1Intrapartum Care &PartographSession 2aCare during labor and deliveryMaternal Health DivisionMinistry of Health & Family W...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India2Session Object...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India3TRUE & FALSE L...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India4Stages of labo...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India5Points to Reme...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India6 Cervical eff...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India7Supportive Car...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India8Supportive Car...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India9Non Pharmacolo...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India10Stages of lab...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India11Stages of lab...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India12Monitoring of...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India13Monitoring of...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India14Monitoring of...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India15Monitoring of...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India16PartographWha...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India17
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India18Filling a Par...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India19Filling a Par...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India20Filling a Par...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India21Plotting a pa...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India22Plotting a Pa...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India23Plotting a pa...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India24Plotting a pa...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India25Plotting a Pa...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India26Plotting a Pa...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India27What are the ...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India28Monitoring of...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India29Abdominal pal...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India30Supportive ma...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India312ndstage mana...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India322ndstage mana...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India33Delivery of H...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India34Delivery of s...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India35Immediate pos...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India36Immediate pos...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India37Postpartum N...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India38Key Messages...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India39MouldingSutur...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India40Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India41Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India42Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India43Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India44Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India45Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India46Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India47Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India48Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India49Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India50Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India51Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India52Partograph Ca...
INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India53Session 2aCas...
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2a intra partum care

  1. 1. 1Intrapartum Care &PartographSession 2aCare during labor and deliveryMaternal Health DivisionMinistry of Health & Family WelfareGovernment of IndiaBEMoC - Presentation 2 (a)
  2. 2. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India2Session ObjectivesTo learn about: How to conduct a normal labour Identify and manage complications duringlabour How to plot a partograph
  3. 3. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India3TRUE & FALSE LABOUR PAINSTrue labour pains False labour painsRegular and predictable IrregularFelt first in lower back & sweepstowards lower abdomenRemains confined to lowerabdomenNot relieved by rest Often relieved by restIncrease in duration , intensityand frequency with timeDoes not increase induration, intensity orfrequency“Show” present “Show” absentAccompanied by cervical changes Not accompanied bycervical changes
  4. 4. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India4Stages of labourFirst stage: From onset of labor till full dilatationof cervix Latent Phase• Cervix < 4 cms• Contractions are weak• Less than 2 contractions per ten minutes Active phase• Cervix > or = 4 cms• Contractions >3 per 10 min lasting 45 - 50sec• Rate of dilatation 1cm / hour or more• Descent present
  5. 5. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India5Points to Remember Examine abdomen before vagina Do not shave perineum Wash hands,clean gloves,explain to the femaleabout PV If bleeding PV - PV not to be done Supine position with her legs flexed and apart
  6. 6. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India6 Cervical effacement Cervical dilatation in cms Presenting part Station and position of presenting part Status of membranes Color of liquorDuring PV examination
  7. 7. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India7Supportive Care during Labour Keep woman informed of her progress Maintain privacy Encourage her to keep herself clean, washperineum Enema NOT ROUTINE: only if needed Empty bladder frequently
  8. 8. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India8Supportive Care during LabourPresence of second person or birthcompanionWoman to be ambulatoryWoman free to choose any positionduring labor & deliveryHold her hand, massage backPlenty of fluids, light fat free food
  9. 9. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India9Non Pharmacological pain relief Calm and gentle voice Offering encouragement, reassurance andpraise Relaxation techniques deep breathingexercises and massage Assisting the woman in voiding urine and inchanging her position
  10. 10. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India10Stages of labourSecond stage: From full dilatation of cervix tilldelivery of baby Full cervical dilatation Bulging thinned out perineum Gaping anus and vagina Head visible at the perineum
  11. 11. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India11Stages of labourThird stage: From delivery of baby to delivery ofplacentaFourth stage: For 2 hrs after delivery of the baby
  12. 12. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India12Monitoring of first stage of labour –Latent phase Monitor every 1/2 hour• Contractions: Frequency: How many contractions in 10 min Duration: Each lasting for how many seconds• Fetal Heart Rate (FHR) Monitor the following every 4 hours: Temperature, pulse,blood pressure Record time of rupture of membranes and color ofamniotic fluid. Emergency signs: Difficulty in breathing, shock, vaginalbleeding
  13. 13. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India13Monitoring of First Stage of LabourIn Latent PhaseAfter 8 hoursContractions stronger,more frequent, no changein dilatation or effacementROM +/-REFER to FRUProlonged latent phaseNo increase in intensity /frequency / duration ofcontractions, membranes notruptured and no progress incervical dilatationAsk woman to relax
  14. 14. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India14Monitoring of first stage of labour –Active phaseMonitor the following every 30 minutes: Maternal pulse, uterine contractions, FHR Look for presence of -• Meconium or blood stained liquor or cordprolapse Monitor the following every 4 hours:• Cervical dilatation (in cm) by P/V• Temperature• Blood pressure
  15. 15. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India15Monitoring of First stage of LabourIn Active Phase Never leave the woman alone Monitor intensively using Partograph Refer immediately if no progress
  16. 16. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India16PartographWhat is a partograph? Graphic recording of the progress of labor& condition of mother and fetus Labor record , thus reduces paper work Tool to identify complications of labor andmake timely referrals
  17. 17. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India17
  18. 18. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India18Filling a PartographIdentification data Name Age, Parity, Date and time ofadmission Registrationnumber; Time of rupture ofmembranes.
