WHO Labour Care Guide versus WHO Modified Partograph: A Narrative Review of Evidence, Clinical Utility, and Implementation Challenges

Abstract

Background: Effective intrapartum monitoring is vital for identifying abnormal labour and enabling timely interventions to reduce maternal and perinatal morbidity. The WHO Modified Partograph has been widely used for decades. The WHO Labour Care Guide (LCG), released after WHO’s 2018 intrapartum care recommendations, was developed to address limitations of earlier tools and to promote respectful, individualized care. Comparative evidence on clinical outcomes, usability, and implementation is growing but remains limited.

Objective: To synthesize and appraise published evidence comparing the WHO LCG with the WHO Modified Partograph, focusing on clinical utility, detection performance (e.g., prolonged/obstructed labour), user experience, and implementation challenges—particularly in low-resource settings.

Methods: A narrative review searched major databases, WHO and NGO guidance sites, and grey literature using terms such as “Labour Care Guide,” “WHO LCG,” “modified partograph,” “intrapartum monitoring,” and “labour outcomes.” Eligible reports comprised randomized and non-randomized studies, systematic reviews, implementation evaluations, and guideline documents assessing performance, outcomes, or implementation of either tool.

Results: Both tools monitor labour progress and maternal–fetal well‑being but differ structurally and operationally: the LCG defines active labour from 5 cm, omits traditional alert/action lines, explicitly documents second‑stage monitoring, and emphasizes respectful, individualized care; the Modified Partograph typically starts at 4 cm and uses alert/action lines. Some studies report higher detection rates of prolonged/obstructed labour with the LCG, while earlier studies and programmatic reports associate correct partograph use with reduced prolonged labour and fewer operative births. Systematic reviews underscore limited high‑quality evidence and variable effects dependent on fidelity of use. Common implementation barriers include insufficient training, perceived documentation burden, interpretation challenges, and resource constraints. Comparative randomized trials and robust implementation research are scarce.

Conclusions: The LCG introduces meaningful conceptual and practical changes that may enhance detection of abnormal labour and patient experience, but current evidence does not conclusively show superior maternal or neonatal outcomes over the Modified Partograph. Priorities are rigorous comparative trials, pragmatic implementation research, focused training and user supports, and context‑adaptation guidance.