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PARTOGRAM PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK RECORDING PROGRESS OF LABOUR
WHY IS IT IMPORTANT TO RECORD THE PROGRESS OF LABOUR <ul><li>To provide continuity of care. </li></ul><ul><li>To provide a...
TOOL FOR RECORDING THE  PROGRESS OF LABOUR PARTOGRAM
PARTOGRAM PARTOGRAM  is a graphical information about the progress of labour in which the salient information about the fe...
PARTOGRAM Is a managerial tool used to record all observations made on a woman and fetus in labour in one chart. Partogram...
PARTOGRAM For all women who are in labour (i.e. either low or high risk group). WHO REQUIRE PARTOGRAM RECORDING
PARTOGRAM Friedman's partogram - 1954 <ul><li>2 phases of labour  (base on dilatation </li></ul><ul><li>of the cervix  )  ...
PARTOGRAM Mother information <ul><li>Fetal well-being   </li></ul><ul><li>Fetal heart rate </li></ul><ul><li>Character of ...
PARTOGRAM WHAT NEED TO BE  RECORDED
PARTOGRAM RECORDING Begin plotting at the “zero” hour on the partogram Enter the outcome of delivery 1 2 All entries made ...
PARTOGRAM RECORDING Mother information <ul><li>Name </li></ul><ul><li>Age </li></ul><ul><li>Parity </li></ul><ul><li>Gesta...
PARTOGRAM RECORDING Fetal information <ul><li>Fetal heart rate </li></ul><ul><li>Membrane and  amniotic  </li></ul><ul><li...
PARTOGRAM RECORDING Fetal information <ul><li>Fetal heart rate monitoring </li></ul><ul><li>Safe and reliable way of knowi...
PARTOGRAM RECORDING Fetal information <ul><li>Character of amniotic fluid </li></ul><ul><li>State of liquor can assess in ...
PARTOGRAM RECORDING Fetal information <ul><li>Moulding of fetal skull </li></ul><ul><li>Provide information about the adeq...
PARTOGRAM RECORDING Labour Progress <ul><li>Cervical dilatation </li></ul><ul><li>Descent </li></ul><ul><li>Uterine contra...
PARTOGRAM RECORDING Labour progress <ul><li>Dilatation and Descent </li></ul><ul><li>Latent  (0-3 cm) and  Active  (3-10 c...
PARTOGRAM RECORDING Latent phase Labour progress recording in latent phase At admission: - Dilatation     2 cm - Descent ...
PARTOGRAM RECORDING Latent phase Labour progress recording in active phase Plot dilatation as “ X ” Plot descent as  “ O ”...
PARTOGRAM RECORDING Latent phase Cervical dilatation + + + + If labour progress well plotting of cervical dilatation shoul...
PARTOGRAM RECORDING Labour progress <ul><li>Uterine Contractions </li></ul><ul><li>Observation is made  ½ hourly </li></ul...
PARTOGRAM RECORDING Labour progress Recording the uterine on the partogram 5 strong contractions in 10 minutes 2 weak cont...
PARTOGRAM RECORDING Mother condition <ul><li>Vital signs – BP, Pulse, T ºC   </li></ul><ul><li>Urine analysis – acetone,  ...
PARTOGRAM RECORDING Mother condition <ul><li>Vital signs recording  </li></ul><ul><li>BP –  4 hourly or more  </li></ul><u...
PARTOGRAM RECORDING Latent phase Analyzing the progress of labour from the partogram + + + + + If progress is satisfactory...
PARTOGRAM RECORDING Latent phase LABOUR PATTERNS Normal labour Prolonged latent phase Primary dysfunctional labour Seconda...
THANK  YOU PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK RECORDING PROGRESS OF LABOUR - PARTOGRAM
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Partogram

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  1. 1. PARTOGRAM PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK RECORDING PROGRESS OF LABOUR
  2. 2. WHY IS IT IMPORTANT TO RECORD THE PROGRESS OF LABOUR <ul><li>To provide continuity of care. </li></ul><ul><li>To provide a basis of decision making. </li></ul><ul><li>To facilitate research. </li></ul><ul><li>To allow audit and review. </li></ul><ul><li>To defend one’s actions – no documentation – no defense. </li></ul>Documentation is important
  3. 3. TOOL FOR RECORDING THE PROGRESS OF LABOUR PARTOGRAM
  4. 4. PARTOGRAM PARTOGRAM is a graphical information about the progress of labour in which the salient information about the fetal well-being, maternal well-being and the progress of labour are recorded into a chart.
