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MANAGING LABOR USING THE PARTOGRAPH
Using the Partograph 2
The Partograph
Assessment of fetal well being
Assessment of maternal well being
Assessment of progress of labor
Using the Partograph 3
1. Measuring Fetal Well Being During Labor
Fetal heart rates and pattern
Degree of molding, caput
Color of amniotic fluid
Using the Partograph 4
2. Measuring Maternal Well Being
During Labor
Pulse, temperature, blood pressure,
respiration
Urine output, ketones, protein
Using the Partograph 5
3. Measuring Progress of Labor
 Cervical dilatation
 Descent of presenting part
 Contractions
–Duration
–Frequency
 Alert and action lines
Using the Partograph 6
Using the Partograph
 Patient information: Name, gravida, Para, hospital
number, date and time of admission, and time of
ruptured membranes
 Fetal heart rate: Record every half hour
 Amniotic fluid: Record the color at every vaginal
examination:
 I: membranes intact
 C: membranes ruptured, clear fluid
 M: meconium-stained fluid
 B: blood-stained fluid
Using the Partograph 7
Using the Partograph (continued)
 Molding:
 1: sutures apposed
 2: sutures overlapped but reducible
 3: sutures overlapped and not reducible
 Cervical dilatation: Assess at every vaginal examination, mark
with cross (X)
 Alert line: Line starts at 4 cm of cervical dilatation to the point of
expected full dilatation at the rate of 1 cm per hour
 Action line: Parallel and 4 hours to the right of the alert line
Using the Partograph 8
Using the Partograph (continued)
 Descent assessed by abdominal palpation: Part of head
(divided into 5 parts) palpable above the symphysis
pubis; recorded as a circle (O) at every vaginal
examination. At 0/5, the sinciput (S) is at the level of the
symphysis pubis
Using the Partograph 9
Using the Partograph (continued)
 Hours: Time elapsed since onset of active phase of labor (observed
or extrapolated)
 Time: Record actual time
 Contractions: Chart every half hour; palpate the number of
contractions in 10 minutes and their duration in seconds
 Less than 20 seconds:
 Between 20 and 40 seconds:

 More than 40 seconds:
 Oxytocin: Record amount per volume IV fluids in drops/min.
every 30 min. when used
 Drugs given: Record any additional drugs given
Using the Partograph 10
Using the Partograph (continued)
 Temperature: Record every 2 hours
 Pulse: Record every 30 minutes and mark with a dot (•)
 Blood pressure: Record every 4 hours and mark with
arrows
 Protein, acetone and volume: Record every time urine
is passed
Using the Partograph 11
The Modified WHO
Partograph
(Figure C-10)
Using the Partograph 12
Sample Partograph for
Normal Labor
(Figure C-11)
Using the Partograph 13
Partograph Showing
Prolonged Active Phase of
Labor (Figure S-6)
Using the Partograph 14
Partograph Showing
Obstructed Labor
(Figure S-7)
Using the Partograph 15
Partograph Showing
Inadequate Uterine
Contractions Corrected with
Oxytocin
(Figure S-8)
Use of a Partograph
Case Studies
Case 1
● Mrs Njoroge was admitted at 5am on
25/09/2009
● The membranes had ruptured at 4am
● Gravida 3, Para 2+0 ,Hospital no. 7886
● On admission foetal head was 4/5 palpable
above the pelvic brim
● The cervix was 2cm dilated
What should be recorded on the partograph ?
Step 2 : 9am
● Fetal head is 3/5 palpable above the
pelvic brim
● Cervix is 5cm dilated
● There are 3 contractions in 10 min each
lasting 20-40 s
● Fetal Heart rate is 120 bpm
● Amniotic fluid is clear
● Skull bones separated sutures easily felt
● Maternal BP 120/70 mmhg,Temp 36.8C
● Pulse 80 bpm
● Urine output 200mls -ve protein or
acetone
questions
● What steps should you take ?
● What advice should be given ?
● What do you expect to find at 1.00pm ?
