This document provides information about the WHO partograph, including:
- The partograph is a graphical record used to monitor labor progress and the condition of the mother and fetus. It was developed by the WHO.
- The history of the partograph is described, from Friedman's original version in 1954 to later refinements by Philpott and Castle in 1972 who introduced alert and action lines.
- The components of the modern partograph are outlined, including sections to monitor fetal condition, labor progress, and maternal condition. Key indicators like cervical dilation, fetal position, and uterine contractions are plotted over time.
- Guidelines for interpreting labor progress using the partograph and determining appropriate actions are provided, such as transferring or
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
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
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
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.
This presentation includes all the events , its sign and symptoms about IOL as well as management of women in the first stage of labor and how to assess the women in labor with the help of partograph.
Overview
While it takes nine months to grow a full-term baby, labor and delivery occurs in a matter of days or even hours. However, it’s the process of labor and delivery that tends to occupy the minds of expectant parents the most.
Read on if you have questions and concerns around the signs and length of labor, and how to manage pain.
Signs of labor
Labor has started or is coming soon if you experience symptoms such as:
increased pressure in the uterus
a change of energy levels
a bloody mucus discharge
Real labor has most likely arrived when contractions become regular and are painful.
Braxton Hicks contractions
Many women experience irregular contractions sometime after 20 weeks of pregnancy. Known as Braxton Hicks contractions, they’re typically painless. At most, they’re uncomfortable and are irregular.
Braxton Hicks contractions can sometimes be triggered by an increase in either mother or baby’s activity, or a full bladder. No one fully understands the role Braxton Hicks contractions play in pregnancy.
They may promote blood flow, help maintain uterine health during the pregnancy, or prepare the uterus for childbirth.
Braxton Hicks contractions don’t cause the cervix to dilate. Painful or regular contractions aren’t likely to be Braxton Hicks. Instead, they’re the type of contractions that should lead you to call your doctor.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
1. WHO Partograph
For Beginner
• Dr Muhammad El Hennawy
• Ob/gyn specialist
• Rass el barr central hospital and
dumyat specialised hospital
• Dumyatt – EGYPT
• www.geocities.com/mmhennawy
2. Partograph
• A partograph is a graphical
record of the observations made
of a women in labour
• For progress of labour and salient
conditions of the mother and
fetus
• It was developed and extensively
tested by the world health
organization WHO
3. History Of Partogram
Friedman's partogram devised in 1954 was based
on observations of cervical dilatation and foetal
station against time elapsed in hours from onset of
labour. The time onset of labour was based on the
patient's subjective perception of her contractility.
Plotting cervical dilatation against time yielded the
typical sigmoid or 'S' shaped curve and station
against time gave rise to the hyperbolic curve.
Limits of normal were defined
4. Philpott and Castle
• in 1972 introduced the concept of "ALERT" and "ACTION"
lines. The aim of this study was to fulfill the needs of paramedical
personnel practising obstetrics in Rhodesian African
primigravidae. The alert line represented the mean rate of
progress of the slowest 10% of patients in the African population
whom they served. Alert line was drawn at a slope of 1
centimetre/hr for nulliparous women starting at zero time i.e.
time of admission . Action line drawn four hours to the right of
the alert line showing that if the patient has crossed the alert line
active management should be instituted within 4 hours, enabling
the transfer of the patient to a specialised tertiary care centre.
• The action line was subsequently drawn two hours to the right of
the alert line
5. Studd's labour stencils
• It were introduced in 1972. These stencils
predicted the expected pattern of
progression of labour based on the extent of
dilataton achieved by the time the patient is
admitted (zero time). Curves showing the
average course of cervical dilatation were
constructed for various dilatation on
admission. Five separate patterns
representing normal labour progression
were constructed. The curves were
transcribed onto acrylic stencils On
admission in labour, the cervical dilatation
was assessed and a stencil was used to draw
the relevant pencil line of expected progress
on the patient's cervicograph which was
then completed. Those crossing the
nomogram line were found to have a three
fold increase in instrumental delivery.
7. Overview
• The partograph can be used by health workers with adequate training
in midwifery who are able to :
- observe and conduct normal labour and delivery.
