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Partograph

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Partograph

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Partograph

  1. 1. partograph Presentedby: DrSaswatiSubhadarshini DrShagufaJamal
  2. 2. Outline of presentation ODefinition. OObjectives of partograph. OImportance of partograph. OComponents of partograph. OBenefits of using partograph. OManagement of labour using partograph.
  3. 3. Partograph It is composite graphical record of key data (maternal and fetal) during labour entered against time on a single sheet of paper . PARTOGRAM It is the process by which normal and abnormal progress of labour and also fetal response in labour can be identified.
  4. 4. Objectives of using partograph O Early detection of abnormal progress of labour. O Prevention of prolonged labour. O Increase the quality and regularity of all observations of mother and fetus. O Early recognition of maternal or fetal problems. O To provide a basis of decision making. O To facilitate research. O To defend one’s actions – no documentation – no defense.
  5. 5. Importance of using partograph : It allows an instant visual assessment of the rate of Cervical dilatation and comparision with an expected normal, so that abnormal progress can be recognized . Early and appropriate actions taken to correct it where possible.
  6. 6. WHO REQUIRE PARTOGRAM RECORDING OFor all women who are in labour.
  7. 7. Components of Partogram Mother information Fetal well-being • Fetal heart rate • Character of liquor • Moulding Labour progress • Dilatation • Descent • Uterine contraction Medications • Oxytocin • Pain relief (e.g. pethidine) Maternal well-being • BP, Pulse, Temperature • Urine – albumin, glucose, acetone • Urine output
  8. 8. What need to be recorded? Begin plotting at the “zero” hour on the partogram Enter the outcome of delivery 1 2 All entries made in relation to time when the observations are made 3 Notes should be legible, dated and timed. 4
  9. 9. Components a. Patient identification Name / Date and time of admission /Gestation/ Medical / Obstetrical issues
  10. 10. b. Fetal heart rate recorded every 30minutes. c. The condition of the membranes and liquor amnii. Mark ‘I’ for intact membrane. ‘C’ for clear liquor amnii. ‘M’ for meconium stained liquor. d. Moulding .
  11. 11. e. Cervicogram * It is a graphic representation of cervical dilatation and descent of the presenting part . * It is an essential part of the partogram . * It offer the chance of early detection of abnormal progess of labour. * First, alert line starts at 3cm cervical dilatation and ends at 10cm at the rate of 1cm/hour.
  12. 12. f.Uterine Contractions 5 strong contractions in 10 minutes 2 weak contractions in 10 minutes 3 moderate contractions in 10 minutes
  13. 13. g.Assess maternal condition regularly by monitoring : O Drugs , IV fluids , and oxytocin , if labour is augmented O Pulse , Blood pressure O Temperature O Urine volume analysis for protein, acetone, glucose and volume.
  14. 14. Benefits of a partograph O A single sheet of paper can provide details of necessary information at a glance. O No need to record labour events repeatedly. O Can predict deviation from normal progress early. O It facilitates handover procedure. O Introduction of partograph in management of labour {WHO 1994} has reduced the incidence of prolonged labour and caesarean section rates. There is improvement in maternal morbidity, perinatal morbidity and mortality.
  15. 15. PARTOGRAM History Friedman's partogram - 1954 2 phases of labour (base on dilatation of the cervix ) Latent phase (dilatation < 3 cm) Active phase (>3 cm dilated) Latent phase Active phase Philpott and Castle - 1972 Introduced the concept of “ALERT” and “ACTION” lines. ALERT LINE – represent the mean rate of slowest progress of labour ACTION LINE – appropriate action should be taken. Normal labour is plotted to the left alert line
  16. 16. Friedman′s Division of Labor : The active phase is further into 3 parts : * Acceleration phase. * Phase of maximum slope and * Decceleration phase.
  17. 17. Normal Progress of Labor * latent phase : 8 hours or less . * active phase : progress of the cervical dilatation remains on the alert line or between the alert and the action lines ( 1cm/hour ). * second stage : reasonable rotation and descent of the presenting part within 1 hour or less .
  18. 18. Abnormal progress of labour o Disorders of 1st stage  Protracted active phase-the rate of cervical dilatation <1.2cm/hr in primipara and <1.5cm/hr in multipara.  Arrest disorder-no cervical dilatation in 2 hrs after active phase of labour. o Secondary arrest is defined when the active phase of labour commences normally but stops or slows significantly for 2 hrs or more prior to full dilatation of cervix.
  19. 19. o Disorders of 2nd stage  Protraction of descent-descent of presenting part is <1cm/hr in nullipara and <2 cm/hr in multipara.  Arrest of descent-no progress of descent is observed.
  20. 20. Moving to the right of alert line O This is a warning sign. O Transfer the woman from health center to hospital. O Decision needed on further management.(usually by obstetrician or resident )
  21. 21. When progress in active phase remains on or left of the alert line / latent phase is less than 8 hours O Do not augment with oxytocin if latent and active phases go normally O Do not intervene unless complications develop O Artificial rupture of membranes ( ARM ) O No ARM in latent phase O ARM at any time in active phase
  22. 22. MANAGEMENT OF LABOUR BETWEEN ALERT AND ACTION LINES (Alert or Referral zone) 1. Health facilities with Basic EmOC O Transfer the woman to hospital unless the cervix is almost fully dilated O ARM may be performed if membranes are still intact and first stage of labour is advanced and delivery is expected soon.
  23. 23. 2. Health Facility with Comprehensive EmOC OPerform ARM at vaginal examination OContinue routine monitoring ORepeat vaginal examination 4 hrs or earlier if delivery is expected sooner ODo not intervene or augment – unless complications develop
  24. 24. MANAGEMENT OF LABOUR AT OR BEYOND THE ACTION LINE 1. Full medical and obstetric assessment 2. Consider IV infusions / catheterization / analgesics (tramadol, pethidine, etc) 3. Options O Perform CS - if fetal distress or obstructed labour or operative vaginal delivery if in 2nd stage without severe fetal distress and/or obstructed. O Oxytocin – if no contraindications O Supportive only – if satisfactory progress is established and dilatation could be anticipated at 1cm/hr or faster.

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