Components of the partograph
Part 1 : fetal condition ( at top )
Part 2 : progress of labour ( at middle )
Part 3 : maternal condition ( at bottom )
Part 1 : Fetal condition
Recording fetal heart rate
Membranes and liquor
Dilated cervix with bag of fore water
C : clear
M : muconium
B : blood stained
Molding the fetal skull bones
. 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 …………… …………...++
severely overlapping bones ( notable ) ……..+++
Part 2 – progress of labour
. Cervical dilatation: it is divided into a latent phase and an active
Descent of the fetal head
Descent of the fetal head
The rule of fifth BY abdominal examination
Assessing descent of the fetal PV;
0 station is at the level of the ischial spine
Alert line ( health facility line )
The alert line drawn from 3 cm dilatation
represents the rate of dilatation of 1 cm / hour
Moving to the right or the alert line means
referral to hospital for extra care
Action line ( hospital line )
The action line is drawn 4 hour to the right of
the alert line and parallel to it
This is the critical line at which specific
management decisions must be made at the
When labor goes from latent to active phase , plotting of the
dilatation is immediately transferred from the latent phase
area to the alert line
Normal labor progress
Then after 4h
Ambulating and position in labor
Walking may be more comfortable than being supine
during early labor
The left lateral position keeps the uterus off the
inferior vena cava; this prevent (supine hypotensive
Evaluation of fetal well-being
Measurement of the fetal heart rate
By hand-held Doppler, or By CTG
Late in first stage
patients may report the urge to push.
This may indicate significant descent of the fetal
head with pressure on the perineum.
Diagnosis of the onset of the 2nd stage
Feeling a desire to evacuate the bladder or
Reflex desire to bear down during
The uterine contractions are more prolonged
Full cervical dilatation
(the surest sign).
Transport the lady to the delivery
. (A)Position: - Lithotomy position or
(B)Paint vulva & perineum with
(C)Apply sterile leggings and towels
(D)Evacuate the bladder by catheter (if
not evacuated before)
B. After crowning,
Prevent straining after crowning.
Allow gradual and slow extension only
inbetween uterine contractions. by doing
Examine neck for looped umbilical cord
If a loop of cord is coiled
around the neck Try to slip it.
If several loops,
apply double clamping
and cut the cord
Support infant’s head as it rotates for
Guide infant’s head downward to deliver
7)Deliver posterior shoulder first ,
then the anterior shoulder
when the anterior shoulder appears under the
pubic arch,the head is lifted upwards to deliver
the posterior shoulder, then downwards to
deliver the anterior shoulder.
8)Hold the fetus from its feet
of intracranial hemorrhage.
9)Milking the cord
Towards the fetal umbilicus add l00 cc of blood to
Alternatively, the infant is held about half minute
below the level of the vaginal introitus before
clamping the cord.
In cases of Rh incompatibility
The cord should be clamped immediately
with no milking to avoid addition of more
bilirubin from destructed R.B.Cs to fetal
circulation →more hyperbilirubinaemia
10)Clamp the cord by 2 ring
forceps and cut inbetween
After delivery and evaluation of infant, clamp and cut cord
D- Management of the 3rd
Normally the placenta is expelled within 10
minutes, if expelled between 10- 30 minutes
(delayed delivery of placenta).
If not expelled within 30 minutes (Retained
Active management of 3rd stage of labor.
CONTROLLED CORD TRACTION
The aim of active management of
labour is to
ensure that the primigravida will deliver a
healthy baby in less than 12 hours
Benefits of Active Management of
It avoids prolonged labour which can lead
Maternal distress and emotional upset.
Fetal hypoxia and distress.
Exhaustion of the medical and nursing staff.
4-Correction of Abnormal Progress
The rate of cervical dilatation should not be less
than 1 cm per hour in the active phase of labour.
If the cervix is not dilating properly, amniotomy
or pitocin drip