- Perform vaginal examination in labour and assess cervical diltation
accurately
- plot cervical diltation accurately on a graph against time
• There is no place for partograph in deliveries at home conducted by
attendants other than those trained in midwifery
• Whether used in health centers or in hospitals , the partograph must be
accompanied by a program of training in its use and by appropriate
supervision and follow up
8. Objectives
• early detection of abnormal progress of a labour
• prevention of prolonged labour
• recognize cephalopelvic disproportion long before obstructed labour
• assist in early decision on transfer , augmentation , or terminjation of
labour
• increase the quality and regularity of all observations of mother and
fetus
• early recognition of maternal or fetal problems
• the partograph can be highly effective in reducing complications from
prolonged labor for the mother (postpartum hemorrhage, sepsis,
uterine rupture and its sequelae) and for the newborn (death, anoxia,
infections, etc.).
9. Partograph function
• The partograph is designed for use in all maternity settings , but has a
different level of function at different levels of health care
• in health center, the partograph,s critical function is
to give early warning if labour is likely to be prolonged and to indicate
that the woman should be transferred to hospital (ALERT LINE
FUNCTION )
• in hospital settings, moving to the right of alert line serves as a
warning for extra vigilance , but the action line is the critical point at
which specific management decisions must be made
• other observations on the progress of labour are also recorded on the
partograph and are essential features in management of labour
10. Components of the partograph
• Part 1 : fetal condition
( at top )
• Pqrt 11 : progress of labour
( at middle )
• Part 111 : maternal condition
( at bottom )
• Outcome : ………………
11. Part 1 : Fetal condition
• this part of the graph is used to monitor and assess fetal condition
• 1 - Fetal heart rate
• 2 - membranes and liquor
• 3 - moulding the fetal skull bones
• Caput
12. Fetal heart rate
Basal fetal heart rate?
• < 160 beats/mi =tachycardia
• > 120 beats/min = bradycardia
• >100 beats/min = severe bradycardia
Decelerations? yes/no
Relation to contractions?
Early
Variable
Late – -----Auscultation - return to baseline
> 30 sec contraction
----- Electronic monitoring
peak and trough (nadir)
> 30 sec
14. moulding the fetal skull bones
• Molding is an important indication of how adequately the
pelvis can accommodate the fetal head
• increasing molding with the head high in the pelvis is an
ominous sign of cephalopelvic disproportion
• separated bones . sutures felt easily ……………….….O
• bones just touching each other ………………………..+
• overlapping bones ( reducible 0 ……………………...++
• severely overlapping bones ( non – reducible ) ……..+++
15. part11 – progress of labour
.Cervical diltation
• Descent of the fetal head
• Fetal position
• Uterine contractions
• this section of the paragraph has as its central feature a graph of
cervical diltation against time
• it is divided into a latent phase and an active phase
16. latent phase:
• it starts from onset of labour until the cervix reaches 3 cm
diltation
• once 3 cm diltation is reached , labour enters the active
phase
• lasts 8 hours or less
• each lasting < 20 sceonds
• at least 2/10 min contractions
17. Active phase:
• Contractions at least 3 / 10 min
• each lasting < 40 sceonds
• The cervix should dilate at a rate of 1
cm / hour or faster
18. Alert line ( health facility line(
• The alert line drawn from 3 cm diltation
represents the rate of diltation of 1 cm /
hour
• Moving to the right or the alert line means
referral to hospital for extra vigilance
19. Action line ( hospital line(
• The action line is drawn 4 hour to the right
of the alert line and parallel to it
• This is the critical line at which specific
management decisions must be made at the
hospital
20. Cervical diltation
• It is the most important information and the surest way to assess
progress of labour , even though other findings discovered on
vaginal examination are also important
• when progress of labour is normal and satisfactory , plotting of
cervical diltation remains on the alert line or to left of it
• if a woman arrives in the active phase of labour , recording of
cervical diltation starts on the alert line
• when the active phase of labor begins , all recordings are
transferred and start by pltting cervical diltation on the alert line
21. Descent of the fetal head
• It should be assessed by abdominal
examination immediately before doing
a vaginal examination, using the rule of
fifth to assess engagement
• The rule of fifth means the palpable
fifth of the fetal head are felt by
abdominal examination to be above the
level of symphysis pubis
• When 2/5 or less of fetal head is felt
above the level of symphysis pubis ,
this means that the head is engage , and
by vaginal examination , the lowest
part of vertex has passed or is at the
level of ischial spines
22. Assessing descent of the fetal head by vaginal
examination;
0 station is at the level of the ischial spine (Sp(.
