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- 1. PARTOGRAPH PARTOGRAPH Dr. Pesona G.Lucksom Dr. Pesona G. Lucksom
- 2. What is PARTOGRAPH? What is PARTOGRAPH ? The partograph is a graphical representation of the events of labour plotted against time in hours, the central feature of which is the graph of cervical dilatation against time.
- 4. Friedman ( 1954from USA) Friedman ( 1954 from USA) Normal cervical dilatation pattern Latent phase Active phase Acceleraation phase - 2.5-4 cm Phase of maximum slope-4-9cm Deceleration phase – 9- 10cm
- 5. • Phillpot andcastle(1972) added alert line and action line. Descent of the presenting part was measured in relation to ischial spines. • O’Driscol(1973) recommends active management in slow progress of labour • Crichton - Later measuring the head in fifths by abdominal examination
- 6. WHO & Partography WHO& Partography • WHO took out a model composite partograph in 1988 for developing countries by synthesis and simplifying and collecting the best features of several partographs • Subsequent modification been made by removing the latent phase and considering the beginning of active phase at 4 cm dilatation of cervix (IMPAC 2000) • Very recently, it has been more simplified and descent of head is not recorded
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- 10. W.H.O W.H.O Recommend Partograph inall labour cases which has reduced the incidence of prolonged labour and LUCS with improvement of maternal morbidity, foetal morbidity and mortality
- 11. Purpose of partography Purposeof partography • Serves as an “early warning system” and assists in early decision on transfer, augmentation and termination of labour. • By early detection and preventing prolong labour it reduces maternal and perinatal morbidity and mortality significantly
- 12. Use of partography Useof partography • It is a tool for managing labour only • It does not help to identify risk factors which is present prior to onset of labour • Partography is designed for use in all maternity settings, but has different level of function at different levels of health care
- 13. Principles Principles of WHOmodel partograph (1988) • Active phase starts at 3 cm dilatation • Latent phase X > 8 hours • Cervical dilatation rate X < 1 cm/hr in active phase • 4 hr lag time will not compromise fetus • Vag. exam - 4 hrly (as less as possible) • A partograph with preset line should be available
- 14. COMPONENTS COMPONENTS • Fetal record •Progress of labour record • Maternal record
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- 16. 1. 1. Fetal condition Fetalcondition • FHR • Liquor- colour • Moulding
- 17. 2. 2. Progress oflabour Progress of labour • Cervical dilatation • Descent of head – abdominal palpation • Uterine contractions: Frequency, Duration
- 18. 3. 3. Maternal condition Maternalcondition • Oxytocin regimen • Drugs and IV fluids • Pulse, BP & Temperature • Urine - volume, protein, acetone
- 19. • Patient information •FHR- half an hour (120 - 160)
- 20. Liquor I: intact memb. C:clear liquor M: meconium stained A: absent liquor Moulding O - bones are separated and sutures easily felt + = bones are touching each other ++ = bones are overlapping +++ = bones are overlapping severely
- 21. Progress of labour Progressof labour • Cervical dilatation: By P/V exam. marked with cross (x) • Alert line: A line starts at 3 cm cx dilat.to expected full dilatation @ 1cm/hour • Action line: parallel and 4 hours to right of alert line • Descent: Part of head (divided by 5 parts) palpable above symph. pubis recorded by O
- 22. Descent of fetalhead Descent of fetal head
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- 26. Cervical dilatation Cervical dilatation •Latent phase: 0-3cm • Active phase: 3cm - 10cm Modified partograph – active phase starts from 4 cm
- 27. Hours: one square is1 hour (modified- one squares 1/2 hour) Time: Record actual time
- 28. Uterine contractions Uterine contractions •Freq - No. of contr. in a 10 minute period • Duration in secs • Chart every hour in latent phase & half hourly in active phase
- 29. Plotting uterine contraction Plottinguterine contraction
- 30. Example Example of uterinecontraction of uterine contraction
- 31. Oxytocin: drops/min½ hourly. U in 1 lt Drugs given Pulse : every ½ hr. mark with Maternal Maternal components components
- 32. BP :every 4 hr or more, mark with arrow Temp: every 4 hr or more Urine : Protein, acetone and volume (2- 4hrly)
- 33. Pt. admitted inlatent phase Pt. admitted in latent phase
- 34. Pt. admitted inactive phase Pt. admitted in active phase
- 35. Transfer Transfer from Latentto Active phase from Latent to Active phase
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- 37. Prolonged latent phase Prolongedlatent phase
- 38. Prolonged active phase Prolongedactive phase
- 39. Advantages of Partography Advantagesof Partography 1. Single sheet of paper with all information 2. No need to record labor events repeatedly 3. Predict deviation from normal duration of labour – proper intervention could be done in time 4. Facilitates hand over and responsibility and accountability of the person conducting labour 5. Simplifies transfer of labour patients to FRU transfer of labour patients to FRU
- 40. Advantages of Advantages ofMODIFIED MODIFIED Partography Partography • Prolonged latent phase – usefulness questioned • False labour may be mistaken for prolonged latent phase – unnecessary intervention • ‘TR’ transfer – difficult for some to plot
- 41. Action Action Normal latentand active phase – no augmentation - ARM only in active phase Between Alert and Action line (indicates delay) Peripheral unit — Transfer to hospital (Memb + do ARM) If in hospital — Extra vigilance, reassessment & decision At or beyond the Action line—specific management decisions must be made - termination (LUCS), augmentation Membranes if ruptured for > 12 hrs give antibiotics (Erythromycin 500 TDS)
- 42. Changes in modifiedVs 1988 Changes in modified Vs 1988 • Latent phase is removed and beginning of active phase is considered at 4 cm dilatation of cervix (IMPAC 2003) • Two squares = 1 hour • Amniotic fluid (instead of liquor) - 5 parameters instead of 4 I: memb.intact, R: memb. ruptured, C: memb rup, clear fluid, M: meconium stained, B: blood stained • Moulding- 1:sutures apposed, 2:sutures overlap but reducible; 3:sutures overlap and not reducible
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- 44. • Partograph shouldnot be started if woman is not in labour • Abdominal examination should be done before vaginal examination • First vag. examination also includes pelvic assessment