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Case Pres Partograph
Case Pres Partograph
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WHAT IS PARTOGRAPH??
A partograph is a graphical record of the observations made of a women in labour
For progress of labour and salient conditions of the mother and fetus
It was developed and extensively tested by the world health organization WHO
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History Of Partogram
Friedman's partogram devised in 1954 was based on observations of cervical dilatation and foetal station against time
elapsed in hours from onset of labour. The time onset of labour was based on the patient's subjective perception of her
contractility. Plotting cervical dilatation against time yielded the typical sigmoid or 'S' shaped curve and station against
time gave rise to the hyperbolic curve.
Limits of normal were defined
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WHO partograph:
Overview
The partograph can be used by health workers with adequate training in midwifery who are able to :
observe and conduct normal labour and delivery.
Perform vaginal examination in labour and assess cervical diltation accurately
plot cervical diltation accurately on a graph against time
There is no place for partograph in deliveries at home conducted by attendants other than those trained in midwifery
Whether used in health centers or in hospitals , the partograph must be accompanied by a program of training in its
use and by appropriate supervision and follow up.
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Objectives
Early detection of abnormal progress of a labour prevention of prolonged labour
Recognize cephalopelvic disproportion long before obstructed labour
Assist in early decision on transfer , augmentation , or terminjation of labour
Increase the quality and regularity of all observations of mother and fetus
Early recognition of maternal or fetal problems
The partograph can be highly effective in reducing complications from prolonged labor for the mother (postpartum
hemorrhage, sepsis, uterine rupture and its sequelae) and for the newborn (death, anoxia, infections, etc.).
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Partograph function
The partograph is designed for use in all maternity settings , but has a different level of function at different levels of
health care in health center, the partograph/s critical function is to give early warning if labour is likely to be prolonged
and to indicate that the woman should be transferred to hospital (ALERT LINE FUNCTION )
In hospital settings, moving to the right of alert line serves as a warning for extra vigilance , but the action line is the
critical point at which specific management decisions must be made other observations on the progress of labour are
also recorded on the partograph and are essential features in management of labour.
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Fetal heart
rate
Basal fetal
heart rate
< 160 beats/mi =tachycardia
> 120 beats/min = bradycardia
>100 beats/min = severe bradycardia
Decelerations? yes/no
Relation to contractions?
- Early
- Variable
- Late –-----Auscultation - return to baseline
> 30 sec contraction
----Electronic monitoring peak and trough (nadir)
> 30 sec
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:latent phase
it starts from onset of labour until the cervix reaches 3 cm diltation
once 3 cm diltation is reached , labour enters the active phase
lasts 8 hours or less
each lasting <20 sceonds
at least 2/10 min contractions
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:Active phase
Contractions at least 3 / 10 min
each lasting < 40 sceonds
The cervix should dilate at a rate of 1 cm / hour or faster
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Cervical diltation
It is the most important information and the surest way to assess progress of labour , even though
other findings discovered on vaginal examination are also important
when progress of labour is normal and satisfactory , plotting of cervical diltation remains on the
alert line or to left of it
if a woman arrives in the active phase of labour , recording of cervical diltation starts on the alert
line
when the active phase of labor begins , all recordings are transferred and start by pltting cervical
diltation on the alert line
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Fetal position
Occiput transverse positions
Uterine contractions
Observations of the contractions are made every hour in the latent phase and every half-hour in the
active phase frequency how often are they felt ?
Assessed by number of contractions in a 10 minutes period duration how long do they last ?
Measured in seconds from the time the contraction is first felt abdominally , to the time the contraction
phases off
Each square represents one contraction
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Palpate number of contraction in ten minutes and duration of each contraction in seconds
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One of the main functions of the partograph is to detect early deviation from normal progress of labor
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Prolonged Active phase
In the active phase of labor , plotting of
cervical diltation will normally remain
on or to the left of the alert line
But some cases will move to the right of
the alert line and this warns that labor
may be prolonged
This will happen if the rate of cervical
diltation in the active phase of labor is
not 1 cm / hour or faster
A woman whose cervical diltation moves to
the right of the alert line must be
transferred and manged in a hospital with
adequate facilities for obstetric
intervention unless delivery is near at
the action line , the woman must be
carefully reassessed for why labor is not
progressing and a decision made on
further management
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Precipitate Labour
- Maximum slope of dilatation of 5 cm/hr or more
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1. It is important to realize that the partograph is a tool for managing labor progress only
2. The partograph does not help to identify other risk factors that may have been present before labor started
3. Only start a partograph when you have checked that there are no complications of pregnancy that require immediate
action
4. A partograph chart must only be started when a woman is in labor,-- be sure that she is contracting enough to start a
partograph
5. If progress of labor is satisfactory , the plotting of cervical diltation will remain or to the left of the alert line
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6. When labor progress well , the diltation should not move to the right of the alert line
7. The latent phase . 0 – 3cm diltation , is accompanied by gradual shortening of cervix . normally , the latent phase should
not last more than 8 hours
8. The active phase , 3 – 10 cm diltation , should progress at rate of least 1 cm/hour
9. When admission takes place in the active phase , the admission diltation, is immediately plotted on the alert line
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10. when labor goes from latent to active phase , plotting of the diltation is immediately transferred from the latent phase
area to the alert line
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11. diltation of the cervix is plotted ( recorded with an X , desent of the fetal head is plotted with
an O , and uterine contractions are plotted with differential shading
12. desent of the head should always be assessed by abdominal examination ( by the rule of fifths felt
above the pelvic brim ) immediately before doing a vaginal examination
13. assessing descent of the head assists in detecting progress of labor
increased molding with a high head is a sign of cephalopelvic disproportion
14. increased molding with a high head is a sign of cephalopelvic disproportion
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15. vaginal examination should be performed infrequently as this is compatible with safe practice ( once
every 4 hours is recommended )
16. when the woman arrives in the latent phase , time of admission is 0 time
17. a woman whose cervical diltation moves to the right of the alert line must be transferred and manged
in an institution with adequate facilities for obstetric intervention , unless delivery is near.
18. when a woman ,s partograph reaches the action line , she must be carefully reassessed to determine
why there is lack of progress , and a decision must be made on further management ( usually by an
obesterician or resident )
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19. when a woman in labor passes the latent phase in less than 8 hours i.e., transfers from latent to active
phase , the most important feature is to transfer plotting of cervical diltation to the alert line using
the letters TR,
20. Leaving the area between the transferred recording blank. The broken transfer line is not part of the
process of labor
21. do not forget to transfer all other findings vertically
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IMPORTANT COSIDERATIONS
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OXYTOCIN
MEMBRANES
if membranes have been ruptured for 12 hours or more , antibiotics should be given
As a first defense against serious infections, give a combination of antibiotics:
ampicillin 2 g IV every 6 hours;
PLUS gentamicin 5 mg/kg body weight IV every 24 hours;
PLUS metronidazole 500 mg IV every 8 hours.
Note:
If the infection is not severe, amoxicillin 500 mg by mouth every 8 hours can be used instead of
ampicillin. Metronidazole can be given by mouth instead of IV.
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FETAL DISTRESS
If a woman is laboring in a health center . transfer her to a hospital with facilities for operative
delivery
In a hospital , immediately :
Conduct a vaginal examination to exclude cord prolapse and observe amniotic fluid
Provide adequate hydraion
Administer oxygen , if avaliablestop oxytocin
-Turn the woman or her left side
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Diagnosis of labour
Regular painful contractions resulting in progressive change of the cervix
+/- show
+/- rupture of membranes
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