Dystocia and Birth Asphyxia: The Digital Partogram

Harshad Sanghvi, M.D.

Vice President and Medical Director, Jhpiego Senior Advisor, Accelovate/USAID Senior Associate, Bloomberg School of Public Health Johns Hopkins University Shoval Dekel ME Product development Engineer, Jhpiego

Global Newborn Health conference, Johannesburg, South Africa

The WHO Paper Partogram

A paper record to monitor labor for Wellbeing of mother Wellbeing of baby Progress of labor Demonstrated to Reduce obstructed labor Unnecessary surgery Sepsis Perinatal and newborn mortality
From WHOs MCPC manual

Partogram
Widely adopted in policy and guidelines, but uneven coverage in effective use Multiple types may be in use in a country Perceived advantages Organizes observations Allows FHW to make sound labor management decisions, predict as well as identify problems Allows rapid handover during shift changes and between providers Useful for quality check and audit Perceived disadvantages Frontline providers find it difficult to plot, and time consuming ( 13+ variables) May not see the benefit We are very prescriptive on frequency of observations even if all is well Often used as a record keeping tool rather than a decision making tool Often not transferred with patient in referral

Intent with the Smart Partogram

Efficiency in entering and plotting observations Automatic graphing Reminds and prompts providers to take critical measurements Provides alerts and alarms for decision-making support if complications are predicted or occur Limits back entry of data onto the partogram after delivery Transmits all observations to central level remote supervisor for guidance and support (telemedicine module) Stores multiple patient data in one device Plan to automate 2 time consuming observations: FHR, contractions

better management of labor and delivery

Generation 1 Full Custom Device Sensor Belt Generation 2 Partoboard (paper based electronic device) Full Custom Device Tablet app Sensor Belt Generation 3 Application to work on an existing device with an operating system (Tablet-like)

ePartogram

Redesign of the Partogram: Partnering with NID Ahmedabad

Cervical Dilation
Faster than 1cm per hour Normal Every 2 hours Less than 1 cm per hourfor up to 4 hours Low Level Every 2 hours If FHR is Low Level High Level Less than 1 cm per hourfor more than 4 hours High Level N/A (requires immediate intervention)

Alarm Reminder Comments

Endusers provide feedback at every stage

Low cost, rapid location of FH tones

Short search time, signal present on large area

A device to obtain the FHR quickly, reliably, with minimal skill, at a low cost that enables widespread distribution

Strong Correlation between Doppler and Baby Beats monitor

E-partogram Project Trajectory

2012 Define User needs and product requirementsKenya providers and Jhpiego clinical and field advisors Currently Optimizingdevice, size, functionality and cost Regulatory process (FDA Class 1) Work with suppliers

2014 Field Studyeffectiveness, feasibility, acceptability

Initial Concept Development Jhpiego and JHU-CBID

2012-ongoing Clinical algorithms and software programming; prototype development; user interface; simulation exercises; user workflow observations; telemedicine module

Fall 2013 Pilot test with Shadow Providers

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