Towards improved, individualized labor care with the WHO next-generation partograph: the PICRINO trial

The overall aim is to evaluate the impacts on neonatal and maternal outcomes of adopting one of two different guidelines for monitoring labor: 1) the newly developed World Health Organization (WHO) Labour Care Guide (LCG); and 2) the currently used standard care guidelines.

The LCG promotes woman-centered care, includes new definitions of onset and progress of labor, and emphasizes the monitoring of supportive care.

However, no randomized controlled trials (RCTs) to date have compared the LCG with standard care with regards to safety and other key outcomes of labor in a high-resource setting.Study design: A national multicenter stepped wedge cluster RCT. Outcome data will be collected from Swedish Health Registers, questionnaires, and interviews.

Population: Women in active labor at 24 participating Swedish maternity wards, randomized to 6 clusters.Intervention: Use of the LCGControl: Use of standard care guidelines.Outcomes: Primary: 1) a neonatal core outcome set; and 2) the rate of intrapartum Cesarean section.Secondary: neonatal and maternal outcomes, women’s and partner’s experiences of childbirth, obstetric staff experiences of LCG, economic evaluation, implementation determinants and outcomes.The main clinical benefit of introducing LCG is expected to be a reduction of adverse neonatal outcomes and decreased numbers of Cesarean sections during labor.

In addition, we expect to see a higher degree of satisfaction among the participating women, partners, and providers.