2. Introduction
History parthograph
Functions,principles and objectives of
parthograph
References
2
3. To discuss on historical development of
partograph
To look at the evidences of benefits of use of
partograph
To illustrate the proper use of partograph
3
4. Globally, there was an estimated number of
287,000 maternal deaths in 2010
Eighty five percent (245,000) of these deaths
occurred in Sub-Saharan Africa and Southern Asia
Among the causes of these deaths were obstructed
and prolonged labour
In Ethiopia MMR is 412/100,000 live births.
The main direct causes of maternal death in
Ethiopia include obstetric complications such as
hemorrhage 29.9%, obstructed labor/ruptured
uterus 22.34% , pregnancy-induced hypertension
16.9%.
4
5. Assessment of progress in labour should
therefore identify those women who are less
likely to deliver normally
Early diagnosis of slow progress and
appropriate interventions should therefore
help in preventing obstructed labour
The partograph (or partogram) is a simple tool
that has been used for this purpose
5
6. The partograph
Is graphic recording of progress of labor and
salient condition of the mother and her fetus
Early warning system at all levels
Increases quality and regularity of all
observations
6
8. 1972 Philpott and Castle (Studies in C and S
Africa ) – The introduction of alert and action
line.
8
9. For active labor only
Started at 4 cms ,currently from 5 cm.
Easier to use
Less interventions
9
10. It isn’t a technology which may malfunction
Requires no major capital investment or
expensive maintenance
A picture is worth a thousand words
Ease of use , Prevention of prolonged labor
Avoids unnecessary use of augmentation
Easy handover of patient
10
11. Early detection of abnormal progress of a
labour and 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
Early recognition of maternal or fetal problems
11
12. During active phase of labor cervical dilatation
should no slower than 1 cm hr.
A lag time of 4 hrs between slowing of labor
and the need for intervention is unlikely to
compromise fetus or the mother,so avoid
unnessary intervention
Vaginally examination should performed 4
hourly,during membrane rupture,signs of
second stage there.
12
14. A) labor progress
1) cervical dilatation
alert line drawn from 4cm to 10 cm,shows rate
of cervical dilatation
Action line –drawn 4hr right to the alert line.
One square=1cm dilatation and 30
min,dilatation plotted with an “x” .
If the progress is satisfactory plotting on or to
the left of alert line.
14
19. B) fetal condition
1)FHR listen for 1 minute after
contraction,between 120 to 160.
The lines for 120 and 160 are darker to remind the
limits of the normal FHB.
Rates >160 and <120 may indicate feta distress
2)Membranes and liqour –I stands=membrane
intact
C=ruptured and clear.
M=stands membrane ruptured meconium stained
19
21. Stop oxytocine if in augmentation
Reposition the woman
Vaginal examination to exclude cord prolapase
and observe amniotic fluid
Adequate hydration
Oxygen if available
21
22. Clear liquor
Grade I - Good volume of liquor, lightly
meconium stained
Grade II - Reasonable volume with a heavy
suspension of meconium
Grade III - Thick meconium/particulate matter
which is undiluted
22
23. 3) moulding
No molding - The cranial bones are separate
along the suture lines(o)
Grade I- Fetal cranial bones are touching each
other along the suture lines(+)
Grade II- Fetal cranial bones are overlapping
but can be separated(++)
Grade III-Fetal cranial bones are overlapping &
are not separable(+++)
23
25. C) maternal condition
Maternal vs ,BP,T every 4 hr,PR every 30 min.
Urine protein, acetone, iv fluids, drugs,
oxytocins.
25
26. Between the alert line and action line
Transfer to hospital equiped with CS set up
ARM + Oxytocine augmentation if no
contraindication
At or beyound the action line
Supportive therapy
Augmentation with oxytocine
Delivery via CS
26
31. Mrs X 25 years old GIIPI alive lady who is 9 mo
amenorrea presented pushing down pain of 12
hrs and passage liqour of 4 hrs duration,who
had regular ANC follow up four times at
LHC,where baseline Ixs determined and told
no problem.previous pregnancy was
normal.otherwise currently she has no danger
signs,no previous known DM,HTN,cardiac
illness.
Then she was sent for basic ixs and admitted to
the ward day 7/1/15,at 2:00 am LOT
31
32. PE-GA=ASL in labor pain
VS= BP (120/80 to 110/70). T 36.5-36.8,RR 20,20
PR 92,88,90,88,94,92,94.90,94
FHR 140,138,148,142,134,140,144,142,140
Uterine contraction 3/10/35-40 sec first 2 hrs of
admission and 4/10/40-50 next 2hrs.
Descent intially 3/5,and after 4 hr 1/5
PV=cervix 5 cm dilated,membrane ruptured
clear,station 0,no molding,afer 4 hrs of
examination
Cervix become 9 cm and the rest are same.
Ixs non revealing.
32
33. 1. World Health Organization Preventing
Prolonged Labour: A practical guide, the
Partograph Part I-IV. 1994 Geneva , WHO
document, WHO/FHE/MSM/93.8 2.
2. World Health Organization partograph in
management of labour. World Health
Organization Maternal Health and Safe
Motherhood Programme. Lancet 1994;343:1399404.
3. Lavender T, Wallymahmed AH, Walkinshaw
SA. Managing labor using partograms with
different action lines: a prospective study of
women's views
33
34. 4. Matthews M. The partograph for the
prevention of obstructed labour. Clin Obstet
Gynecol 2009; 52: 256-69
5. The WHO Partograph: Training Video
6.uptodate
34