Can the use of a next generation partograph based on WHO’s latest intrapartum care recommendations improve neonatal outcomes? A stepped-wedge cluster randomized trial (PICRINO))

The overall aim of the proposed research is to evaluate the impact of the use of two different guidelines for monitoring labor progress, the World Health Organization (WHO) Labour Care Guide 2020 (LCG) versus standard care, on neonatal outcomes.

The hypothesis is that the use of LCG will reduce severe neonatal outcomes compared with standard care.In 2018, the WHO changed their recommendations for the definition of onset and progress of labor, and in 2020 they published a new guideline for labor care (LCG).

Compared with standard care guidelines used in Sweden today, the woman reaches active phase of labor at a later cervical opening, and a slower labor progress is accepted.

Further, LCG emphasizes patient engagement and care individualization to a higher extent than is the case in current guidelines.

No study has compared LCG with standard care in regard to severe neonatal and maternal outcomes.Population: Women in active labor at participating sites between 2023 through 2025.

All 46 delivery units in Sweden will be invited to participateIntervention: Use of the LCG in women in active labor, introduced by a stepped-wedge cluster randomization design.Control: Use of standard care labor guidelines.Outcome: Primary: Severe neonatal outcomes.

Secondary: Less severe neonatal outcomes, maternal outcomes, women and partner experiences of childbirth and obstetric team experiences.