24. Uterine contractions
• Observations of the contractions are made every hour in the
latent phase and every half-hour in the active phase
• frequency how often are they felt ?
• Assessed by number of contractions in a 10 minutes period
• duration how long do they last ?
Measured in seconds from the time the contraction is first felt
abdominally , to the time the contraction phases off
• Each square represents one contraction
25. Palpate number of contraction in ten
minutes and duration of each contraction in
seconds
• Less than 20 seconds:
• Between 20 and 40 seconds:
• More than 40 seconds:
26. Part111: maternal condition
Name / DOB /Gestation
Medical / Obstetrical issues
Assess maternal condition regularly by monitoring :
• drugs , IV fluids , and oxytocin , if labour is augmented
• pulse , blood pressure
• Temperature
• Urine volume , analysis for protein and acetone
28. - latant phase is less than 8 hours
- progress in active phase remains
on or left of the alert line
• Do not augment with oxytocin if
latent and active phases go normally
• Do not intervene unless complications
develop
• Artificial rupture of membranes
( ARM )
• No ARM in latent phase
• ARM at any time in active phase
29. Between alert and action lines
• In health center , the women must be transferred to a
hospital with facilities for cesarean section , unless the
cervix is almost fully dilated
• Observe labor progress for short period before transfer
• Continue routine observations
• ARM may be performed if membranes are still intact
30. At or beyond action line
• Conduct full medical assessement
• Consider intravenous infusion / bladder catheterization / analgesia
• Options
- Deliver by cesarean section if there is fetal distress or obstructed
labour
- Augment with oxytocin by intravenous infusion if there are no
contraindications
32. • One of the main functions of the partograph
is to detect early deviation from normal
progress of labor
33. Moving to the right of alert line
• This means warning
• Transfer the woman from health center to
hospital
• reaching the action line
• This means possible danger
• Decision needed on future management
(usually by obesteritian or resident )
34. Prolonged latent phase
• If a woman is admitted in labor
in the latent phase ( less than 3
cm diltation ) and remains in the
latent phase for next 8 hours
• Progress is abnormal and she
must br transferred to a hospital
for a decision about further
action
• This is why there is a heavy line
drawn on the partograph at the
end of 8 hours of the latent phase
35. Polonged Active phase
• In the active phase of labor , plotting of
cervical diltation will normally remain
on or to the left of the alert line
• But some cases will move to the right of
the alert line and this warns that labor
may be prolonged
• This will happen if the rate of cervical
diltation in the active phase of labor is
not 1 cm / hour or faster
• A woman whose cervical diltation
moves to the right of the alert line must
be transferred and manged in a hospital
with adequate facilities for obstetric
intervention unless delivery is near
• at the action line , the woman must be
carefully reassessed for why labor is not
progressing and a decision made on
further management
36. Secondary arrest of
cervical diltation
• Abnormal progress of labor may
occur in cases with normal
progress of cervical diltation then
followed by secondary arrest of
diltation
37. Secondary arrest of head descant
• Abnormal progress of labor may occur with normal progress of
descent of the fetal head then followed by secondary arrest of
desscent of fetal head
40. • It is important to realize that the partograph is a tool for
managing labor progress only
• The partograph does not help to identify other risk factors
that may have been present before labor started
41. • only start a partograph when you have checked that there are
no complications of pregnancy that require immediate action
• a partograph chart must only be started when a woman is in
labor,-- be sure that she is contracting enough to start a
partograph
• if progress of labor is satisfactory , the plotting of cervical
diltation will remain or to the left of the alert line
42. • when labor progress well , the diltation should not move to the
right of the alert line
• the latent phase . 0 – 3 cm diltation , is accompanied by gradual
shortening of cervix . normally , the latent phase should not last
more than 8 hours
• the active phase , 3 – 10 cm diltation , should progress at rate of
at least 1 cm/hour
• when admission takes place in the active phase , the admission
diltation, is immediately plotted on the alert line
43. • when labor goes from latent to active phase , plotting of
the diltation is immediately transferred from the latent
phase area to the alert line
44. • diltation of the cervix is plotted ( recorded with an X , desent of the
fetal head is plotted with an O , and uterine contractions are plotted
with differential shading