  19. 19. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India19Filling a PartographFetal Condition Count fetal heartrate every half hour Count for one fullminute, immediatelyfollowing a uterinecontraction Fetal distress: FHR <120beats/minute or>160 beats/minuteArrange for referral
  20. 20. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India20Filling a PartographRecord status of membranes andamniotic fluid in Partograph as follows: Membranes intact (mark ‘I’) Membranes ruptured (mark ‘R’) Clear liquor (mark ‘C’) Meconium stained liquor (mark ‘M’)
  21. 21. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India21Plotting a partographLabor Begin plotting in activelabor Cervical dilatation > 4cms and > 2contractions / 10minutes Plot the initial finding.Note the time. Repeat P/V after 4hours and plot thecervical dilatation
  22. 22. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India22Plotting a PartographChart the contractions every half an hour Number of contractions in 10 mins Duration in seconds.• Less than 20 seconds• Between 20 and 40 seconds ////• More than 40 seconds
  23. 23. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India23Plotting a partographMaternal Condition Record maternal pulseevery half hour and markwith a dot ( . ) Record maternal BPevery 4 hours using avertical arrow, with upperend signifying systolicBP and lower enddiastolic BP Record the temperatureevery 4 hours and noteon temperature graph
  24. 24. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India24Plotting a partographInterventions Mention dose, routeand time ofadministration ofany drug Mention the fooditems and liquidsconsumed
  25. 25. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India25Plotting a Partograph If Alert line is crossed(the plotting moves tothe right of the alertline) it indicatesabnormal labour :prolonged/ obstructedlabour Note the time Refer patient to FRU Send partograph withpatient
  26. 26. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India26Plotting a Partograph Crossing of the Action line (the plottingmoves to the right of the Action line) :indicates the need for intervention By the time the action line is crossed thewoman should ideally have reached the FRUfor the appropriate intervention to take place
  27. 27. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India27What are the indications for referral to FRU –on the basis of partograph ? FHR is <120 beats / min or > 160 beats / min Meconium and /or blood stained amniotic fluid When cervical dilatation plotting crosses thealert line (moves towards the right side of thealert line) Contractions not increasing in duration,intensity and frequency (e.g. < 2 contractionslasting for < 20 sec in 10 min)
  28. 28. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India28Monitoring of second stage of labourMonitor the following every 5 minutes Frequency,duration and intensity ofcontractions FHR Perineal thinning and bulging Visible descent of foetal head duringcontractions Presence of any signs indicating anemergency
  29. 29. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India29Abdominal palpationWatch for signs of imminent deliveryGaping of vulvaThinning and bulging of perineumPouting of anusHead of the baby seen at vulvaEncourage the woman to push duringcontractions when she has an urge to do sowhile taking deep breaths
  30. 30. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India30Supportive management during secondstage Any position woman is comfortable: dorsallithotomy, tanding, sitting, squatting. Encourage bearing down when has urge topush at full dilatation Discourage bearing down before the cervix isfully dilated Do not ask her to hold breath Avoid ironing (sweeping and stretching) theperineum
  31. 31. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India312ndstage management (contd...)OXYTOCICS: not routinely recommended insecond stage.EPISIOTOMY: not routine complicated vag. Delivery (malpresent) h/o third/fourth degree perineal tears foetal distress Instrumental/assisted delivery.
  32. 32. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India322ndstage management (contd...) Encourage rapid breathing with mouth open. Hydration- oral / IV fluids DO NOT apply fundal pressure 5 clean’s- surface, hands, cord tie, blade,cord stump Prepare for active mgmt. 3rdstage
  33. 33. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India33Delivery of Head Ensure a controlled delivery of the head bykeeping one hand gently on the head andother supporting the perineum Feel gently around the baby’s neck forpresence of umbilical cord If it is loose around the neck, deliver the babythrough the loop of the cord, or slip the cordover the baby’s head If it is tight around the neck, doubly clamp andcut in between
  34. 34. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India34Delivery of shoulders and rest of the body Wait for the spontaneous rotation and deliveryof the shoulders. This usually happens within1-2 minutes Apply gentle pressure downwards to deliverthe top (anterior) shoulder Then lift the baby up, towards the mother’sabdomen, to deliver the lower (posterior)shoulder Deliver one shoulder at a time Rest of the baby’s body follows smoothly Note the time of birth
  35. 35. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India35Immediate postpartum care Fourth stage: first one hr after delivery. After placental delivery- check uterus wellcontracted Examine perineum, lower vagina and vulva fortears. Estimate the blood loss Clean the perineum Sanitary napkins
  36. 36. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India36Immediate postpartum care Dispose placenta in correct, safe andculturally appropriate manner. Keep mother and baby together- encourageearly breastfeeding. Encourage woman to eat,drink and rest. Encourage woman to pass urine. Do not discharge the woman before 24 hoursafter delivery.
  37. 37. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India37Postpartum Nutrition: advise to eat greater amount of foods Exclusive breastfeeding and rooming in Contraception: advise regarding birth spacingor limitation. Registration of birth Postpartum visits- first at 7-10 days. Second at6 weeks
  38. 38. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India38Key MessagesLet the woman choose a comfortableposition during labour and deliveryMaintain a partograph
  39. 39. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India39MouldingSutures apposed +Sutures overlapped but reducible 2+Sutures overlapped but not reducible 3+SymbolsCervix xHead OBreech wFetal heart rate .Amniotic fluidMembranes intact IMembranes ruptures, clear fluid CMeconium stained fluid MBlood stained fluid B1WHO Managing complications in pregnancy and childbirthPARTOGRAPHUsual frequency of examinationVaginal examination 4 hourlyFetal Heart Rate ½ - ¼ hourlyDescent: Abdominal palpation1Descent: Abdominal palpation1Contractions: Palpate abdomen (uterine fundus) over 10 minMild <20 secondsSutures overlapped but reducible 20-40 secondsSutures overlapped but not reducible >40 seconds
  40. 40. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India40Partograph Case 1Name: Mrs KAHospital No.: 462432 XYAge (Years): 20Parity: Para 0 +0Gestational age (Weeks): 38TimeCervix(cm)Membranes/LiquorLie PresentationFHR(/Min.)Moulding DescentContractions(/10 Min.)9am 2cm Intact longitudinal Cephalic 140 o 5/52 (<20seconds)History• Lower abdominal pains• No drainage of liquorTime 9amPulse rate (/Min.) 90Blood pressure (mmHg) 120/80Temperature (oC) 37.1oQuestions• What actions will you take?• How will you look after thiswoman?
  41. 41. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India41Partograph Case 2Name: Mrs ADHospital No.: 462432 XYAge (Years): 18Parity: Para 2+0Gestational age (Weeks): 38Time Cervix (cm)Membranes/LiquorLie Presentation FHR(/Min.)Moulding Descent Contractions(/10 Min.)4pm 4cm Intact longitudinal Cephalic 144 0 3/5 3 (35sec. each)8pm 8cm Clear longitudinal Cephalic 146 0 2/5 4 (45 sec. each)History• Lower abdominal pains for 2 hours• Drainage of liquor for 1 hourTime 4pm 8pmPulse rate (/Min.) 88 90Blood pressure (mmHg) 120/70 120/70Temperature (oC) 37o37oQuestions• What actions will you takeat 4pm?
  42. 42. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India42Partograph Case 2Name: Mrs ADHospital No.: 462432 XYAge (Years): 18Parity: Para 2+0Gestational age (Weeks): 38Time Cervix(cm)Membranes/LiquorLie Presentation FHR(/Min.)Moulding Descent Contractions(/10 Min.)4pm 4cm Intact longitudinal Cephalic 144 0 3/5 3 (35sec. each)8pm 8cm clear longitudinal Cephalic 146 0 2/5 4 (45 sec. each)History• Lower abdominal pains for 2 hours• Drainage of liquor for 1 hourTime 4pm 8pmPulse rate (/Min.) 88 90Blood pressure (mmHg) 120/70 120/70Temperature (oC) 37o37oQuestions• What actions will you takeat 4pm?• What actions will you takeat 8pm?
  43. 43. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India43Partograph Case 3Name: Mrs DGHospital No.: 462432 XYAge (Years): 19Parity: Para 0 +1Gestational age (Weeks): 38Time Cervix(cm)Membranes/LiquorLie PresentationFHR(/Min.)MouldingDescentContractions(/10 Min.)6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each)10am 5cm Artificial rupture ofmembranes: clearlongitudinal Cephalic 146 0 3/5 2 (20sec. each)12pm(noon)8cm clear LongitudinalCephalic 140 0 2/5 2 (10 sec. each)2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each)History• Lower abdominal pains for 10 hours• No drainage of liqourTime 6am 10am 12pm 2pmPulse rate (/Min.) 80 84 88 92Blood pressure (mmHg) 130/70 130/70 140/70 140/70Temperature (oC) 37.3o37 37.5 37.5Questions• What actions arerequired?• When would the nextexamination be?
  44. 44. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India44Partograph Case 3Name: Mrs DGHospital No.: 462432 XYAge (Years): 19Parity: Para 0 +1Gestational age (Weeks): 38Time Cervix(cm)Membranes/LiquorLie PresentationFHR(/Min.)MouldingDescentContractions(/10 Min.)6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each)10am 5cm Artificial rupture ofmembranes: clearlongitudinal Cephalic 146 0 3/5 2 (20sec. each)12pm (noon) 8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each)2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each)History• Lower abdominal pains for 10 hours• No drainage of liqourTime 6am 10am 12pm 2pmPulse rate (/Min.) 80 84 88 92Blood pressure (mmHg) 130/70 130/70 140/70 140/70Temperature (oC) 37.3o37 37.5 37.5Questions• Comment on thepartograph. Whatactions are required?• When would the nextexamination be?
  45. 45. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India45Partograph Case 3Name: Mrs DGHospital No.: 462432 XYAge (Years): 19Parity: Para 0 +1Gestational age (Weeks): 38Time Cervix(cm)Membranes/LiquorLie PresentationFHR(/Min.)MouldingDescentContractions(/10 Min.)6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each)10am 5cm Artificial rupture ofmembranes: clearlongitudinal Cephalic 146 0 3/5 2 (20sec. each)12pm (noon) 8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each)2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each)History• Lower abdominal pains for 10 hours• No drainage of liqourTime 6am 10am 12pm 2pmPulse rate (/Min.) 80 84 88 92Blood pressure (mmHg) 130/70 130/70 140/70 140/70Temperature (oC) 37.3o37 37.5 37.5Questions• Comment on thepartograph. Whatactions are required?• When would the nextexamination be?
  46. 46. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India46Partograph Case 3Name: Mrs DGHospital No.: 462432 XYAge (Years): 19Parity: Para 0 +1Gestational age (Weeks): 38Time Cervix(cm)Membranes/LiquorLie PresentationFHR(/Min.)MouldingDescentContractions(/10 Min.)6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each)10am 5cm Artificial rupture ofmembranes: clearlongitudinal Cephalic 146 0 3/5 2 (20sec. each)12pm(noon)8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec.each)2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec.each)History• Lower abdominal pains for 10 hours• No drainage of liqourTime 6am 10am 12pm 2pmPulse rate (/Min.) 80 84 88 92Blood pressure (mmHg) 130/70 130/70 140/70 140/70Temperature (oC) 37.3o37 37.5 37.5Questions• Comment on thepartograph. Whatactions are required?
  47. 47. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India47Partograph Case 4Name: Mrs HAHospital No.: 462432 XYAge (Years): 16Parity: Para 0 + 0Gestational age (Weeks): 39Time Cervix (cm)Membranes/LiquorLie PresentationFHR(/Min.)Moulding Descent Contractions(/10 Min.)10am 4cm Spontaneousrupture, clearL Cephalic 150 1 + 3/5 3 (30 sec.each)2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec.each)4pm 6cm Meconium stained L Cephalic 164 3 + 3/5 4 (45 sec.each)History• Labour at home for 6 hours• Membrane ruptured 4 hours before admissionTime 10am 2pm 4pmPulse rate (/Min.) 80 86 92Blood pressure (mmHg) 120/70 130/70 130/70Temperature (oC) 37 37.2 37.2Questions• Plot the information on a partograph.• What action will you take?• When would you perform the nextvaginal examination?
  48. 48. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India48Partograph Case 4Name: Mrs HAHospital No.: 462432 XYAge (Years): 16Parity: Para 0 + 0Gestational age (Weeks): 39Time Cervix(cm)Membranes/LiquorLie Presentation FHR(/Min.)Moulding Descent Contractions(/10 Min.)10am 4cm Spontaneousrupture, clearL Cephalic 150 1 + 3/5 3 (30 sec.each)2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec.each)4pm 6cm MeconiumstainedL Cephalic 164 3 + 3/5 4 (45 sec.each)History• Labour at home for 6 hours• Membrane ruptured 4 hours before admissionTime1 10am 2pm 4pmPulse rate (/Min.) 80 86 92Blood pressure(mmHg)120/70 130/70 130/70Temperature (oC) 37 37.2 37.2Questions• Comment on the partograph.• When would you perform the nextvaginal examination?Maternal and Newborn Health Unit Liverpool School of Tropical MedicineLSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Careand Newborn Care
  49. 49. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India49Partograph Case 4Name: Mrs HAHospital No.: 462432 XYAge (Years): 16Parity: Para 0 + 0Gestational age(Weeks):39Time Cervix(cm)Membranes/LiquorLie PresentationFHR(/Min.)Moulding Descent Contractions(/10 Min.)10am 4cm Spontaneous rupture,clearL Cephalic 150 1 + 3/5 3 (30 sec. each)2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec. each)4pm 6cm Meconium stained L Cephalic 164 3 + 3/5 4 (45 sec. each)History• Labour at home for 6 hours• Membrane ruptured 4 hours before admissionTime 10am 2pm 4pmPulse rate (/Min.) 80 86 92Blood pressure (mmHg) 120/70 130/70 130/70Temperature (oC) 37 37.2 37.2Questions• Comment on the partograph.• What action will you take in aBEOC and CEOC health facilityMaternal and Newborn Health Unit Liverpool School of Tropical MedicineLSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care andNewborn Care
  50. 50. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India50Partograph Case 5Questions• You are called. What would youdo?• When will you do another vaginalexamination?Name: Mrs SAHospital No.: 462432 XYAge (Years): 24Parity: Para 3+1Gestational age (Weeks): 39Time Cervix(cm)Membranes/LiquorLie PresentationFHR(/Min.)Moulding Descent Contractions(/10 Min.)10am 4cm Spontaneous rupture2 hours ago, clearL Cephalic 140 0 3/5 3 (30 seconds)2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds)4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds)History• Lower abdominal pains 3 hours• Drainage of liquor 2 hoursTime 10am 2pm 4pmPulse rate (/Min.) 86 90 92Blood pressure (mmHg) 130/70 130/70 130/70Temperature (oC) 37o37o37
  51. 51. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India51Partograph Case 5Questions• Comment on the partograph.• What action would you take?Name: Mrs SAHospital No.: 462432 XYAge (Years): 24Parity: Para 3+1Gestational age (Weeks): 39Time Cervix (cm)Membranes/LiquorLie Presentation FHR(/Min.)Moulding Descent Contractions(/10 Min.)10am 4cm Spontaneous rupture2 hours ago, clearL Cephalic 140 0 3/5 3 (30 seconds)2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds)4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds)History• Lower abdominal pains 3 hours• Drainage of liquor 2 hoursTime 10am 2pm 4pmPulse rate (/Min.) 86 90 92Blood pressure(mmHg)130/70 130/70 130/70Temperature (oC) 37o37o37
  52. 52. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India52Partograph Case 5Questions• Comment on the partograph.• What action will you take?• What are the options for delivery?Name: Mrs SAHospital No.: 462432 XYAge (Years): 24Parity: Para 3+1Gestational age (Weeks): 39Time Cervix(cm)Membranes/LiquorLie Presentation FHR(/Min.)Moulding Descent Contractions(/10 Min.)10am 4cm Spontaneous rupture2 hours ago, clearL Cephalic 140 0 3/5 3 (30 seconds)2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds)4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds)History• Lower abdominal pains 3 hours• Drainage of liquor 2 hoursTime 10am 2pm 4pmPulse rate (/Min.) 86 90 92Blood pressure (mmHg) 130/70 130/70 130/70Temperature (oC) 37o37o37
  53. 53. INTRAPARTUM CARE & PARTOGRAPHMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India53Session 2aCase Study No. …………….. 1-3Page no……………………… 15-19Answer to Case Study……… 125-127
  54. 54. 54Thank you
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