Trial reportNature medicine2024
Effects of the WHO Labour Care Guide on cesarean section in India: a pragmatic, stepped-wedge, cluster-randomized pilot trial.
Trial report in Nature medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07445373 (Role of WHO Labour Care Guide in Improving Maternal and Fetal Outcomes in Primi and Multigravida in Labour), which is not on this map. Cited by 20 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Role of WHO Labour Care Guide in Improving Maternal and Fetal Outcomes in Primi and Multigravida in Labour
Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- FIGO position statement on the use of the WHO labor care guide versus the partograph.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Guideline
- Clinical pathways for secondary care and the effects on professional practice, patient outcomes, length of stay and hospital costs.The Cochrane database of systematic reviews · 2025Pooled it
- Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study.International journal of women's health · 2025Trial
- Toward Labour-Care Tools That Survive Low-Resource Realities: Reflections From the PartoMa Group on the WHO Labour Care Guide Implementation Strategy.Birth (Berkeley, Calif.) · 2026Article
- A multi-faceted hospital-based intervention for intrapartum care in sub-Saharan Africa: a stepped-wedge cluster-randomized trial.Nature medicine · 2026Article
- Associations between organizational readiness and implementation fidelity in national implementation of WHO's labour care guide in Sweden: a prospective observational study.Implementation science communications · 2026Article
- World Health Organization Labor Care Guide: scientific rationale, global adoption, and early policy implementation in the Republic of Moldova.AJOG global reports · 2026Article
- Neural network approach for predicting outcomes of external cephalic version for breech presentation: a retrospective cohort study.Journal of Zhejiang University. Science. B · 2026Article
- Developing a Co-Designed Strategy to Improve Labor Monitoring and Management in India Using the World Health Organization Labour Care Guide: A Mixed-Methods Formative Study.Birth (Berkeley, Calif.) · 2026Article
- Article
- Mothers' experiences of implementing a normal labor and delivery management program based on evidence-based clinical practice in Iran.Journal of education and health promotion · 2026Article
- Acceptability of the WHO labor care guide among midwives in Tanzania: an exploratory qualitative study.Frontiers in public health · 2026Article
- The influence of advanced maternal age on the success rate, delivery mode and maternal and fetal outcomes of pregnant women undergoing external cephalic version: a retrospective cohort study.BMC pregnancy and childbirth · 2025Article
- Effects of World Health Organization labor care guide on maternal and neonatal outcomes: A systematic review and meta-analysis.International journal of reproductive biomedicine · 2025Article
- Article
- Effectiveness of the modified WHO labour care guide to detect prolonged and obstructed labour among women admitted at publicly funded facilities in rural Mbarara district, Southwestern Uganda: an ambispective cohort study.medRxiv : the preprint server for health sciences · 2024Article
- Article
- Delivering high-quality childbirth care.Nature medicine · 2024Article
- Editorial: New technologies improve maternal and newborn safety.Frontiers in medical technology · 2024Article
- A multimodal model in the prediction of the delivery mode using data from a digital twin-empowered labor monitoring system.Digital healthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
29 authors at 11 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Cesarean section rates worldwide are rising, driven by medically unnecessary cesarean use. The new World Health Organization Labour Care Guide (LCG) aims to improve the quality of care for women during labor and childbirth. Using the LCG might reduce overuse of cesarean; however, its effects have not been evaluated in randomized trials. We conducted a stepped-wedge, cluster-randomized pilot trial in four hospitals in India to evaluate the implementation of an LCG strategy intervention, compared with routine care. We performed this trial to pilot the intervention and obtain preliminary effectiveness data, informing future research. Eligible clusters were four hospitals with >4,000 births annually and cesarean rates ≥30%. Eligible women were those giving birth at ≥20 weeks' gestation. One hospital transitioned to intervention every 2 months, according to a random sequence. The primary outcome was the cesarean rate among women in Robson Group 1 (that is, those who were nulliparous and gave birth to a singleton, term pregnancy in cephalic presentation and in spontaneous labor). A total of 26,331 participants gave birth. A 5.5% crude absolute reduction in the primary outcome was observed (45.2% versus 39.7%; relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care outcomes were not significantly different, though labor augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for other health outcomes or women's birth experiences. These findings can guide future definitive effectiveness trials, particularly in settings where urgent reversal of rising cesarean section rates is needed. Clinical Trials Registry India number: CTRI/2021/01/030695 .
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.