FIGO position statement on the use of the WHO labor care guide versus the partograph

Abstract

The partograph, a graphical tool for recording labor events and assessing progress, was initially introduced by Dr. Emmanuel Friedman in 1954. Subsequent development by Philpott and Castle led to the widely adopted partograph in 1972. The World Health Organisation (WHO) endorsed its use in all labor wards in 1994, based on a multicenter trial demonstrating a significant reduction in prolonged labor, labor augmentation, emergency caesarean sections, and intrapartum stillbirths. In 2018, the WHO updated its global recommendations on intrapartum care, prompting a revision of the partograph. This resulted in the 2020 launch of the WHO Labor Care Guide (LCG), a supplementary monitoring tool. The LCG comprises seven sections, focusing on information at admission, supportive care, maternal and fetal care, labor progress, medication, and shared decision-making. Unlike the classic partograph, the LCG considers the active phase of labor to begin at a cervical dilatation of 5 cm. This evolution reflects ongoing efforts to improve maternal and fetal outcomes through evidence-based labor management. In this position statement FIGO recommends that the WHO LCG should be universally adopted and used to monitor labor in all settings to reduce maternal and perinatal mortality, and to support the implementation of the WHO recommendations: intrapartum care for a positive childbirth experience.