This document provides information about the WHO partograph, including:
- The partograph is a graphical record used to monitor the progress of labor and the condition of the mother and fetus.
- It was developed by the WHO to allow health workers to monitor labor and identify issues that may require intervention or transfer to a higher level of care.
- The partograph includes sections to record fetal condition, progress of labor including cervical dilation over time, and maternal condition. Crossing lines on the graph indicate when closer monitoring or actions are required.
The document discusses the partograph, a graphical record used to monitor labor. It was developed by the WHO to allow early detection of abnormal labor progress.
The partograph includes sections to monitor the fetal condition, labor progress, and maternal condition over time. It graphs cervical dilation against time to identify normal vs prolonged labor. Lines are included to indicate when extra vigilance or interventions are needed.
The partograph aims to prevent prolonged labor and its complications by allowing early decision making about transfers, augmentations, or terminations. Its use requires adequate training but it can effectively reduce problems from prolonged labor for both mother and baby when properly implemented.
The document provides an overview of the WHO partograph, which is a graphical record used to monitor the progress of labor and the condition of the mother and fetus. It describes the history and development of the partograph, including Friedman's original design from 1954 and later additions by Philpott and Castle in 1972, who introduced the "alert line" and "action line". The document then explains the components, objectives, and proper use and interpretation of the partograph to monitor labor progress and determine if intervention is needed.
The document provides an overview of the partograph, which is a graphical record used to monitor the progress of labor and the condition of the mother and fetus. It describes the history and development of the partograph, including Friedman's original partogram from 1954 and later modifications by Philpott and Castle that introduced alert and action lines. The WHO partograph is explained in detail, outlining its components for monitoring fetal condition, labor progress, and maternal condition. Guidelines are provided for normal labor progression and management based on the partograph, as well as how to identify and respond to abnormal labor progress. Key considerations for using oxytocin augmentation are also reviewed.
The document provides information on using the WHO partograph to monitor labor progress. It describes the components of the partograph including fetal condition, labor progress, and maternal condition. It explains how to interpret the partograph and what actions to take at different stages, such as transferring a woman if she crosses the alert line or making management decisions if she reaches the action line. The purpose is to detect abnormal labor progress early so issues can be addressed promptly to prevent complications for mother and baby.
This document discusses the use of a partograph to monitor labor. A partograph is a graphical record used to monitor the progress of labor and assess the condition of the mother and fetus. It tracks cervical dilation, fetal descent, contractions and other metrics. Tracking these metrics against timelines helps identify abnormal labor progress. If progress deviates from alert or action lines, it warns of potential complications and need for intervention or transfer to higher level care. The partograph is a tool to manage labor but does not identify pre-existing risk factors. Its aim is early detection of problems to improve outcomes for mother and baby.
The partograph is a tool used to monitor labor and detect any abnormalities. It was developed by the WHO for use in resource-limited settings. The partograph includes sections to monitor the fetal condition, labor progress (including cervical dilation over time), and maternal condition. Key features include alert and action lines to indicate management changes needed. Using the partograph can reduce prolonged labor risks and improve maternal and neonatal outcomes.
The partograph is a graphical record used to monitor labor. It was originally developed in the 1950s and has since been refined. The modern WHO partograph monitors maternal and fetal conditions including cervical dilation, fetal position, and uterine contractions. It uses alert and action lines to identify abnormal labor progress. When the alert line is crossed, extra vigilance is needed and crossing the action line requires medical intervention such as augmentation or cesarean delivery. Using the partograph can reduce complications from prolonged labor by facilitating early detection and treatment.
The document discusses the partograph, a graphical record used to monitor labor. It was developed by the WHO to allow early detection of abnormal labor progress.
The partograph includes sections to monitor the fetal condition, labor progress, and maternal condition over time. It graphs cervical dilation against time to identify normal vs prolonged labor. Lines are included to indicate when extra vigilance or interventions are needed.
The partograph aims to prevent prolonged labor and its complications by allowing early decision making about transfers, augmentations, or terminations. Its use requires adequate training but it can effectively reduce problems from prolonged labor for both mother and baby when properly implemented.
The document provides an overview of the WHO partograph, which is a graphical record used to monitor the progress of labor and the condition of the mother and fetus. It describes the history and development of the partograph, including Friedman's original design from 1954 and later additions by Philpott and Castle in 1972, who introduced the "alert line" and "action line". The document then explains the components, objectives, and proper use and interpretation of the partograph to monitor labor progress and determine if intervention is needed.
