nulliparas, 1.59 for multiparas), decreasing
chance of instrumental vaginal delivery (OR 0.67 for nulliparas, 0.64 for multiparas),
and emergency cesarean delivery (OR 0.39 for nulliparas). Abnormal progress as
defined by the normogram is associated with use of epidural anesthesia, induction of
labor, augmentation, dystocia, and increased incidence of operative delivery. No
significant difference is found between normal and abnormal second stages of labor in
fetal outcome as determined by Apgar scores. The study concluded that the second-
stage partogram offers an objective basis for management of the second stage of
labor.20

Pettersson KO, Svensson ML, Christensson K. (2000 June) A study was

done with the objective to evaluate the impact of an educational intervention of
midwives' use of the Angolan model of the World Health Organization's (WHO)
partograph. The setting used was a peripheral delivery unit with approximately 1500
deliveries per year, run by eleven midwives in Luanda, Angola. The quasi-
experimental, One-Group Pre-test-Post-test design was used in this study. Fifty
partographs plotted with an initial dilatation < 8 cm were randomly selected from the
first period of six month to form sample I, and another fifty from the second six-
months period to form sample II. In-service education (theory and practice) performed

10
by a team of midwives and an obstetrician. The study reported that when comparing
sample II with sample I, statistically significant improvements were found in seven of
10 measured variables. This indicates a positive effect of the educational intervention
on a proper use of the partograph. Due to the small sample size, however, this study
cannot evaluate action taken in relation to prolonged labor. The in-service educational
programme may be of use when introducing the WHO partograph in similar settings
and the findings of this study may indicate which parts of the programme need more
emphasis. Conclusion of the study was that the midwives improved in general their
documentation of the partograph. However, they tended to exceed established criteria
for responsibilities at the peripheral delivery unit, a fact supported by an increased
number of missed transfers. The study did not, however, answer the question why the
midwives acted as they did in the referred cases.21

Rahbar T., Atrkar Roshan Z. (1999-2000) examined the effect of

Partograph on the first stage of delivery in pregnant women who came to the delivery
section of AL-Zahra Educational hospital in 1999-2000. In this semi- experimental
study 218 samples are collected and the data collection tool was Partograph that used
in labors. Data analysis indicated that using Partograph had decreased the number of
cesarean. In order to examine relationship between the number of cesarean with using
Partograph and without it X2 statistical test was used. The results indicated that there
was a significant relationship between these two variables. (P <0.05) With using
Partograph, the average length of the first stage of delivery was 3/89 ± 2.8 H in
experimental group and 3/85 ± 3/6 H in control group. In order to compare the
average length of the first stage of delivery in experimental and control groups, T-test
was used. The result indicated that there is no significant difference between two
groups. Based on the findings the researcher recommends that as using Partograph has
decreased the number of Cesarean, the people in charge of hospitals use Partograph
for all the mothers at the time of delivery.22

11
6.4 STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of instructional module for nurses on use of

partograph during labor in selected district hospital at Bijapur, Karnataka State.

6.5 OBJECTIVES OF THE STUDY

1. To identify the pre-test knowledge of staff nurses about use of partograph

during labor.

2. To educate the staff nurses regarding use of partograph during labor by using
instructional module.

3. To reassess the post test knowledge of staff nurses regarding use of partograph
during labor.

4. To identify the relationship between post test knowledge and selected

demographic variables.

 Demographic Variables

1. Age : 20-30 years

30-40 years

40-50 years

2. Sex : Male nurses

Female nurses

3. Religion : Christian, Hindus,

Muslims, Others.

4. Education: Auxiliary Nurse

Midwives;

General Nursing; Bachelor

of Nursing.
12
 5. Designation: Charge Nurses, Staff Nurses,

Assistant Nurses.

