Despite the recommendation of the WHO on the use of the partograph for tracking labour progress and identifying complications, its utilisation in many low- and middle-income countries (LMICs) remains suboptimal, ranging between 20% and 80% (1). Several barriers contribute to this limited uptake, including inadequate training, insufficient knowledge and resources among healthcare providers, poor attitudes and clinical skills, and systemic challenges such as weak clinical leadership and lack of quality assurance mechanisms. Strategies to improve adherence include on-the-job training, supportive supervision, and addressing context-specific barriers. While emerging technologies may help overcome these challenges, further evaluation is required to determine their feasibility and effectiveness (1, 2).

Digital technologies such as the electronic partograph are transforming how labour and birth are documented. Recent studies have shown that the digital paperless partograph is more user-friendly and preferred by healthcare providers, resulting in higher completion rates and improved staff compliance (3). It has demonstrated effectiveness comparable to the WHO partograph in managing labour, with similar maternal and perinatal outcomes (4). In high-volume settings, the digital paperless partograph is simpler to use and may serve as a viable alternative to the WHO-modified version (5). Overall, it is an efficient, user-friendly tool for monitoring labour and promoting safe delivery practices (3–5).

The systematic review of partograph adherence trends in healthcare services recommends on-the-job training, routine monitoring, and supportive supervision to improve compliance. It emphasises the importance of partograph use in improving maternal and neonatal outcomes and calls for further research to identify effective interventions (1). The developed device digitises the traditional paper partograph, enables simultaneous patient recording, and provides a decision support system to detect abnormalities during labour. The objective of the digital paperless version is to enhance the safety, efficiency, and quality of labour monitoring (6). Future studies should focus on developing effective, non-invasive methods for assessing labour progress while simultaneously collecting data on an electronic “partograph” for accurate documentation with emphasis on the preferences and views of the women in labour (7). The electronic partograph is a tool designed to enhance the care of women in labour by addressing challenges in the use of traditional partographs. It offers real-time decision support, improved data entry, and increased access and transfer of information for effective labour management (8).

Innovations in partograph technologies are increasingly being explored to address existing gaps. This scoping review maps the range of existing innovations in partograph tools and technologies, with a focus on their application in documenting labour progress and birth outcomes. It aims to identify trends, gaps, and opportunities for future research and implementation. This scoping review was conducted on the basis of the population, concept, and context (PCC) framework. See details in Table 1. The population constituted adult women in labour; the concept involved mapping existing innovations in partograph technologies for monitoring progress of labour; and the context was global.

The review aims to answer the following question: 1.

What are the existing innovations in partograph technologies used to document the progress of labour and birth globally?

This scoping review was carried out in accordance with the method suggested by Arksey and O'Malley (9, 10). The review followed five steps: identifying the research question; searching for relevant studies; selecting appropriate studies; charting the data; and collating, summarising, and reporting results. Recommendations by Levac and colleagues were taken into consideration throughout the process (11). A scoping study approach enables a systematic search, selection, and examination of the literature, as well as synthesis and mapping of evidence to address research questions (9, 10). The Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR) was used to present the scoping review (11). The PRISMA-ScR provides a reporting guideline comprising 20 essential items and two optional items for this scoping review (11). This guideline facilitates methodological transparency and acceptance of research findings (11). The protocol for this scoping review has been registered with the Open Science Framework (https://osf.io/m96tw/).

Step 1: identifying the research question: the present scoping review aims to answer the following question

This scoping review reveals that electronic partographs (e-partographs) are increasingly recognised as feasible and effective tools for improving labour monitoring. Evidence from Bangladesh and rural India shows that e-partographs enhance user compliance, reduce caesarean section rates, and shorten prolonged labour durations, contributing to better quality of maternal care (2, 16). Consistent with this result, a study in Tanzania demonstrated rapid skill acquisition among skilled birth attendants (SBAs) using the e-partograph. Across 84 shifts monitoring 103 women, 87%–91% of SBAs completed tasks confidently by their first shift, reaching full proficiency by the fifth shift. Most SBAs (93%) reported comfort and efficiency in using the tool, highlighting its usability and adaptability in clinical settings (8). Further evidence from Ethiopia reinforces these findings, where two-thirds of obstetric healthcare providers expressed intent to adopt mobile-based partographs. Their motivation was strongly influenced by perceived usefulness, ease of use, relevance to their roles, and positive attitudes towards digital tools (25). Together, these studies suggest that e-partographs are not only technically viable but also well accepted by frontline healthcare workers. Their integration into labour management protocols could significantly improve decision-making, reduce complications, and enhance maternal and neonatal outcomes, particularly in low-resource settings.