The document provides an overview of the partograph, which is a graphical record used to monitor the progress of labor and the condition of the mother and fetus. It describes the history and development of the partograph, including Friedman's original partogram from 1954 and later modifications by Philpott and Castle that introduced alert and action lines. The WHO partograph is explained in detail, outlining its components for monitoring fetal condition, labor progress, and maternal condition. Guidelines are provided for normal labor progression and management based on the partograph, as well as how to identify and respond to abnormal labor progress. Key considerations for using oxytocin augmentation are also reviewed.
The document provides information on using the WHO partograph to monitor labor progress. It describes the components of the partograph including fetal condition, labor progress, and maternal condition. It explains how to interpret the partograph and what actions to take at different stages, such as transferring a woman if she crosses the alert line or making management decisions if she reaches the action line. The purpose is to detect abnormal labor progress early so issues can be addressed promptly to prevent complications for mother and baby.
This document discusses the use of a partograph to monitor labor. A partograph is a graphical record used to monitor the progress of labor and assess the condition of the mother and fetus. It tracks cervical dilation, fetal descent, contractions and other metrics. Tracking these metrics against timelines helps identify abnormal labor progress. If progress deviates from alert or action lines, it warns of potential complications and need for intervention or transfer to higher level care. The partograph is a tool to manage labor but does not identify pre-existing risk factors. Its aim is early detection of problems to improve outcomes for mother and baby.
The partograph is a tool used to monitor labor and detect any abnormalities. It was developed by the WHO for use in resource-limited settings. The partograph includes sections to monitor the fetal condition, labor progress (including cervical dilation over time), and maternal condition. Key features include alert and action lines to indicate management changes needed. Using the partograph can reduce prolonged labor risks and improve maternal and neonatal outcomes.
The partograph is a graphical record used to monitor labor. It was originally developed in the 1950s and has since been refined. The modern WHO partograph monitors maternal and fetal conditions including cervical dilation, fetal position, and uterine contractions. It uses alert and action lines to identify abnormal labor progress. When the alert line is crossed, extra vigilance is needed and crossing the action line requires medical intervention such as augmentation or cesarean delivery. Using the partograph can reduce complications from prolonged labor by facilitating early detection and treatment.
The partograph is a graphical record used to monitor labor. It was originally developed in the 1950s and has since been refined. The modern WHO partograph monitors maternal and fetal conditions including cervical dilation, fetal position, and uterine contractions. It uses alert and action lines to indicate abnormal labor progress. When the alert line is crossed, extra vigilance is needed and crossing the action line requires medical intervention such as augmentation or cesarean delivery. Using the partograph can reduce complications from prolonged labor by facilitating early detection and management of issues.
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
The document defines and describes the history, uses, components and functions of a partograph. A partograph is a graphical record that plots the progress of labor over time, including cervical dilation, fetal descent, uterine contractions and maternal/fetal conditions. It allows healthcare providers to monitor labor, detect abnormalities early, and make timely decisions about delivery or transfer. The WHO modified the partograph to simplify use and begin plotting at 4cm dilation. It is an effective tool for reducing prolonged labor complications for mothers and newborns.
1) The document summarizes the management of normal labor and the use of the partograph to monitor labor. It describes the stages of labor, mechanisms of labor, and complications that can occur.
2) The partograph is a graphic record that aids in early detection of problems in the mother and fetus. It includes monitoring of cervical dilation, fetal descent, uterine contractions, and fetal and maternal conditions.
3) Key principles of the WHO partograph include commencing the active phase at 3cm dilation, the latent phase not exceeding 8 hours, and cervical dilation slowing to less than 1cm/hr requiring intervention.
The document provides information on using a partograph to monitor labor. A partograph is a composite chart used to graphically record observations of a woman in labor. It can serve as an early warning system to detect abnormal labor progress and help make timely decisions about interventions. Key components of the partograph include monitoring cervical dilation, fetal descent, contractions, and maternal condition. Deviations from normal labor progress such as a prolonged latent phase or active phase may indicate issues that require actions like transfer or augmentation of labor.
The partograph is a tool used to monitor labor and identify complications. It consists of 3 parts to track the fetal condition, labor progress, and maternal condition over time. The document outlines the components of each part, including monitoring the fetal heart rate, cervical dilation, descent of the head, and uterine contractions. It provides a case study example of plotting findings from labor onto the partograph to assess progress.
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 document discusses the partogram, a tool for recording the progress of labor. It explains that the partogram graphs cervical dilation, fetal descent, and uterine contractions on a chart to allow healthcare providers to monitor labor and identify complications early. The document outlines the components recorded on a partogram, including fetal heart rate, amniotic fluid, maternal vital signs, and medications. It describes how to interpret the alert and action lines plotted on the partogram to determine if labor is progressing normally or requires intervention. The partogram is an important tool that facilitates continuity of care during labor and allows early detection of problems like prolonged or obstructed labor.
