Partograph is a composite graphical recording of progress of labour and salient condition of mother and fetus. For progress of labor and conditions of the mother and the fetus. It was developed and extensively tested by the world health organization (WHO)
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
Preparation for delivery of mother, baby and midwife and equipmentsDR MUKESH SAH
In addition to their delivery bags, midwives “carry” many other invaluable tools ... family planning, delivery preparation, postnatal counseling and breastfeeding. ... With this equipment, we can recover 80% of newborns. ... “Midwifery feels good when both the mother and baby come out of the labor ward alive.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
Preparation for delivery of mother, baby and midwife and equipmentsDR MUKESH SAH
In addition to their delivery bags, midwives “carry” many other invaluable tools ... family planning, delivery preparation, postnatal counseling and breastfeeding. ... With this equipment, we can recover 80% of newborns. ... “Midwifery feels good when both the mother and baby come out of the labor ward alive.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Partogram is a useful tool for the assessment and management of labour. This presentation describes the method to plot partogram and means how to assess prolonged labour by using it.
Partogram by dr alka mukherjee dr apurva mukherjee nagpur m.s. indiaalka mukherjee
The partograph or partogram has been established as the “gold standard” labor monitoring tool universally. It has recommended by the World Health Organization (WHO) for use in active labor The function of the partograph is to monitor the progress of labor and identify and intervene in cases of abnormal labor.
Even though the partograph has been utilized for over four decades in obstetric practice, reports of obstructed labor and its serious maternal and fetal sequelae have questioned the efficacy of the partograph at times. Moreover, evidence of efficacy of partograph is equivocal as suggested by a Cochrane review However, some of the trials studied in this Cochrane review have limitations with respect to the settings, population studied and conduct of labor. The partograph is an “easy-to-use” tool, but if not used correctly it will affect the final outcome.
In this context, we aim to decipher the efficacy and the utility of the partograph in the contemporary conduct of childbirth across all resource settings and health-care personnel and to suggest solutions to further enhance its efficacy in the optimizing labor outcomes.
The development of partograph provided health workers a pictorial overview of labor which can identify pathological labor to allow early intervention.
Most guidelines for normal human labor progress are derived from Friedman’s clinical observations of women in labor. In 1954, he introduced the concept of partogram by graphically plotting cervical dilatation against time. The curve obtained was a sigmoid curve. He divided the first stage of labor into latent phase and active phase. Active phase was further divided into acceleration, maximum slope and deceleration. From his observations, he obtained the following values
WHO has recommended use of the partograph, a low-tech paper form that has been hailed as an effective tool for the early detection of maternal and fetal complications during childbirth. Yet despite decades of training and investment, implementation rates and capacity to correctly use the partograph remain low in resource-limited settings. Nevertheless, competent use of the partograph, especially using newer technologies, can save maternal and fetal lives by ensuring that labor is closely monitored and that life-threatening complications such as obstructed labor are identified and treated. To address the challenges for using partograph among health workers, health-care systems must establish an environment that supports its correct use. Health-care staff should be updated by providing training and asking them about the difficulties faced at their health center. Then only the real potential of this wonderful tool will be maximally utilized
A Partograph is a graphical record of progress during labor.
Progress is measured by cervical dilatation against time in hours, as well as by providing a record of the important conditions of the mother and fetus that may arise during the process
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
4. Definition
Partograph is a composite graphical recording of
progress of labour and salient condition of mother
and fetus.
For progress of labor and conditions of the mother
and the fetus
It was developed and extensively tested by the world
health organization (WHO)
5. History
The idea of recording was started first by Freidman
in 1954 by using graphic records of cervical
dilatation in labor.
Further developed and extended by Philpot in 1972.
Records in it can be easily analyzed and it provides a
basis for early recognition of any deviation from the
normal.
6. History…
Introduced a partograph for use in developing
countries in 1994
To increase the detection of woman with prolonged
labour or obstructed labour
To improve the management of labour.
7. Importance
It helps to detect whether labour has been
progressing satisfactory or not.
It helps to make early recognition of problem for the
mother or fetus.
It helps for timely decision of the need for
augmentation and termination of labour
8. Advantages
A single sheet of paper can provide details of
necessary information at a glance.
No need to record labour events repeteadly in
different sheet so it does not consume the time.
It can be predict deviation from normal labour so
appropriate steps could be taken in time.
9. Advantages …
It facilitates handover procedure Reduce the
incidence of prolonged labour and caeseran section.
An introduction of partograph in labour management
brings improvement in reducing maternal and fetal
morbidity and mortality.
10. Uses
Assessment of fetal well being, maternal well being and
labor.
An important tool for preventing and diagnosing
prolonged/obstructed labor
Associated with fewer operative deliveries and more
appropriate use of intrapartum oxytocin
For BEOC sites, essential to predict the need for transfer
for caeserian section.
11. Principles of plotting partograph
Active phase is commence at 4 cm dilation
Latent phase should not last longer than 8 hour.
During active labour, the rate of cervical dilatation
should not be slower than 1cm / hour.