6. Is there any Continuous

Nursing Education given ?: Yes ( )

No ( )

7. Do you have any

Labor Room experience? : Yes ( )

No ( )

8. Have you used

Partograph before? : Yes ( )

No ( )

6.6 OPERATIONAL DEFINITIONS:

1. Assess:

It refers to judging the worth of instructional module on nurses

regarding the use of partograph during labor.

2. Effectiveness:

It refers to the capacity of instructional module on partograph and its

use by nurses during labor.

3. Instructional module:

13
 It refers to systematically organized directive on the use of partograph
during labor.

4. Nurses:

It refers to the trained nurses working in selected district hospital in Bijapur.

5. Partograph:

It refers to the graphical recording of maternal and fetal condition during labor
by the nurses of selected hospitals.

6. Labor:

It refers to the process by which the fetus, placenta and membranes are

expelled through the birth canal.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA : All the nurses working in the selected

district hospital at Bijapur.

7.2 METHODS OF COLLECTION

OF DATA : Questionnaire method.

7.2.1 SAMPLING CRITERIA :

INCLUSION CRITERIA : Charge Nurses, Staff nurses, Assistant Nurses,

auxiliary nurse midwives working at selected

hospitals at Bijapur.

 Who are in the age group of 20-50 years

 Who are present at the time of the study

and willing to participate in the study?

14
 EXCLUSION CRITERIA : Nurses who are

 Above 50 years of age

 Not willing to participate at the time of

data collection.

7.2.2 RESEARCH DESIGN : A Quasi experimental study is

planned for the research study.

7.2.3 VARIABLES UNDER STUDY

 Dependent Variable : Knowledge of staff nurses on use

of partograph during labor.

 Independent Variable : Instructional module on use of

partograph during labor for nurses.

7.2.4 SETTING : Selected district hospital, Bijapur.

7.2.5 POPULATION : Nurses working in selected district

hospital Bijapur will be the
population of this study.
7.2.6 SAMPLING TECHNIQUE : The sampling technique adopted for

the study is purposive sampling

15
 technique.

7.2.7SAMPLE SIZE : The sample size for the present study

is 100 nurses working at the district

hospital at Bijapur.

TOOL OF RESEARCH : Structured knowledge questionnaire

will be constructed in 2 parts and an

instructional module.

Part 1 : Demographic data

Part 2 : Knowledge based questions regarding

use of partograph during labor.

7.2.8 COLLECTION OF DATA : The data will be collected using structured

knowledge questionnaire method. The

investigator will obtain the written

permission from the district

surgeon/health officer of the District

hospital at Bijapur. Nurses will be

selected using random sampling

technique method. The purpose of the

study will be explained.

16
7.2.9 METHODS OF DATA ANALYSIS AND PRESENTATION:

The method used for data analysis is the descriptive and

inferential statistics.

1. Descriptive statistic analysis includes percentage (%) Percentage, mean,

median, frequency and standard deviation for nurses regarding use of
partograph during labor in district hospital, Bijapur.
2. Inferential Statistics includes independent “t test, paired -t test” chi-square
test and Anova test for the assessment of knowledge and to associate with
socio demographic variable.

7.3 Does the study require any investigation or intervention to be conducted on

patients or other humans or animals? If so, describe briefly?

Yes, the study will be conducted on nurses to assess the knowledge on use of
partograph during labor.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, informed. Consent will be obtained from concerned authority and subject
prior to the study.

17
8. LIST OF REFERENCES:

1.Raddi S.A, et al,“ A study to identify lived experiences of woman with pregnancy
induced hypertension”.Nightingale Nursing times 2007 March:36-37.

2.Sridevi. R, “Use of partograph on outcome of labor”, Nightingale Nursing times

,Vol-6,No.-1, 2010 April: 29-39.

3.Annamma Jacob, “A Comprehensive Textbook of Midwifery”, 2nd

edition,2008,Jaypee publications, New Delhi ,Page no. 151.

