More Related Content


  2.  The PARTOGRAPH was first introduced in 1954 by Friedman. Graphically depicting the dilatation of the cervix during labour.  Philpott and Castle in 1972 developed Friedman's concept into a tool for monitoring labour by adding the action and alert lines.
  3.  A partograph is a graphical record of key data (maternal & fetal) during labour, entered against time on a single sheet of paper.  It was developed and extensively tested by the world health organization WHO
  4.  Early detection of abnormal progress of a labour . Prevention of prolonged labour.  Recognize cephalopelvic disproportion- long before obstructed labour assist in early decision on transfer , augmentation , or termination of labour. Increase the quality and regularity of all observations of mother and fetus
  5.  Early recognition of maternal or fetal problems  The partograph can be highly effective in reducing complications from prolonged labor for the mother (postpartum hemorrhage, sepsis, uterine rupture) and for the newborn (death, anoxia, infections, etc)
  6.  Part I : Fetal Condition ( At Top )  Part II : Progress Of Labour ( At Middle)  Part III : Maternal Condition ( At Bottom )  Outcome : ………………
  7.  Name  DOA/Time  Gravida/Parity  Age  Gestational week  IP Number  ROM  LMP  EDD  Labour duration (Hr)  Faculty/ Clinic Name
  8.  This part of the graph is used to monitor and assess fetal condition 1 - Fetal heart rate 2 - Membranes and liquor 3 - Moulding the fetal skull bones
  9.  Fetal heart rate > 180 beats/min =Tachycardia < 160 beats/min = Bradycardia < 100 beats/min = Severe Bradycardia
  10.  Intact Membranes ……………………………………….I  Ruptured Membranes + Clear Liquor …………………….C  Ruptured Membranes + Meconium- Stained Liquor ……..M  Ruptured Membranes + Blood – Stained Liquor …………B  Ruptured Membranes + Absent Liquor…………………....A
  11.  Molding is alteration of the shape of the fore-coming head while passing through the resistant birth passage during labor.  Increasing Molding with the head, high in the pelvis is an ominous sign of cephalopelvic disproportion.  Separated Bones Sutures Felt Easily ……………….….O  Bones Just Touching Each Other ………………………..+  Overlapping Bones ( Reducible ) ……………………...++  Severely Overlapping Bones ( Non – Reducible ) ……..+++
  12.  Cervical dilatation  Descent ofthe fetal head Fetal position  Uterine contractions  This section of the paragraph has as its central feature a graph of cervical dilatation against time  It is divided into a latent phase and an active phase
  13.  It starts from onset of labour until the cervix reaches 4 cm dilatation  Once 4 cm dilatation is reached , labour enters the active phase  Lasts 8 hours or less  Each lasting <20 seconds  At least 2/10 min contractions ACTIVE PHASE  Contractions at least 3 / 10 min each lasting< 40 seconds  The cervix should dilate at a rate of 1 cm / hour or faster
  14.  The alert line drawn from 4cm dilatation represents the rate of dilatation of 1cm / hour  Moving to the right or the alert line means referral to hospital for extra vigilance ACTION LINE ( HOSPITAL LINE)  It is drawn 4 hours to the right of the alert line and parellel to it.  This is the critical line at which specific management decisions must be made at the higher level of health care facility.
  15.  It is the most important information and the surest way toassess progress of labour.  When progress of labour is normal and satisfactory, plotting of cervical dilatation remains on the alert line or to left of it.  If a woman arrives in the active phase of labour , recording of cervical dilatation starts on the alert line
  16.  It should be assessed by abdominal examination immediately before doing a vaginal examination, using the rule of fifth to assess engagement  The rule of fifth means the palpable fifth of the fetal head are felt by abdominal examination to be above the level of symphysis pubis  When 2/5 or less of fetal head is felt above the level of symphysis pubis , this means that the head is engaged , and by vaginal examination , the lowest part of vertex has passed or is at the level of ischial spines
  17.  Observations of the contractions are made every hour in the latent phase and every half-hour in the active phase  Frequency- How often are they felt ?  Assessed by number of contractions in a 10 minutes period.  Duration - How long do they last ?  Measured in seconds from the time the contraction is first felt abdominally , to the time the contraction phases off  Each square represents one contraction
  18.  Less than 20 seconds:  Between 20 and 40 seconds:  More than 40 seconds:
  19.  Stop oxytocin infusion if there is evidence of uterine hyperactivity or fetal distress  Augment with oxytocin only after artificial rupture of membranes.
  20. Assess maternal condition regularly by monitoring Drugs , IV Fluids , Oxytocin  Pulse  Blood Pressure  Temperature  Urine Volume , Analysis For Protein And Acetone
  21.  DariaDaria was admitted in active labour at22:00  Gravida 1 Para 0  Fetal heart rate 130 beats per minute  Fetal head 5/5 palpable  Cervical dilatation 5 cm Three contractions in 10 minutes eachlasting 30 seconds Intact membranes  The bones are separated and the sutures can be felt easily  Pulse 70 per minute  Blood pressure 120/80 mm Hg  Temperature 36.8  At 2:00Fetal head 2/5 palpable  Cervical dilatation 9 cm Four contractions in 10 minutes, eachlasting more than 40 secondsIntact membranes  The bones are still separated and the sutures can be felt easily
  22.  Nima Bhaskar,textbook of Midwifery and Obstetrical Nursing.2nd edition,Emmess publications, Newdelhi 2016,205- 209  D.C Datta, textbook of obstetrics 8th edt,jaypee publication, Newdelhi,2017,607-608  Myles textbook for midwives 16th edt,2014,339  Kamini rao textbook of midwifery and obstetrics for nurses,1st edt.elsevier publication 2011,449  Internet souces (Images)