Plot the information on the partograph
Step 3
 09.30 am : FHR 120 bpm,cont 3/10 each lasting 30s ,
pulse 80 bpm
 10.00 am : FHR 136bpm,cont 3/10 each 30s,Pulse
80bpm
 10.30 am : FHR 140 bpm,Cont 3/10 each lasting 35s ,
Pulse 88bpm
 11.00 am : FHR 130bpm,cont 3/10 each lasting 40 s,
Pulse 88bpm,Temp 37 C
 11.30 am : FHR 136 bpm, Cont 4/10 each lasting
40 s,pulse 84bpm
 12.00 FHR 140 bpm,cont 4/10 each 40s,pulse 88 bpm
 12.30 pm : FHR 130 bpm, cont 4/10 each lasting 40s
pulse 88 bpm
 13.00 pm : FHR 140bpm , cont 4/10 , each lasting 45s ,
Pulse 88 bpm
Vaginal exam 13.00pm
 foetal head 0/5 palpable above the pelvic
brim
 The cervix is fully dilated
 Amniotic fluid is clear
 Skull bones separated , sutures easily felt
 BP 100/70 mmHg
 Urine output 150 mls –ve for protein and
acetone
Questions
Plot the findings on the partograph and
answer the following :-
1. What steps should you take ?
2. What advice should be given ?
3. What do you expect to happen next ?
Step 4
At 13.20 pm spontaneous vaginal delivery to a
Live Female Infant weighing 2.85kg.
Questions
1. How long was the Active phase of the first
stage of labour ?
2. How long was the active phase of Labour ?
3. How long was the second stage of labour ?
Case study 2
Mrs Ibrahim was admitted on 25/09/09 at
10.00am.On nursing assessment the
following information was obtained :-
 Membranes intact,Gravida 1,para 0+0
 Hospital No. 1443
 Foetal head 5/5 palpable above pelvic
brim
 Cervix 4 cm dilated
 2 contractions in 10 min each lasting 20s
 Foetal heart rate 140 bpm
 Blood pressure 100/770 mmhg
 Temperature 36.2 c, Pulse 80 bpm
 Urine output 400mls,-ve protein ,acetone
Questions
1. What is your diagnosis ?
2. What action will you take ?
Step 2
 10.30 am : FHR 140bpm,cont 2/10
lasting 15s,Pulse 90 bpm
 11.00 am : FHR 136bpm,cont 2/10
lasting 15s,pulse 88,membranes intact
 11.30 am : FHR 140bpm,cont 2/10 each
lasting 20s Pulse 84bpm
 12.00 Md : FHR 236bpm,cont 2/10 each
lasting 15s,pulse 88bpm,T-36.2 C
VE done.Foetal head 5/5 above pelvic
brim,cervix 4cm dilated, membranes
intact.
Step 3
 12.30 pm : FHR 136 bpm cont 1/10
lasting 15s Pulse 90bpm
 13.00 hrs: FHR 140bpm cont 1/10
lasting 15s pulse 88bpm
 13.30 hrs : FHR 130bpm cont 1/10
lasting 20s ,Pulse 88bpm
 14.00 hrs : FHR 140bpm cont 2/10
lasting 20s,Pulse 90 bpm,Bp
100/70mmHg
Foetal head 5/5 above pelvic brim .VE
done at 14.00 hrs ; membranes intact
cervix 4cm dilated .Urine 400mls neg for
protein or acetone.
Questions
Q1. What is your diagnosis ?
Q2. What action should you take now ?
Nursing Diagnosis
Prolonged labour related to ineffective
uterine contractions.
