Maternal Care: Skills workshop Recording observation on the partogram

3,127 views
2,949 views

Published on

Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care

1 Comment
1 Like
Statistics
Notes
No Downloads
Views
Total views
3,127
On SlideShare
0
From Embeds
0
Number of Embeds
15
Actions
Shares
0
Downloads
103
Comments
1
Likes
1
Embeds 0
No embeds

No notes for slide

Maternal Care: Skills workshop Recording observation on the partogram

  1. 1. 8C Skills workshop: Recording observations on the partogram B. Recording the urinary data Objectives 1. Volume is recorded in ml. 2. Protein is recorded as 0 to 4+. When you have completed this skills 3. Ketones are recorded as 0 to 4+. workshop you should be able to: • Record and assess the condition of the RECORDING THE mother. • Record and assess the condition of the CONDITION OF THE FETUS fetus. • Record and assess the progress of labour. C. Recording the fetal heart rate pattern The following two observations must be recorded on the partogram:THE PARTOGRAM 1. The baseline heart rate.The condition of the mother, the condition 2. The presence or absence of decelerations. Ifof the fetus, and the progress of labour are decelerations are present, you must recordrecorded on the partogram. whether they are early or late decelerations (see figure 8C-3).RECORDING THE D. Recording the liquor findingsCONDITION OF Three symbols are used:THE MOTHER I = Intact membranes. C = Clear liquor draining.A. Recording the blood pressure, M = Meconium-stained liquor draining (seepulse and temperature figure 8C-3).The maternal blood pressure, pulse and tem-perature should be recorded on the partogram.
  2. 2. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 179Figure 8C-1: An example of a partogram
  3. 3. 180 MATERNAL CARE Time: 06:00 10:00 Blood pressure: 110/70 130/80 Pulse: 70/min 90/min Temp: 37 °C 37.1 °C Volume: 175 ml 150 ml Protein: None None Ketones: None + Glucose: None None Blood: None ++Figure 8C-2: Recording blood pressure, pulse, temperature and urine results on the partogram LIQUOR: C = Clear liquor M = Meconium-stained liqourFigure 8C-3: Recording the fetal heart rate pattern and the liquor findings on the partogramE. How often should you record chart that is used for the cervical dilatation. Thethe liquor findings? length of the line drawn indicates the length of the endocervical canal in cm. It is drawnThe recordings should be made: on the chart whenever the cervical dilatation1. At each vaginal examination. is recorded. Alternatively, the length of the2. Whenever a change in the liquor is noted, endocervical canal, measured in cm or mm, e.g. when the membranes rupture or if the can be noted in the space provided. patient starts to drain meconium-stained liquor after having had clear liquor before. H. Recording the amount of the head palpable above the brim of the pelvis (descent and engagement)RECORDING THE The findings are recorded by marking an ‘O’PROGRESS OF LABOUR on the partogram (see figure 8C-4). I. Recording the position of the fetal headF. Recording the cervical dilatation The position of the fetal head is recordedCervical dilatation is measured in cm and then by marking the ‘O’ with fontanelles and therecorded by marking an ‘X’ on the partogram. sagittal suture. Alternatively, the position can be noted (e.g. ROA) in the space provided (seeG. Recording the length of figure 8C-4). This is recorded at every vaginalthe cervix (effacement) examination.The length of the cervix is recorded by drawinga thick, vertical line on the same part of the
  4. 4. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 181 Time: 06:00 10:00 14:00 Dilatation: 2 cm 4 cm 6 cm Length: 2 cm 5 mm 2 mm Head above brim: 4/5 3/5 2/5 Position: ROP ROP ROP Moulding: no no + Note: Transfer of recordings on chart from latent to active phase at 10:00.Figure 8C-4: Recording the cervical dilatation, cervical length, the amount of fetal head above the brim,position of the head, and moulding on the partogram 06:00: One weak contraction in ten minutes 08:00: Two moderate contractions in ten minutes 10:00: Three strong contractions in ten minutes An infusion of one unit of oxytocin in one litre at 15 drops per minute is being administered from 9:00 and at 30 drops per minute from 10:00.Figure 8C-5: Recording the duration and frequency of contractions on the partogramJ. Recording moulding of the fetal head contractions in ten minutes, and five blocks if five or more contractions in ten minutes (seeThe degree of moulding (i.e. 0 to 3+) is also figure 8C-5).recorded on the partogram. M. Recording drugs and intravenousK. Recording the duration of contractions fluid given during labourThe duration of contractions is also recorded In the space provided on the partogram youon the partogram. The block is stippled if the should record:contractions last less than 20 seconds (i.e.weak contractions), the block is striped if the 1. The name of the drug.contractions last between 20 and 40 seconds 2. The dose of the drug given.(i.e. moderate contractions) and the block is 3. The time the drug was given.coloured-in completely if the contractions 4. The type of intravenous fluid.last more than 40 seconds each (i.e. strong 5. The time the intravenous fluid was started.contractions). 6. The rate of administration. 7. The amount of intravenous fluid givenL. Recording the frequency of contractions (after completion).The number of contractions occurring within N. Assessment and managementten minutes is recorded by marking off oneblock for each contraction, e.g. two blocks After each examination an assessment mustmarked off equals two contractions in ten be made and recorded on the partogram. Allminutes, four blocks marked off equals four