1) The partograph is a graphical record used to monitor the progress of labour and detect abnormalities through charting cervical dilation, fetal descent, contractions, and fetal/maternal conditions.
2) It consists of 3 sections - fetal condition, labour progress, and maternal condition - to provide an objective assessment of factors indicating normal vs obstructed labour.
3) Abnormal progress detected by crossing the alert line (1cm dilation/hour) or action line requires reassessment and management decisions to prevent complications.
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.
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
This document discusses the process of labor and outlines the female pelvis and fetal skull anatomy. It describes the stages of normal labor and the mechanism of labor. Abnormal labor patterns including protraction disorders and arrest disorders are defined. Risk factors for abnormal labor include older age, diabetes, and prior complications. Dystocia can cause issues for both the mother and neonate. Causes of dystocia are classified as abnormal power, abnormal passage, or abnormal passenger. Management may include supportive care, augmentation, and operative delivery depending on the type of dystocia. The role of the partograph in monitoring labor is also summarized.
Management of normal labour Final yr.pptxIram Chaudhry
This document provides an outline and overview of the management of normal labor. It defines the three stages of labor as follows:
1) First stage (cervical dilation from 0-10cm): divided into latent phase and active phase
2) Second stage (fetal descent and expulsion): from full dilation until delivery of the baby
3) Third stage (placental expulsion): from delivery of the baby until delivery of the placenta
It describes the assessment, monitoring and care provided during each stage, including vaginal exams, partograms to monitor progress, fetal monitoring, positioning, pain management, and active management of the third stage to prevent postpartum hemorrhage. The
Normal labor and delivery involves 3 stages: 1) dilation of the cervix, 2) delivery of the baby, and 3) delivery of the placenta. The fetus moves through the birth canal via engagement, descent, flexion, internal rotation, extension, and external rotation. Labor is considered normal if it is spontaneous in onset, involves a single cephalic fetus at term, lasts less than 12 hours for first-time mothers and 8 hours for others, and results in an unassisted vaginal birth.
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.
The partogram is a graphical record used to monitor labor. It includes information on the condition of the mother and fetus over time. Monitoring labor progress can allow early detection of abnormalities and prevent prolonged labor. The WHO partogram from 1994 includes lines to monitor cervical dilation and guide management. A modified version from 2007 removed the latent phase and started active phase at 4 cm dilation. The partogram is a valuable tool that can reduce complications when used to carefully track the stages of labor.
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the use of a partograph to monitor labor. It begins by explaining the importance of monitoring during labor to detect problems early. It then describes the components of the partograph including patient identification, fetal condition, labor progress, and maternal condition. The document outlines how to use the partograph to assess cervical dilation, descent of the fetal head, contractions and other metrics against alert and action lines to monitor labor progress and make decisions about interventions or transfers.
The document discusses normal labour and delivery. It describes the stages of labour including the first, second, and third stages. It explains the interaction between the powers (uterine contractions), passengers (fetus), and passages (pelvis and birth canal). It discusses assessing cervical dilation, fetal position and station, and monitoring the fetus. It also covers managing each stage of labor, identifying abnormal labour, and addressing complications.
This document provides guidance on monitoring labor using a partograph. It describes the components and use of the partograph, including recording cervical dilation, fetal descent, fetal heart rate, amniotic fluid, moulding, and other metrics every 30 minutes to 4 hours. It explains that the partograph allows monitoring of labor progress and detection of abnormalities compared to alert and action lines. Referral is indicated if measurements cross the alert line.
This document provides an anatomy overview of the foot, including its dorsum, sole, muscles, nerves, arteries, and veins. It describes the following key points:
- The extensor digitorum brevis and extensor hallucis brevis muscles originate on the dorsum of the foot and insert on the toes, acting to extend the toes.
- The sole of the foot contains 4 layers of muscles that flex the toes, with nerves like the medial and lateral plantar nerves innervating these muscles.
- Major arteries like the dorsalis pedis and plantar arch supply the foot, and veins like the great saphenous drain it.
- Joints between the tarsal
The partograph is a graphical record used to monitor labor. It was originally developed in the 1950s and has since been refined. The modern WHO partograph monitors maternal and fetal conditions including cervical dilation, fetal position, and uterine contractions. It uses alert and action lines to indicate abnormal labor progress. When the alert line is crossed, extra vigilance is needed and crossing the action line requires medical intervention such as augmentation or cesarean delivery. Using the partograph can reduce complications from prolonged labor by facilitating early detection and management of issues.
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
The document defines and describes the history, uses, components and functions of a partograph. A partograph is a graphical record that plots the progress of labor over time, including cervical dilation, fetal descent, uterine contractions and maternal/fetal conditions. It allows healthcare providers to monitor labor, detect abnormalities early, and make timely decisions about delivery or transfer. The WHO modified the partograph to simplify use and begin plotting at 4cm dilation. It is an effective tool for reducing prolonged labor complications for mothers and newborns.