4.Margaret M. Opiah, “Factors affecting utilization of partograph in monitoring labor

in selected hospital in Beyelsa State,2001 Jan, African Journal of Primary health care
and Family Medicine.http://www.phcfm.org.

5.World Health Organization. Reduction of maternal mortality. A Joint

WHO/UNFPA/UNICEF/World Bank Statement. World Health Organization, Geneva
1999.

6.Federal Ministry Of Health, Nigeria/UNICEF. Women and Children friendly health

services in Nigeria:National Guidelines (Standards,Criteria and Key indicators). 2004.

7.Dr. Muhammed El Hennawy, “WHO Partograph for beginners”,

8.J.Kamini, “Assessment of knowledge, attitude and practices of pregnant woman on

selected aspects of antenatal care”,Nightingale nursing times,2007 feb:60-61.

9.Susheela, “Maternal mortality the journal of family welfare”, 1997:42(1): 2-5.

10.Oladapo O T, et al, “Knowledge and use of the partograph among health care
personnel at the peripheral maternity centers in Nigeria,” [serial online] 2006 Aug;
[cited on 2010 Oct 23] 26(6):538-41. http://www.pubmed.com

18
11.Fahdhy M,Chongsuvivatwong V,“Evaluation of partograph implementation by
Midwives for maternity home birth in Medan, Indonesia”, [serial online] 2005 Dec;
[cited on 2010 Oct 16]21(4):301-10. http://www.pubmed.com

12.Denise F. Polit,et al, “Essentials of nursing research”,7 edition,2010,Wolters

Kluwer/ Lippincott Williams and Wilkins,Philadelphia, Page no.

13.Gao Y, Barclay L, “Availability and quality of emergency obstetric care in Shanxi

Province, China”, Int.J. Gyneacol obstet, 2010 Aug; 110 (2): 181-5.E pub,2010 Jun 8,
http://www.pubmed.com

14.Fawole A O, et al “Utilization of the partograph in Primary Health Care facilities

in south western Nigeria”, Niger J Clin Pract, 2010 June; 13(2): 200-4.
http://www.pubmed.com

15.Lavender T, et al “Effect of Partogram use on outcomes for women in spontaneous

labor at term,” Cochrane Database Syst Rev, 2008 Oct 8 ;( 4).
http://www.pubmed.com

16.Orji E, “Evaluating progress of labor in nulliparous and multiparous using the

modified WHO Partograph,” Int J Gynaecol Obstet,2008 Sept; 102(3):249-52.
http://www.pubmed.com

17.A.O.Fatusi, et al, “Evaluation of health workers training in use of the

Partogram”,International Journal of Gynaecology and obstetrics, Jan
2008,Volume100,issue1,Pages41-44.http://www.ijgo.org/article/S0020-7292(07)

18.Mathews J E et al, “Comparison of two WHO partographs”, Int J Gynaecol Obstet,

2007 Feb; 96(2):147-50. http://www.pubmed.com

19.Chalumeau M, et al, “Can clinical risk factors for late still birth in west Africa be
detected during antenatal care or only during labor?”, [serial online],2002 Jun [cited
on 2010 Oct 16], 31 (3):661-8. http://www.pubmed.com

20.Sizer AR, et al, “ A second stage partogram”, Obstet and Gynaecol,

Nov2000,Volume96,issue 5, Part 1-p 678-683. http://www.pubmed.com

19
21.Pettersson KO, et al. “Evaluation of an adapted model of the WHO partograph
used by Angolan Midwives in a periphery delivery unit”, Midwifery 2000 Jun; 16 (2):
82-8. http://www.pubmed.com

22.Rahbar T, Atrkar Roshan Z, “Effect of partograph on First Stage of Labor, Medical

Faculty Journal of Guilan Univ. Med Sciences, 2003 Nov[cited on 2010 Oct 24]
http://www.pubmed.com

20
9. SIGNATURE OF CANDIDATE:

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12.1 REMARKS OF THE PRINCIPAL

12.2 SIGNATURE

21