  5. 5. 182 MATERNAL CAREFigure 8C-6: Documenting medication, assessment, management and time on the partogrammanagement in labour must also be recorded CASE STUDY 1on the partogram. A primigravida at term is admitted to aO. Recording the time on the partogram primary-care perinatal clinic at 06:00 withThe time, to the nearest half hour, should also a history of painful contractions for severalbe entered on the partogram whenever an hours. She received antenatal care and isobservation is recorded, medication is given, an known to be HIV negative. The maternalassessment is made or management is altered. and fetal conditions are satisfactory. On abdominal examination a single fetus with a longitudinal lie is found. The presenting partEXERCISES ON THE is the fetal head, and 4/5 is palpable above the brim of the pelvis. Two contractions in tenCORRECT USE OF minutes, each lasting 15 seconds are noted.THE PARTOGRAM On vaginal examination the cervix is 1 cm long and 2 cm dilated. The fetal head is in the right occipito-lateral position.Only the information given in the cases willbe shown on the partogram. In practice, allthe appropriate spaces on the partogram 1. Is the patient in active labour?must be filled in. No. The cervix is less than 3 cm dilated. The patient is, therefore, still in the latent phase of labour.
  6. 6. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 1832. How should you enter your 5. Where should you enter thefindings on the partogram? findings obtained at 10:00?As the patient is still in the latent phase of The findings must be entered on the latentlabour, the descent and amount of fetal head phase part of the partogram, four hours topalpable above the brim, the presenting part the right of the findings at 06:00. However, asand the position of the head, and the length and the patient is now in active labour, the datadilatation of the cervix, must be recorded on must then be transferred to the active phasethe vertical line forming the left-hand margin part of the partogram. This must be indicatedof the latent phase part of the partogram. The with an arrow.correct way of entering the above data on thepartogram is shown in figure 8C-7. 6. How should you transfer the findings at 10:00 from the latent to the active3. How should you manage phase part of the partogram?this patient further? The X (cervical dilatation) must be movedThe patient must have the routine horizontally to the right until it lies on theobservations (such as pulse rate, blood alert line. This will again be at 5 cm dilatation.pressure and fetal heart) performed at the The O (number of fifths of the head above theusual intervals. She must be offered analgesia pelvic brim) is similarly transferred to lie onand sedation. Adequate analgesia, e.g. the same vertical line opposite the two lines onpethidine 100 mg and hydroxyzine 100 mg the vertical axis. The new position of the heador promethazine 25 mg, should be given (ROA) must be indicated on the O. The lengthby intramuscular injection as soon as the of the cervix is recorded by a 5 mm thick blackpatient asks for pain relief. A second complete column on the base line vertically below theexamination should be done at 10:00, i.e. four X and O. The fact that the membranes havehours after the first complete examination. been ruptured is entered in the block providedThe patient must be encouraged to walk about for medication/ I.V. fluids/management. Aas this will help the progress towards the ‘C’ in the block provided for liquor indicatesactive phase of the first stage of labour. that the liquor is clear. The correct method of transferring the above findings from the latentAt the second complete examination the to the active part of the partogram is shown inmaternal and fetal conditions are satisfactory. figure 8C-7. (The length of the cervix and theOn abdominal examination 2/5 of the fetal position of the fetal head may also be enteredhead is palpable above the brim of the pelvis. in the appropriate blocks provided elsewhereThree contractions in ten minutes, lasting on the partogram).between 30 seconds each, are noted. Onvaginal examination the cervix is 2 mm longand 5 cm dilated. The head is in the rightoccipito-anterior position. The membranes CASE STUDY 2are artificially ruptured and the liquor isfound to be clear. A multigravida is admitted to the labour ward at 08:00 in labour at term. She received4. Is the patient still in the antenatal care and is known to be HIVlatent phase of labour? negative. The maternal and fetal conditions are satisfactory. On abdominal examinationNo. The cervix is more than 3 cm dilated. The the head is 5/5 palpable above the brimpatient is, therefore, in the active phase of of the pelvis. Three contractions in tenlabour. minutes, each lasting 25 seconds are noted. On vaginal examination the cervix is 1 mm long (i.e. fully effaced) and 4 cm dilated.
  7. 7. 184 MATERNAL CAREFigure 8C-7: Information from case study 1 correctly entered onto the partogram