This review underscores the growing potential of mobile-based partograph technologies in improving labour monitoring and maternal outcomes. A study from Kenya demonstrated that an Android tablet-based e-partograph significantly enhanced foetal outcomes and supported timely interventions to maintain normal labour. Healthcare providers found the tool to be adoptable and practical in clinical settings (20). These findings align with those of earlier research suggesting that digital paperless partographs can effectively replace the WHO-modified partograph, offering a more efficient and user-friendly alternative for labour monitoring and safe delivery (3–5). The consistent usability and acceptability across different contexts highlight the importance of designing mobile-based partographs that meet both job requirements and user expectations. Such tools not only streamline clinical workflows but also empower frontline staff to make timely decisions, particularly in resource-constrained environments. Their successful adoption depends on intuitive design, relevance to clinical tasks, and integration into existing maternal health systems. This review found that digital paperless partographs, as evaluated across studies from India and Egypt, were as effective as the WHO-modified partograph in monitoring labour and guiding clinical decision-making. These tools offer a simpler, time-efficient, and user-friendly alternative, making them particularly suitable for settings with high patient volumes and limited staffing (1, 5, 14, 18, 19). Importantly, the digital paperless partograph demonstrated delivery durations comparable to those managed with the WHO partograph, indicating clinical reliability. Its ease of use and minimal training requirements make it highly adaptable for peripheral health centres, where resources are often constrained. Moreover, its implementation does not incur additional costs, making it a practical solution for improving maternal care and potentially reducing maternal mortality in low-resource environments (3–5). These findings suggest that the digital paperless partograph could serve as a scalable and sustainable innovation in labour monitoring, especially in underserved healthcare systems.

This scoping review identified the potential of DAKSH to enhance patient care and reduce the workload of healthcare providers. Developed through iterative testing and user feedback, DAKSH includes built-in checks that improve the completeness and accuracy of patient records, supporting better clinical documentation and decision-making (17). The value of partograph use is further reinforced by a study conducted by Ahmed et al., which showed that labour monitored with a partograph, as compared to no partograph, resulted in improved tracking of labour progress and better delivery outcomes (15). These findings emphasise the importance of structured monitoring tools in improving maternal and neonatal care. In addition, previous studies have shown that tablet-based electronic partographs address common challenges in traditional partograph use. They offer real-time decision support, streamline data entry, and improve access to clinical information, all of which contribute to more effective labour management (8). These digital tools not only enhance the quality of care but also support timely interventions, coordination among providers, and better health outcomes. Collectively, the evidence suggests that mobile- and tablet-based partograph applications, when well designed and integrated into routine practice, can significantly strengthen intrapartum care, especially in resource-constrained settings.

In summary, the current research landscape demonstrates a clear shift towards more objective, technology-driven approaches to labour monitoring. Digital partographs—particularly those delivered via mobile- and tablet-based applications—show strong potential to enhance clinical decision-making, reduce adverse outcomes, and improve the overall quality of maternal care.

However, while these technologies offer significant clinical advantages, their successful implementation in LMICs demands more than technical innovation alone. Key challenges include infrastructural constraints such as unreliable electricity and internet connectivity, which can impede the consistent use of digital tools in rural or under-resourced settings. Furthermore, limited digital literacy among healthcare workers remains a barrier, as many frontline providers may lack the training or confidence to use new technologies effectively without ongoing support.

Sustainability is another critical concern. Many digital health interventions are introduced through externally funded pilot projects, yet long-term adoption hinges on integration into national health systems, alignment with policy frameworks, and sustained investment in maintenance and capacity-building. Without these elements, there is a risk of abandonment or underutilisation.

This review also underscores the importance of designing user-centred and context-appropriate tools that align with the workflows and expectations of healthcare providers. When effectively integrated, digital partographs can support real-time decision-making, improve data quality, and facilitate timely referrals—ultimately contributing to better maternal and neonatal outcomes.

In conclusion, digital partographs represent a promising innovation in maternal and neonatal healthcare. To realise their full potential, coordinated efforts among practitioners, policymakers, and researchers will be essential to overcome implementation barriers and ensure equitable access across diverse healthcare settings.