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Partogram
This document discusses the stages of labor and how they are recorded on a partogram. It describes the normal progression through each stage of labor (latent phase, active phase, second stage) and defines what constitutes abnormal progression based on alert and action lines on the partogram. Causes of abnormal progression are outlined, including prolonged latent phase, primary dysfunctional labor, secondary arrest, and prolonged second stage. The key information recorded on the partogram is also summarized.
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Partogram
- 2. Content • • • • • Stage of labor Contentof partogram Normal partogram in multi and nuli Causes of abnormal partogram Abnormal partogram – – – – Prolong latent phase Primary dysfunctional labor Secondary arrest Prolong second stage
- 3. First Stage oflabour • • • • Latent phase Slow Contractions irregular Cervix: – – – – shortens (effaces) Softens Moves Dilates up to 3-4 cm • 3-8h less in multi
- 4. First Stage oflabour (2) • Active phase • Regular painful contractions • Progressive cervical dilatation greater than 4 cm • 2-6h shorter in multi
- 5. second stage • Fulldilatation until delivery • Can allow a ‘passive’ second stage for the head to descend • Then active by assistance of mother bushing • 30min up to 1h in multi • 1h up to 2h in primi
- 6. Partograph and Criteria forActive Labor • Label with patient identifying information • Note fetal heart rate, color of amniotic fluid, presence of moulding, contraction pattern, medications given • Plot cervical dilation • Alert line starts at 4 cm--from here, expect to dilate at rate of 1 cm/hour • Action line: 4h from alert linne if patient does not progress as above, action is required
- 7. Recording cevical dilataion •At addmision • Then after 4h
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- 12. Recording of liqour&molding • • • • I: intact C : clear M : muconium B : blood stained • +1 : suture fell • +2: toutched • +3: overlapping
- 13. Recording of maternalcondition
- 14. Cuases of abnormalpartogarm • ‘3Ps’ – 1. passenger (excessive fetal size , malpositions ,congenital anomalies , multiple gestation, 2. passages,(pelvic contraction , soft tissue abnormalities of the birth canal , masses or neoplasia , placental previa location • CPD ?
- 15. 3- powers • Lessthan three contractions in 10 minutes, each lasting less than 40 seconds • Inco-ordanated
- 16. Prolong Latent Phase •Cevix not full effaced and not dialated beyond 4cm after 8h of regular contraction • Most common in primi delay in the chemical process which soften the cervix and allow effacement • Management – – – – Simple analgesia Encourage mobilization Reassurance ARM and oxytocin will cuase poor progress later
- 18. Primary Dysfunctional • Poorprogress in the active phase <1cm/h • Primi dysfunctional uterin conti • Multi malpresintation, CPD • Management – ARM +oxcytocin primi i(in multi ,CPD may be but with cution 2.5 u in 500ml dexterose – c/s multi ,CPD,fetal comparamise, VBAC, breach
- 21. Secondary Arrest • Secondaryarrest of cervical dilatation and descent of presenting part tapiclly after7 cm dilatation • Most common causes is CPD • Management – ARM +oxcytocin primi i(in multi ,CPD may be but with cution 2.5 u in 500ml dexterose – c/s multi ,CPD,fetal comparamise, VBAC, breach
- 24. Delay in thesecond stage • Addational cuases:– OP position: long internal rotation , persistance OP – Epidural anathesia – Secondary uterine inerta : dehydration and ketosi – Narrow med cavity (android pelvis) : deep transver arrest
- 25. managment • Oxytocin infusionif contraction is not stronge • In DEEP transverse arrest rotational forceps may use to brings the head to OA position • C/S is best option • Manual rotation also an option