P/v should be performed as infrequently as it is
compatible with safe practice (4 hourly
recommended).
12. Components
Basic recordings
Fetal heart recording
Amniotic fluid and moulding
Dilation of cervix
Descent of fetqal head
13. Components…
Time and hour
Uterine contraction
Oxytocin drip
Drug and other intravenous fluid
Maternal condition
Urine analysis
14. Patient information
- Name, age, gravida, para
- Date and time of admission
- Time of membrane rupture
- Hospital number
- Time of onset of labour
15. Fetal heart recording
Recorded every half hourly and each small square
equals to half an hour. Plot one dot (.) in line at the
level of the heart rate indicated in figure on left hand.
If abnormal in 3 reading then take action.
16. Amniotic fluid and moulding
Amniotic fluid
Amniotic sac whether intact (+) or (-) and if it is
ruptured, record the colour of amniotic fluid at
every vaginal examination and time of rupture.
Following abbreviation stand for:
I : membrames intact
C : membranes ruptured, clear liquor
M: meconium stained liquor
B : for blood stained liquor
A : liquor absent
17. Amniotic fluid and moulding
Moulding is an important finding as to know how
well the pelvis will accommodate the fetal head.
Bones are separated and sutures can be felt easily
+ : Bones just touch each other
++ : Bones overlap but are reducible
+++: Bones overlap but are irreversible
18. Dilatation of cervix
Assessed at every vaginal examination and marked
with cross (×).
Begin plotting on the partograph when patient is in
active phase of labour (4cm).
Remember, first cervical dilatation should be plotted
on alert line. Subsequent cervical dilatation is plotted
on alert line
19.
20. Alert line: a line starts at 4 cm of cervical dilatation
to the point of expected full dilatation at the rate 1
cm per hour.
Action line: parallel and 4 hours to the right of the
alert line. Any patient whose progress was slower the
action line was considered suitable for intervention
to expedite delivery.
21. Descent of the head
It is recorded as fifths of head palpable above the brim or
head (divided into 5 parts) palpable above the symphysis
pubis.
At 5/5, the 5 parts of the head is palpable above the
symphysis pubis or brim in which the both sinciput and
occiput is plpable at same level. If the head is deflexed and
sinciput is higher the occiput in well flexed head.
4/5, sinciput high and occiput easily felt at above the pelvic
brim.
22. Descent of Head…
At 3/5th sinciput easily felt and occiput felt at the
pelvic brim.
At 2/5th sinciput and occiput just felt.
At 1/5th sinciput felt, occiput not felt.
A 0/5th no of the head is palpable.
23. Hour and time
Hours: refer to the time elapsed since onset of active
labour.
Time: record actual time according to the hours of
active phase of labour started.
The time is recorded hourly intervals in the space
provided. ‘O’ hour time for spontaneous labour is the
time of admission to the labour ward and for induced
labour is the time of induction. Then time is recorded
on the basis of first vaginal examination.
24. Uterine contraction
The squares in the vertical columns are shaded
according to the duration and intensity.
Chart every half hourly (each small vertical square
equals to half an hour). Plot the number of
contraction in 10 minutes and duration in seconds.
25. Uterine contraction…
There are 5 verticle columns.
Shade the square according to duration of
contraction as follows—
- Less than 20 seconds:
- Between 20-40 seconds:
- More than 40 seconds:
26. Drugs…
Oxytocin: record the amount of oxytocin per
volume and Intravenous fluid in drops per minute
in every 30 minutes when used (on the base of
escalating).
Drugs given: Any drug given is recorded in the
appropriate boxes.
27. Maternal condition
Maternal condition is a record of pulse, blood pressure,
temperature, urine, oxytocin, drug and IV fluid (if used).
All the observation for the mother,s condition is written
at the bottom of the partograph.
Pulse: record every 30 minutes and mark with a dot (.).
28. Maternal condition…
Blood pressure: record every 4 hourly and mark with
record more frequently, if blood pressure is elevated.
Temperature: record every 2 hourly
Urine: record volume of urine, output every time as
urine is passed. The protein and acetone should be
tested in hospital if possible.
29. Duration of labour
Date and time of
- True labour pain.
- Membrane rupture
- Cervix fully dilated
- Baby born
- Placenta delivered
Type of delivery
Delivery conducted by
Time of delivery
30. Third stage
Method of delivery of placenta
Complete or incomplete
Blood loss: …. ml approx.
Post delivery BP
Perineum: intact, episiotomy , laceration
33. References
Dutta DC, Konar H. Textbook of obstetrics. 7th Ed.
New Delhi. Jaypee Brothers Medical Publishers.
2013: P. 530- 531
Fraser DM, Cooper MA, Myles Textbook for
Midwives. 14th edition, Churchill Livingstone.2006.
Tuitui R. Mannual of Midwifery B,3rd Edition. 2005
Managing complication in pregnancy and childbirth :
A guide for midwives and doctors. Integrated
Management of Pregnancy and Childbirth. WHO.
2005.