Background: Unnecessary caesarean section (CS) and suboptimal labour monitoring remain important challenges in maternity care. The World Health Organization (WHO) Labour Care Guide (LCG) was introduced as a next-generation tool to support individualized, woman-centred intrapartum care and to improve clinical decision-making beyond rigid partograph thresholds.
Objective: To evaluate the impact of implementing the WHO LCG on caesarean section rate, labour progress monitoring, and neonatal outcomes in a tertiary care setting.
Materials and Methods: A tertiary-care observational cohort study was conducted among term, low-risk women admitted in active labour (?5 cm cervical dilatation) and monitored using the WHO LCG. Data were recorded using structured labour monitoring documentation and analysed using descriptive statistics (n, %), with 95% confidence intervals for key proportions.
Results: A total of 105 women were included. The majority were primigravida (76.2%). Labour onset was spontaneous in 52.4% and induced in 47.6%. Normal vaginal delivery occurred in 90.5% (95% CI: 83.4-94.7), instrumental delivery in 1.9% (95% CI: 0.5-6.6), and caesarean section in 7.6% (95% CI: 3.9-14.3). The most common indication for CS was fetal distress (62.5%), followed by cephalopelvic disproportion (25.0%) and deep transverse arrest (12.5%). Neonatal outcomes showed respiratory distress in 6.7% (95% CI: 3.3-13.1) and low Apgar score in 10.5% (95% CI: 6.0-17.7). Overall findings suggest that LCG-based monitoring was feasible in a tertiary setting and was associated with a high vaginal birth rate and acceptable neonatal outcomes within this low-risk cohort.
Conclusion: Implementation of the WHO Labour Care Guide in a tertiary care labour ward supported structured monitoring and decision-making, with low CS rate and reassuring neonatal outcome profile in low-risk term pregnancies. Further controlled implementation studies are recommended to confirm causal impact and to evaluate documentation quality and woman-centred care indicators.
International Journal of Clinical Obstetrics and Gynaecology
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