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  • 1. RECORDING PROGRESS OF LABOUR PARTOGRAM PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK
  • 2. WHY IS IT IMPORTANT TO RECORD THEPROGRESS OF LABOUR Documentation is important  To provide continuity of care.  To provide a basis of decision making.  To facilitate research.  To allow audit and review.  To defend one’s actions – no documentation – no defense.
  • 3. TOOL FOR RECORDING THE PROGRESS OF LABOUR PARTOGRAM
  • 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. PARTOGRAM IT’S SIGNIFICANT: 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.
  • 6. PARTOGRAM WHO REQUIRE PARTOGRAM RECORDING For all women who are in labour (i.e. either low or high risk group).
  • 7. PARTOGRAM Friedmans partogram - 1954 2 phases of labour (base on dilatation of the cervix ) Active phase Latent phase (dilatation < 3 cm) Active phase (>3 cm dilated)Latent 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. PARTOGRAM Mother information Fetal well-being • Fetal heart rate • Character of liquor • Moulding Labour progress • Dilatation • Descent • Uterine contraction Medications • Oxytocin • Pain relief (e.g. pethidine) Maternal well-being • BP, Pulse, Temperature • Urine – albumin, glucose, acetone • Urine output
  • 9. PARTOGRAM WHAT NEED TO BE RECORDED
  • 10. PARTOGRAM RECORDING 3 Notes should be legible, dated and timed. 41 Enter the outcome of deliveryBegin plotting at the“zero” hour on thepartogram2All entries made inrelation to time whenthe observations aremade
  • 11. PARTOGRAM RECORDING Mother information  Name  Age  Parity  Gestational period  Date/time of admission  Time of rupture membrane  Short antenatal history
  • 12. PARTOGRAM RECORDING Fetal information  Fetal heart rate  Membrane and amniotic fluid  Moulding
  • 13. PARTOGRAM RECORDING Fetal information Fetal heart rate monitoring 1. Safe and reliable way of knowing fetus is well. 2. Listen after each contraction for one minutes. 3. Recorded ½ hourly (each square is ½ hour)
  • 14. PARTOGRAM RECORDING Fetal information Character of amniotic fluid 1. State of liquor can assess in monitoring fetal condition. 2. Observation to be recorded - Membrane intact record as “I” - Membrane rupture: a) liquor clear record as “C” b) meconiun stained liquor “M” c) liquor absent record as “A”
  • 15. PARTOGRAM RECORDING Fetal information Moulding of fetal skull 1. Provide information about the adequacy of pelvis to accommodate fetal head 2. Record the degree of moulding 0 → bones separated + → bones touching but can be separated. ++ → bone over lapping +++ → bones over lapping severely
  • 16. PARTOGRAM RECORDING Labour Progress  Cervical dilatation  Descent  Uterine contraction
  • 17. PARTOGRAM RECORDING Labour progress Dilatation and Descent 1. Latent (0-3 cm) and Active (3-10 cm) phase. 2. Dilatation of cervix plotted as “X” axis and Descent plotted as “O” axis. 3. First vaginal examination done on admission is recorded. 4. Subsequent vaginal examination is done every 2-4 hourly. 5. Transfer from latent to active phase.
  • 18. PARTOGRAM RECORDING Labour progress recording in latent phase Plot dilatation as “X”Latent phase Plot descent as “O” At admission:++ - Dilatation → 2 cm - Descent → -2 2 hours after admission: - Dilatation → 2 cm - Descent → -1 As the dilatation is only 2 cm therefore the labour progress is in the latent phase
  • 19. PARTOGRAM RECORDING Labour progress recording in active phase Plot dilatation as “X”Latent phase Plot descent as “O” Active phase + Latent phase+ ++ 0 hours 2 hours 4 hours (admission) Dilatation “O” 2 cm 4 cm 7 cm Descent “X” -2 -1 +1
  • 20. PARTOGRAM RECORDING Cervical dilatationLatent phase + 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. PARTOGRAM RECORDING Labour progress Uterine Contractions 1. Observation is made ½ hourly 2. Assess the frequency, duration. 3. Each square represent 1 contraction felt in 10 minutes. 4. Frequency – highlight the numbers of square. 5. Duration – shade the contraction in the square. < 20 sec - Mild 20-40 sec - Moderate > 45 sec - Strong
  • 22. PARTOGRAM RECORDING Labour progress Recording the uterine on the partogram Nos. of Contraction in 10 mins 2 weak contractions in 10 minutes 5 strong contractions in 10 minutes 3 moderate contractions in 10 minutes
  • 23. PARTOGRAM RECORDING Mother condition  Vital signs – BP, Pulse, TºC  Urine analysis – acetone, albumin, glucose  Urine volume  Medications or drug given
  • 24. PARTOGRAM RECORDING Mother condition  Vital signs recording BP – 4 hourly or more frequent if indicated Pulse - ½ hourly TºC – 4 hourly  Urine analysis – dipstick acetone → Nil or + albumin → Nil or + glucose → Nil or +  Urine volume
  • 25. PARTOGRAM RECORDING Analyzing the progress of labour from the partogram Active phase If progress is satisfactory theLatent phase + 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.
  • 26. PARTOGRAM RECORDING LABOUR PATTERNS Active phaseLatent phase Normal labour Prolonged latent phase Primary dysfunctional labour Secondary arrest
  • 27. RECORDING PROGRESS OF LABOUR - PARTOGRAM THANK YOU PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK