Partograph importance in abnormal labour

Partograph
Shrooti Shah
Lecturer
National Medical College Nursing Campus

Definition
• It is a composite graphical recording of cervical
dilatation and descent of head against duration of
labour in hours.
• It also gives information about fetal and maternal
condition that are all recorded on single sheet of
paper.

History
• E.A. freidman in 1954 provide a foundation basis for
development of partograph on the basis of
observation of large number of woman in labour.
• After that, the composite picture of labour was
reported by philpott in 1972, who combined details of
progress of labour together with information about
fetal and maternal conditions.

Advantage of using Partograph
1. A single sheet of paper can provide details of
necessary information at a glance.
2. No need to record labour events repeatedly
3. Gives clear picture of normality and abnormality in
labour.
4. It can predict deviation from duration of labour. So
appropriate steps could be taken in time.

Advantage of using Partograph…
5. It facilitates handover procedure of staffs.
6. Save working time of staff against writing labour
notes in long hand.
7. Educational value for all staff.

Principles of plotting partograph
• The active phase of labour commence at 4 cm
cervical dilatation.
• The latent phase of labour should not last longer than
8 hours.
• During active labour, the rate of cervical dilatation
should not be slower than 1cm/hours.
• A lag time at 4 hours between a slowing of labour
and the need for intervention is unlikely to
compromises the fetus or the woman and avoid
unnecessary intervention

Method of recording partograph
• Patient information: Fill out name, gravida, para,
hospital number, date and time of admission and time
of ruptured membranes.

• Fetal heart rate: The rate of the fetal heart rate
indicates the state of the fetus inside the uterus.
Record every half hour.

• Amniotic fluid: Record the colour of amniotic
fluid at every vaginal examination:
• I: membranes intact;
• C: membranes ruptured, clear fluid;
• M: meconium-stained fluid;
• B: blood-stained fluid.

Moulding
• Moulding is a state of reduction or loss of space between
skull bones.
• Presence of increased moulding of the head high in the
pelvis indicates CPD.
• Recording of degree of moulding
• 0: Bones are separated and sutures can be felt easily
• 1: sutures apposed
• 2: sutures overlapped but reducible
• 3: sutures overlapped and not reducible

Cervical dilatation
• Assessed at every vaginal examination and marked
with a cross (X).
• Begin plotting on the partograph at 4 cm.
• This graph consists of homogenous squares, ten
square vertically, each square indicate one centimeter
of cervical dilatation.

Cervical dilatation
• The cross (X) in the graph are joined by a continuous
line begin plotting on the partograph at 4 cm.
• The climbing tendency of this line normally lies on
the left of the middle of the graph.
• Alert line: A line starts at 4 cm of cervical dilatation
to the point of expected full dilatation at the rate of 1
cm per hour.
• Action line: Parallel and 4 hours to the right of the
alert line

Descent of the head
• This is assessed by abdominal examination before
doing vaginal examination.
• Refers to the part of the head (divided into 5 parts)
palpable above the symphysis pubis.
• Recorded as a circle (O) at every vaginal
examination.

• Hours: Refers to the time elapsed since onset of
active phase of labour.
• Time: Record actual time.

Uterine contractions
• Uterine contractions are recorded graphically on the
partograph according to their strength and frequency.
• Observation of contraction is made half hourly in the
active phase.
• Palpate the number of contractions in 10 minutes and
their duration in seconds

Oxytocin drip
• This consists of two lines, one for the record of unit
of oxytocin per liter of intravenous fluid and other
one is for drop of fluid per minute.
• The recording can be made at the interval of 30
minutes as the uterine contraction

Drugs and other intravenous fluids
• Record any additional drug given and are
recorded at the particular point of time.
• This includes sedatives, antibiotics, IV fluids
etc. The name of the drugs and doses given
should be written clearly in the long box.

Maternal condition
• Pulse: Record every 30 minutes and mark with a dot (.).
• Blood pressure: Record every 4 hours and mark with
arrows.
• Temperature: Record every 2 hours.

Urine analysis
• During the course of labour, the examination of urine
is important.
• In case of maternal distress the volume of urine may
decrease and it may contain ketone bodies.

Exercise 1
• Mrs. Sita pokharel, 25 yrs old, Primigravida was
admitted in the latent phase of labour at 5 AM
2072/10/14:
- fetal head 4/5 palpable;
- cervix dilated 2 cm;
- 3 contractions in 10 minutes, each lasting 20
seconds;
- normal maternal and fetal condition.

Exercise 1
• At 9 AM:
- Fetal heart rate; 134/min
- Membrane: intact
- Moulding : sutures are not apposed.
- Fetal head is 3/5 palpable
- Cervix dilated 5 cm
- 4 contractions in 10 minutes, each lasting 20
seconds
- Mother’s Pulse: 80/min, BP: 110/70 mm of Hg,
Temp: 98°F

Exercise 1
• 9: 30 a.m: FHR 120, contraction 3/10 each 30
seconds, pulse 80/min
• 10:00 a.m.: FHR 136, contraction 3/10 each 30
seconds, pulse 88/min, Temp: 98 F

Exercise 1
• 12:00 p.m.: FHR 140, contraction 4/10 each 40

Exercise 1
• At 1 PM:
- Fetal heart rate: 140/min
- Membrane ruptured, amniotic fluid : Clear, Moulding: not
present
- Fetal head is 0/5 palpable;
- cervix is fully dilated;
- 4 contractions in 10 minutes each lasting 45 seconds;
- spontaneous vaginal delivery occurred at 2:20 PM.
- Alive male infant weighing 3000gms.

Exercise 2
• Mrs. Rita Rai was admitted at 10 am on
2072/10/13, Membranes ruptured at 4 am,
Gravida 3, Para 2, Hospital number 7886.
• Fetal head 3/5 palpable above the symphysis
pubis
• Cervix 4 cm dilated
• 3 contractions in 10 minutes, each lasting 30
seconds
• FHR :140/min
• Amniotic fluid: Clear

Exercise 2
• Sutures apposed
• Blood pressure: 120/70 mm of Hg
• Temperature : 98° F
• Pulse: 80/minute
• Urine output: 200ml, negative protein and
acetone

Exercise 2
• 10: 30 am: FHR 130, contractions 3/10 each 35
sec, Pulse 80/minute
• 12: 00 MD: FHR 140, contractions 3/10 each 40
sec, Pulse 90/minute, Temperature 97°F

Exercise 2
• 12: 30 pm: FHR 130, contractions 3/10 each 40
• 1: 00 pm: FHR 130, contractions 3/10 each 45
• 1:30 pm: FHR 130, contractions 3/10 each 50
• 2:00 pm: FHR 130, contractions 4/10 each 45
sec, Pulse 90/minute, Temperature 97°F, Blood
pressure 100/70 mm of Hg
• Fetal head: 3/5 palpab;e, cervix : 6cm dilated,
sutures overlapped but reducible

Exercise 2
• 2:30 p.m.: FHR 120, contraction 4/10 each 40 secs,
pulse 90/min, clear fluid
pulse 88/min, blood stained fluid
pulse 100/min
• 4:00 p.m.: FHR 90, contraction 4/10 each 50 secs, pulse
100/min, Temperature 97°F
100/min
110/min

Exercise 2
• At 5:00 p.m.:
• Fetal head 3/5 palpable above the symphysis
pubis
• Cervix 6 cm dilated
• Amniotic fluid meconium stained
• Sutures overlapped and not reducible
• Urine output 100 ml; protein negative, acetone
1+
• Cesearean section at 5:30 p.m., live female
infant, weight: 4500gms

Exercise 3
• Mrs. Sarita` was admitted at 10 am on 14/10/2072.
• Membrane Intact
• Gravida 1 para 0
• Hospital no. 1443
• The fetal head is 5/5 palpable above the symphysis
pubis
• The cervix is 4 cm dilated
• 2 contractions in10 minutes, each lasting less than 20
seconds
• FHR 140/min
• Membrane - Intact

Exercise 3
• At 10 am: Blood pressure: 100/70 mm of Hg,
Temperature: 97, Pulse: 80/min, Urine output: 400ml,
negative: Protein and acetone
• 10:30 am: FHR:140, contraction 2/10 each 15 sec, Pulse
90/min
• 11:00 am: FHR: 136, contraction 2/10 each 15 sec,
pulse 88/min
• 11:30 am: FHR: 140, contraction 2/10 each 20 sec,
pulse 84/min
• 12:00 MD: FHR: 136, contraction 2/10 each 20 sec,
pulse 88/min, temperature: 98F, fetal head: 5/5 palpable,
cervix: 4cm, membrane: intact

Exercise 3
• 12:30 p.m: FHR: 136, contraction 1/10 each 20 sec,
pulse 90/min
• 1:00 p.m: FHR: 140, contraction 2/10 each 20 sec, pulse
84/min
88
90/min, Temperature 98F, Blood pressure :100/70 mm of
Hg. The fetal head is 5/5 palpable, urine output: 300ml,
negative protein and acetone, cervix: 4cm, sutures
apposed, Labour augmented with 5 units oxytocin in
500ml RL @10d/min, Membranes artificially ruptured,
clear fluid

Exercise 3
• 2:30p.m: 2 contractions in 10 minutes, each lasting 30
seconds, infused rate increased to 20 dpm, FHR;140,
pulse 90/min.
• 3:00 p.m.: 3 contractions in 10 minutes, each lasting 30
seconds, infusion rate: 30d/min, FHR: 140, Pulse:
88/min
• 3:30 p.m.: 3 contractions in 10 minutes, each lasting 30
seconds, infusion rate: 40d/min, FHR: 140, Pulse:
88/min
• 4:00 p.m: Fetal head 2/5 palpable, cervix 6cm, sutures
apposed, 3 contractions in 10 minutes, each lasting 30
seconds, FHR; 144/min, Pulse: 92/min, Amniotic fluid:
Clear

Exercise 3
• At 4:30 p.m: 3 contractions in 10mins,each lasting
45secs, FHR;140/min, Pulse:90/min, infusion remains at
50d/min
• At 5:00 p.m: FHR 138, Pulse 92/min, contractions 3/10
each 40 sec, Maintain at 50d/min.

Exercise 3
• At 7:00 p.m.: Fetal head 0/5 palpable, 4 contractions in
10 minutes, each lasting 50 seconds, FHR; 144/min,
pulse: 90/min, cervix fully dilated
• At 8:10 p.m.: Spontaneous vaginal delivery. alive male
infant weighing 2,600 gms

Practice doesn’t make man perfect,
perfect practice makes man perfect, so
keep practising….

Partograph importance in abnormal labour

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