• desent of the head should always be assessed by abdominal
examination ( by the rule of fifths felt above the pelvic brim )
immediately before doing a vaginal examination
• assessing descent of the head assists in detecting progress of labor
• increased molding with a high head is a sign of cephalopelvic
disproportion
45. • vaginal examination should be performed infrequently as this is
compatible with safe practice ( once every 4 hours is
recommended )
• when the woman arrives in the latent phase , time of admission
is 0 time
• a woman whose cervical diltation moves to the right of the alert
line must be transferred and manged in an institution with
adequate facilities for obstetric intervention , unless delivery is
near
46. • when a woman ,s partograph reaches the action line , she must be
carefully reassessed to determine why there is lack of progress , and
a decision must be made on further management ( usually by an
obesterician or resident )
• when a woman in labor passes the latent phase in less than 8 hours
i.e., transfers from latent to active phase , the most important feature
is to transfer plotting of cervical diltation to the alert line using the
letters TR,
• Leaving the area between the transferred recording blank. The
broken transfer line is not part of the process of labor
• do not forget to transfer all other findings vertically
48. OXYTOCIN
• Oxytocics must be preserved in a cool ,
dark place
• A local regime may be used
• Oxytocin should be titrates against
uterine contractions and increased every
half- hour until contractions are 3 or 4
in10 minutes , each lasting 40 – 50
seconds
• It may br maintained at the rate thoughout
the second stage of labor
• Stop oxytocin infusion if there is
evidence of uterine hyperactivity and / or
fetal distress
• Oxytocin must be used with caution in
multiparous women and rarely , if at all ,
in women of para 4 or more
• Augment with oxytocin only after
artificial rupture of membranes and
provided that the liquor is clear
49. MEMBRANES
• if membranes have been ruptured for 12 hours
or more , antibiotics should be given
• As a first defense against serious infections, give a combination of
antibiotics:
- ampicillin 2 g IV every 6 hours;
- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;
- PLUS metronidazole 500 mg IV every 8 hours.
Note:
If the infection is not severe, amoxicillin 500 mg by mouth every 8
hours can be used instead of ampicillin. Metronidazole can be given
by mouth instead of IV.
50. FETAL DISTRESS
• If a woman is laboring in a health center . transfer her to a hospital
with facilities for operative delivery
• In a hospital , immediately :
- Conduct a vaginal examination to exclude cord prolapse and observe
amniotic fluid
- Provide adequate hydraion
- Administer oxygen , if avaliablestop oxytocin
-Turn the woman or her left side
51. Diagnosis of labour
Regular painful contractions resulting
in progressive change of the cervix
+/- show
+/- rupture of membranes
53. The partograph in the management
of labor following cesarean section.
• In women undergoing a trial of labor following cesarean
section, the partographic zone 2-3 h after the alert line
represents a time of high risk of scar rupture. An action
line in this time zone would probably help reduce the
rupture rate without an unacceptable increase in the rate of
cesarean section
55. • Full electronic capture of patient
information during childbirth including,
• CTG's,
• partograms,
• all labour events,
• outcome information,
• fetal blood sampling results and cord
blood gases direct from the blood gas
analyser
This information can be shown in real time
to enhance communication within and
outside the delivery suite to improve
patient care and reduce human error.
• It can be accessed over the anywhere,
anytime, from within a hospital or from a
home..
56. COMPUTERIZED LABOR MANAGEMENT
To accurately and continuously measure cervical dilatation and fetal
head station in labor and the fetal monitoring and the mother monitoring
A ultrasound–based computerized labor management system was
designed
The Fetal Monitoring System and
The mother Monitoring System with
The system´s in-vivo generated individual Partograms
with real time dilatation and head station measurements.
The measurements had accuracy of < 5mm =
all parturients were comfortable throughout the insertion and the testing
period.
There was no infection, bleeding or any significant local complication at
any attachment site
57. • This system provides accurate continuous measurements of
dilatation and station.
• The method is superior to digital examination and provides real
time diagnosis of non-progressive and precipitous labor.
• The system is likely to reduce discomfort and infections associated
to multiple vaginal examinations..
58. The Fetal Monitoring System
is a computer based training system that can be accessed over
the anywhere, anytime, from within a hospital or from a
home.