  8. 8. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 185The presenting part is in the left occipito- cause. Intact membranes and inadequateposterior position. The patient complains that uterine contractions are diagnosed as theher contractions are painful. causes of the poor progress.1. Is the patient in the active 4. How should you record thesephase of labour? findings on the partogram?Yes, as the cervix is more than 3 cm dilated. The X must be recorded on the horizontal line corresponding to 5 cm cervical dilatation, four2. How should you record your findings? hours to the right of the record at 08:00. The O (the position of the fetal head and length ofAs the patient is in the active phase of labour, the cervix), are recorded on the same verticalthe findings must be entered on the active line as the X. The correct way of recordingphase part of the partogram. The X (cervical these observations is shown in figure 8C-8.dilatation) is recorded on the alert line,opposite the 4 on the vertical axis indicating 5. Is the progress of labour satisfactory?4 cm dilatation. The O (number of fifthspalpable above the pelvic brim) is recorded No. This is immediately apparent byabove the X opposite the 5 on the vertical line. observing that the second X has crossedThe length of the cervix is recorded by a 1 mm the alert line. For labour to have progressedcolumn on the base line, vertically below the X satisfactorily, the cervix should have been atand O. The correct way of recording the above least 8 cm dilated (4 cm initially plus 1 cmfindings is in figure 8C-8. per hour over the past four hours).3. How should you manage 6. How should you managethe patient further? this patient further?The routine observations (e.g. pulse rate, blood The membranes must be ruptured. Rupturepressure, fetal heart, and urine output) must be of the membranes will result in strongerperformed at the usual intervals. The patient uterine contractions. Because there hasmust be offered analgesia. Pethidine 100 mg been inadequate progress of labour, a thirdand hydroxyzine 100 mg or promethazine complete examination should be performed25 mg should be given by intramuscular at 14:00, i.e. two hours after the secondinjection as soon as the patient requests pain complete examination.relief. A second complete examination should At the third complete examination the maternalbe done at 12:00, i.e. four hours after the first and fetal conditions are satisfactory. Oncomplete examination. abdominal examination the head is 1/5 palpableAt the second complete examination the above the pelvic brim. Four contractions in tenmaternal and fetal conditions are satisfactory. minutes, each lasting 50 seconds are observed.On abdominal examination the head is 3/5 On vaginal examination the cervix is 1 mmpalpable above the brim of the pelvis. Three long and 9 cm dilated. The presenting part is incontractions in ten minutes, each lasting 25 the left occipito-anterior position. The findingsseconds, are noted. On vaginal examination are recorded as shown in figure 8C-8.the cervix is 5 mm long and 5 cm dilated withbulging membranes. 7. What is your assessment of theThe presenting part is in the left occipito- progress of labour at 14:00?transverse position. Poor progress is Labour is progressing satisfactorily. This isdiagnosed and a systemic assessment of the shown by the third X having moved closerpatient is made in order to determine the to the alert line. The head, which has rotated
  9. 9. 186 MATERNAL CAREfrom the left occipito-posterior to the left phase part of the partogram. The X (cervicaloccipito-anterior position, is also engaged. A dilatation) is recorded on the alert linespontaneous vertex delivery may be expected opposite the 5 on the vertical line. The otherwithin an hour. findings are entered in their appropriate places as shown in figure 8C-9.CASE STUDY 3 2. Is the decision to schedule the next complete examination at 13:00 correct?A gravida 2 para 1 is admitted to the labour Yes. There are no signs of cephalopelvicward at 09:00 in labour at term. She has already disproportion (e.g. 3+ moulding) onhad painful contractions for the past two hours. admission, and the maternal and fetalTwo years before she had a difficult forceps conditions are satisfactory.delivery for a prolonged second stage of labour.The infant’s birth weight was 3000 g. The 3. What observations must be donematernal and fetal conditions are satisfactory. carefully during the next four hours?On abdominal examination the head is 4/5palpable above the brim of the pelvis. The Meconium in the liquor indicates that thecervix is 2 mm long and 5 cm dilated. There fetus is at an increased risk for fetal distress.is 1+ of moulding present and the presenting Therefore, the fetal heart rate pattern must bepart is in the right occipito-posterior position. observed carefully for signs of fetal distressThe patient is HIV negative and an artificial (e.g. late decelerations).rupture of the membranes is performed and asmall amount of meconium-stained liquor is 4. What is likely to happen to thisdrained. The patient is given pethidine 100 mg patient’s progress of labour?and hydroxyzine 100 mg. A second completeexamination is scheduled for 13:00. The most likely outcome is the development of cephalopelvic disproportion. On abdominal examination the head will remain 3/5 or1. How should you record more palpable above the pelvic brim (i.e.the above findings? unengaged) and on vaginal examination thereAs the patient is in the active phase of labour, will be 3+ moulding. An urgent Caesareanthe findings must be entered on the active section should then be performed.
  10. 10. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 187Figure 8C-8: Information from case study 2 correctly entered onto the partogram
  11. 11. 188 MATERNAL CAREFigure 8C-9: Information from case study 3 correctly entered onto the partogram

×