  5. 5. PARTOGRAM Is a managerial tool used to record all observations made on a woman and fetus in labour in one chart. Partogram helps to identify at an early stage those women whose labour is slow. A managerial tool for prevention of prolonged labour. IT’S SIGNIFICANT:
  6. 6. PARTOGRAM For all women who are in labour (i.e. either low or high risk group). WHO REQUIRE PARTOGRAM RECORDING
  7. 7. PARTOGRAM Friedman's partogram - 1954 <ul><li>2 phases of labour (base on dilatation </li></ul><ul><li>of the cervix ) </li></ul><ul><li>Latent phase (dilatation < 3 cm) </li></ul><ul><li>Active phase (>3 cm dilated) </li></ul>Latent phase Active phase Philpott and Castle - 1972 Introduced the concept of “ALERT” and “ACTION” lines. ALERT LINE – represent the mean rate of slowest progress of labour ACTION LINE – appropriate action should be taken. Normal labour is plotted to the left alert line
  8. 8. PARTOGRAM Mother information <ul><li>Fetal well-being </li></ul><ul><li>Fetal heart rate </li></ul><ul><li>Character of liquor </li></ul><ul><li>Moulding </li></ul><ul><li>Labour progress </li></ul><ul><li>Dilatation </li></ul><ul><li>Descent </li></ul><ul><li>Uterine contraction </li></ul><ul><li>Medications </li></ul><ul><li>Oxytocin </li></ul><ul><li>Pain relief (e.g. pethidine) </li></ul><ul><li>Maternal well-being </li></ul><ul><li>BP, Pulse, Temperature </li></ul><ul><li>Urine – albumin, glucose, acetone </li></ul><ul><li>Urine output </li></ul>
  9. 9. PARTOGRAM WHAT NEED TO BE RECORDED
  10. 10. PARTOGRAM RECORDING Begin plotting at the “zero” hour on the partogram Enter the outcome of delivery 1 2 All entries made in relation to time when the observations are made 3 Notes should be legible, dated and timed. 4
  11. 11. PARTOGRAM RECORDING Mother information <ul><li>Name </li></ul><ul><li>Age </li></ul><ul><li>Parity </li></ul><ul><li>Gestational period </li></ul><ul><li>Date/time of admission </li></ul><ul><li>Time of rupture membrane </li></ul><ul><li>Short antenatal history </li></ul>
  12. 12. PARTOGRAM RECORDING Fetal information <ul><li>Fetal heart rate </li></ul><ul><li>Membrane and amniotic </li></ul><ul><li>fluid </li></ul><ul><li>Moulding </li></ul>
  13. 13. PARTOGRAM RECORDING Fetal information <ul><li>Fetal heart rate monitoring </li></ul><ul><li>Safe and reliable way of knowing fetus is well. </li></ul><ul><li>Listen after each contraction for one minutes. </li></ul><ul><li>Recorded ½ hourly (each square is ½ hour) </li></ul>
  14. 14. PARTOGRAM RECORDING Fetal information <ul><li>Character of amniotic fluid </li></ul><ul><li>State of liquor can assess in monitoring fetal condition. </li></ul><ul><li>Observation to be recorded </li></ul><ul><li>- Membrane intact record as “I” </li></ul><ul><li>- Membrane rupture: </li></ul><ul><li> a) liquor clear record as “C” </li></ul><ul><li> b) meconiun stained liquor “M” </li></ul><ul><li> c) liquor absent record as “A” </li></ul>
  15. 15. PARTOGRAM RECORDING Fetal information <ul><li>Moulding of fetal skull </li></ul><ul><li>Provide information about the adequacy of pelvis to accommodate fetal head </li></ul><ul><li>Record the degree of moulding </li></ul><ul><li>0  bones separated </li></ul><ul><li>+  bones touching but can </li></ul><ul><li>be separated. </li></ul><ul><li>++  bone over lapping </li></ul><ul><li>+++  bones over lapping </li></ul><ul><li>severely </li></ul>