Actions
A1. Artificial rupture of membrane-
amniotic fluid clear
Cervix 4cm dilated,skull bones separated
A2. Augmented with I.V oxytocin 2.5 units
in 500mls 5 % dextrose to flow at
10dpm
Step 4
14.30 hrs
2 contractions in 10 min each lasting 30s
Oxytocin infusion rate increased to 30 dpm
FHR 140 bpm, pulse 88 bpm,Bp 120/80
mmHg
15.00 hrs
3 contractions in 10 mins lasting 30s
Oxytocin infusion rate increased to 30dpm
FHR 140bpm,pulse 90 bpm
15.30 hrs
3 contractions on 10 min lasting 30s
Oxytocin infusion rate increased to 40dpm
FHR 140 bpm , Pulse 88bpm
16.00hrs : VE
Descent 2/5 above the pelvic brim
Cervix 6cm dilated
3 contractions in 10 min each lasting 30s
Oxytocin infusion rate increased to 50 dpm

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USING PARTOGRAPH.ppt student 2023 slidevvvvvvvvvvvccc

  • 1. MANAGING LABOR USING THE PARTOGRAPH
  • 2. Using the Partograph 2 The Partograph Assessment of fetal well being Assessment of maternal well being Assessment of progress of labor
  • 3. Using the Partograph 3 1. Measuring Fetal Well Being During Labor Fetal heart rates and pattern Degree of molding, caput Color of amniotic fluid
  • 4. Using the Partograph 4 2. Measuring Maternal Well Being During Labor Pulse, temperature, blood pressure, respiration Urine output, ketones, protein
  • 5. Using the Partograph 5 3. Measuring Progress of Labor  Cervical dilatation  Descent of presenting part  Contractions –Duration –Frequency  Alert and action lines
  • 6. Using the Partograph 6 Using the Partograph  Patient information: Name, gravida, Para, hospital number, date and time of admission, and time of ruptured membranes  Fetal heart rate: Record every half hour  Amniotic fluid: Record the color at every vaginal examination:  I: membranes intact  C: membranes ruptured, clear fluid  M: meconium-stained fluid  B: blood-stained fluid
  • 7. Using the Partograph 7 Using the Partograph (continued)  Molding:  1: sutures apposed  2: sutures overlapped but reducible  3: sutures overlapped and not reducible  Cervical dilatation: Assess at every vaginal examination, mark with cross (X)  Alert line: Line starts at 4 cm of cervical dilatation to the point of expected full dilatation at the rate of 1 cm per hour  Action line: Parallel and 4 hours to the right of the alert line
  • 8. Using the Partograph 8 Using the Partograph (continued)  Descent assessed by abdominal palpation: Part of head (divided into 5 parts) palpable above the symphysis pubis; recorded as a circle (O) at every vaginal examination. At 0/5, the sinciput (S) is at the level of the symphysis pubis
  • 9. Using the Partograph 9 Using the Partograph (continued)  Hours: Time elapsed since onset of active phase of labor (observed or extrapolated)  Time: Record actual time  Contractions: Chart every half hour; palpate the number of contractions in 10 minutes and their duration in seconds  Less than 20 seconds:  Between 20 and 40 seconds:   More than 40 seconds:  Oxytocin: Record amount per volume IV fluids in drops/min. every 30 min. when used  Drugs given: Record any additional drugs given
  • 10. Using the Partograph 10 Using the Partograph (continued)  Temperature: Record every 2 hours  Pulse: Record every 30 minutes and mark with a dot (•)  Blood pressure: Record every 4 hours and mark with arrows  Protein, acetone and volume: Record every time urine is passed
  • 11. Using the Partograph 11 The Modified WHO Partograph (Figure C-10)
  • 12. Using the Partograph 12 Sample Partograph for Normal Labor (Figure C-11)
  • 13. Using the Partograph 13 Partograph Showing Prolonged Active Phase of Labor (Figure S-6)
  • 14. Using the Partograph 14 Partograph Showing Obstructed Labor (Figure S-7)
  • 15. Using the Partograph 15 Partograph Showing Inadequate Uterine Contractions Corrected with Oxytocin (Figure S-8)
  • 16. Use of a Partograph Case Studies
  • 17. Case 1 ● Mrs Njoroge was admitted at 5am on 25/09/2009 ● The membranes had ruptured at 4am ● Gravida 3, Para 2+0 ,Hospital no. 7886 ● On admission foetal head was 4/5 palpable above the pelvic brim ● The cervix was 2cm dilated What should be recorded on the partograph ?