  16. 16. PARTOGRAM RECORDING Labour Progress <ul><li>Cervical dilatation </li></ul><ul><li>Descent </li></ul><ul><li>Uterine contraction </li></ul>
  17. 17. PARTOGRAM RECORDING Labour progress <ul><li>Dilatation and Descent </li></ul><ul><li>Latent (0-3 cm) and Active (3-10 cm) phase. </li></ul><ul><li>Dilatation of cervix plotted as “X” axis and Descent plotted as “O” axis. </li></ul><ul><li>First vaginal examination done on admission is recorded. </li></ul><ul><li>Subsequent vaginal examination is done every 2-4 hourly. </li></ul><ul><li>Transfer from latent to active phase. </li></ul>
  18. 18. PARTOGRAM RECORDING Latent phase Labour progress recording in latent phase At admission: - Dilatation  2 cm - Descent  -2 2 hours after admission: - Dilatation  2 cm - Descent  -1 Plot dilatation as “ X ” Plot descent as “ O ” + + As the dilatation is only 2 cm therefore the labour progress is in the latent phase
  19. 19. PARTOGRAM RECORDING Latent phase Labour progress recording in active phase Plot dilatation as “ X ” Plot descent as “ O ” + + + + Latent phase Active phase +1 -1 -2 Descent “ X ” 7 cm 4 cm 2 cm Dilatation “ O ” 4 hours 2 hours 0 hours (admission)
  20. 20. PARTOGRAM RECORDING Latent phase Cervical dilatation + + + + If labour progress well plotting of cervical dilatation should always remain to the left of alert line. If it cross to right of action line this warns that labour may be prolonged.
  21. 21. PARTOGRAM RECORDING Labour progress <ul><li>Uterine Contractions </li></ul><ul><li>Observation is made ½ hourly </li></ul><ul><li>Assess the frequency, duration. </li></ul><ul><li>Each square represent 1 contraction felt in 10 minutes. </li></ul><ul><li>Frequency – highlight the numbers of square. </li></ul><ul><li>Duration – shade the contraction in the square. </li></ul><ul><li>< 20 sec - Mild </li></ul><ul><li>20-40 sec - Moderate </li></ul><ul><li>> 45 sec - Strong </li></ul>
  22. 22. PARTOGRAM RECORDING Labour progress Recording the uterine on the partogram 5 strong contractions in 10 minutes 2 weak contractions in 10 minutes 3 moderate contractions in 10 minutes Nos. of Contraction in 10 mins
  23. 23. PARTOGRAM RECORDING Mother condition <ul><li>Vital signs – BP, Pulse, T ºC </li></ul><ul><li>Urine analysis – acetone, </li></ul><ul><li>albumin, glucose </li></ul><ul><li>Urine volume </li></ul><ul><li>Medications or drug given </li></ul>
  24. 24. PARTOGRAM RECORDING Mother condition <ul><li>Vital signs recording </li></ul><ul><li>BP – 4 hourly or more </li></ul><ul><li> frequent if indicated </li></ul><ul><li>Pulse - ½ hourly </li></ul><ul><li>T ºC – 4 hourly </li></ul><ul><li>Urine analysis – dipstick </li></ul><ul><li>acetone  Nil or + </li></ul><ul><li>albumin  Nil or + </li></ul><ul><li>glucose  Nil or + </li></ul><ul><li>Urine volume </li></ul>
  25. 25. PARTOGRAM RECORDING Latent phase Analyzing the progress of labour from the partogram + + + + + If progress is satisfactory the plotting will remain on or to the left of the alert line. If labour is not progressing normally the plotting will be to the right of the alert line. Active phase
  26. 26. PARTOGRAM RECORDING Latent phase LABOUR PATTERNS Normal labour Prolonged latent phase Primary dysfunctional labour Secondary arrest Active phase
  27. 27. THANK YOU PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK RECORDING PROGRESS OF LABOUR - PARTOGRAM
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