  • 18. Step 2 : 9am ● Fetal head is 3/5 palpable above the pelvic brim ● Cervix is 5cm dilated ● There are 3 contractions in 10 min each lasting 20-40 s ● Fetal Heart rate is 120 bpm ● Amniotic fluid is clear ● Skull bones separated sutures easily felt ● Maternal BP 120/70 mmhg,Temp 36.8C ● Pulse 80 bpm ● Urine output 200mls -ve protein or acetone
  • 19. questions ● What steps should you take ? ● What advice should be given ? ● What do you expect to find at 1.00pm ? Plot the information on the partograph
  • 20. Step 3  09.30 am : FHR 120 bpm,cont 3/10 each lasting 30s , pulse 80 bpm  10.00 am : FHR 136bpm,cont 3/10 each 30s,Pulse 80bpm  10.30 am : FHR 140 bpm,Cont 3/10 each lasting 35s , Pulse 88bpm  11.00 am : FHR 130bpm,cont 3/10 each lasting 40 s, Pulse 88bpm,Temp 37 C  11.30 am : FHR 136 bpm, Cont 4/10 each lasting 40 s,pulse 84bpm  12.00 FHR 140 bpm,cont 4/10 each 40s,pulse 88 bpm  12.30 pm : FHR 130 bpm, cont 4/10 each lasting 40s pulse 88 bpm  13.00 pm : FHR 140bpm , cont 4/10 , each lasting 45s , Pulse 88 bpm
  • 21. Vaginal exam 13.00pm  foetal head 0/5 palpable above the pelvic brim  The cervix is fully dilated  Amniotic fluid is clear  Skull bones separated , sutures easily felt  BP 100/70 mmHg  Urine output 150 mls –ve for protein and acetone
  • 22. Questions Plot the findings on the partograph and answer the following :- 1. What steps should you take ? 2. What advice should be given ? 3. What do you expect to happen next ?
  • 23. Step 4 At 13.20 pm spontaneous vaginal delivery to a Live Female Infant weighing 2.85kg. Questions 1. How long was the Active phase of the first stage of labour ? 2. How long was the active phase of Labour ? 3. How long was the second stage of labour ?
  • 24. Case study 2 Mrs Ibrahim was admitted on 25/09/09 at 10.00am.On nursing assessment the following information was obtained :-  Membranes intact,Gravida 1,para 0+0  Hospital No. 1443  Foetal head 5/5 palpable above pelvic brim  Cervix 4 cm dilated  2 contractions in 10 min each lasting 20s  Foetal heart rate 140 bpm  Blood pressure 100/770 mmhg  Temperature 36.2 c, Pulse 80 bpm  Urine output 400mls,-ve protein ,acetone
  • 25. Questions 1. What is your diagnosis ? 2. What action will you take ?
  • 26. Step 2  10.30 am : FHR 140bpm,cont 2/10 lasting 15s,Pulse 90 bpm  11.00 am : FHR 136bpm,cont 2/10 lasting 15s,pulse 88,membranes intact  11.30 am : FHR 140bpm,cont 2/10 each lasting 20s Pulse 84bpm  12.00 Md : FHR 236bpm,cont 2/10 each lasting 15s,pulse 88bpm,T-36.2 C VE done.Foetal head 5/5 above pelvic brim,cervix 4cm dilated, membranes intact.
  • 27. Step 3  12.30 pm : FHR 136 bpm cont 1/10 lasting 15s Pulse 90bpm  13.00 hrs: FHR 140bpm cont 1/10 lasting 15s pulse 88bpm  13.30 hrs : FHR 130bpm cont 1/10 lasting 20s ,Pulse 88bpm  14.00 hrs : FHR 140bpm cont 2/10 lasting 20s,Pulse 90 bpm,Bp 100/70mmHg Foetal head 5/5 above pelvic brim .VE done at 14.00 hrs ; membranes intact cervix 4cm dilated .Urine 400mls neg for protein or acetone.
  • 28. Questions Q1. What is your diagnosis ? Q2. What action should you take now ?
  • 29. Nursing Diagnosis Prolonged labour related to ineffective uterine contractions. Actions A1. Artificial rupture of membrane- amniotic fluid clear Cervix 4cm dilated,skull bones separated A2. Augmented with I.V oxytocin 2.5 units in 500mls 5 % dextrose to flow at 10dpm
  • 30. Step 4 14.30 hrs 2 contractions in 10 min each lasting 30s Oxytocin infusion rate increased to 30 dpm FHR 140 bpm, pulse 88 bpm,Bp 120/80 mmHg 15.00 hrs 3 contractions in 10 mins lasting 30s Oxytocin infusion rate increased to 30dpm FHR 140bpm,pulse 90 bpm
  • 31. 15.30 hrs 3 contractions on 10 min lasting 30s Oxytocin infusion rate increased to 40dpm FHR 140 bpm , Pulse 88bpm 16.00hrs : VE Descent 2/5 above the pelvic brim Cervix 6cm dilated 3 contractions in 10 min each lasting 30s Oxytocin infusion rate increased to 50 dpm

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