1) The document summarizes the management of normal labor and the use of the partograph to monitor labor. It describes the stages of labor, mechanisms of labor, and complications that can occur.
2) The partograph is a graphic record that aids in early detection of problems in the mother and fetus. It includes monitoring of cervical dilation, fetal descent, uterine contractions, and fetal and maternal conditions.
3) Key principles of the WHO partograph include commencing the active phase at 3cm dilation, the latent phase not exceeding 8 hours, and cervical dilation slowing to less than 1cm/hr requiring intervention.
The document provides information on using a partograph to monitor labor. A partograph is a composite chart used to graphically record observations of a woman in labor. It can serve as an early warning system to detect abnormal labor progress and help make timely decisions about interventions. Key components of the partograph include monitoring cervical dilation, fetal descent, contractions, and maternal condition. Deviations from normal labor progress such as a prolonged latent phase or active phase may indicate issues that require actions like transfer or augmentation of labor.
The partograph is a tool used to monitor labor and identify complications. It consists of 3 parts to track the fetal condition, labor progress, and maternal condition over time. The document outlines the components of each part, including monitoring the fetal heart rate, cervical dilation, descent of the head, and uterine contractions. It provides a case study example of plotting findings from labor onto the partograph to assess progress.
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 document discusses the partogram, a tool for recording the progress of labor. It explains that the partogram graphs cervical dilation, fetal descent, and uterine contractions on a chart to allow healthcare providers to monitor labor and identify complications early. The document outlines the components recorded on a partogram, including fetal heart rate, amniotic fluid, maternal vital signs, and medications. It describes how to interpret the alert and action lines plotted on the partogram to determine if labor is progressing normally or requires intervention. The partogram is an important tool that facilitates continuity of care during labor and allows early detection of problems like prolonged or obstructed labor.
1) The partograph is a graphical record used to monitor the progress of labour and detect abnormalities through charting cervical dilation, fetal descent, contractions, and fetal/maternal conditions.
2) It consists of 3 sections - fetal condition, labour progress, and maternal condition - to provide an objective assessment of factors indicating normal vs obstructed labour.
3) Abnormal progress detected by crossing the alert line (1cm dilation/hour) or action line requires reassessment and management decisions to prevent complications.
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.
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
This document discusses the process of labor and outlines the female pelvis and fetal skull anatomy. It describes the stages of normal labor and the mechanism of labor. Abnormal labor patterns including protraction disorders and arrest disorders are defined. Risk factors for abnormal labor include older age, diabetes, and prior complications. Dystocia can cause issues for both the mother and neonate. Causes of dystocia are classified as abnormal power, abnormal passage, or abnormal passenger. Management may include supportive care, augmentation, and operative delivery depending on the type of dystocia. The role of the partograph in monitoring labor is also summarized.
Management of normal labour Final yr.pptxIram Chaudhry
This document provides an outline and overview of the management of normal labor. It defines the three stages of labor as follows:
1) First stage (cervical dilation from 0-10cm): divided into latent phase and active phase
2) Second stage (fetal descent and expulsion): from full dilation until delivery of the baby
3) Third stage (placental expulsion): from delivery of the baby until delivery of the placenta
It describes the assessment, monitoring and care provided during each stage, including vaginal exams, partograms to monitor progress, fetal monitoring, positioning, pain management, and active management of the third stage to prevent postpartum hemorrhage. The
Normal labor and delivery involves 3 stages: 1) dilation of the cervix, 2) delivery of the baby, and 3) delivery of the placenta. The fetus moves through the birth canal via engagement, descent, flexion, internal rotation, extension, and external rotation. Labor is considered normal if it is spontaneous in onset, involves a single cephalic fetus at term, lasts less than 12 hours for first-time mothers and 8 hours for others, and results in an unassisted vaginal birth.
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.
The partogram is a graphical record used to monitor labor. It includes information on the condition of the mother and fetus over time. Monitoring labor progress can allow early detection of abnormalities and prevent prolonged labor. The WHO partogram from 1994 includes lines to monitor cervical dilation and guide management. A modified version from 2007 removed the latent phase and started active phase at 4 cm dilation. The partogram is a valuable tool that can reduce complications when used to carefully track the stages of labor.
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the use of a partograph to monitor labor. It begins by explaining the importance of monitoring during labor to detect problems early. It then describes the components of the partograph including patient identification, fetal condition, labor progress, and maternal condition. The document outlines how to use the partograph to assess cervical dilation, descent of the fetal head, contractions and other metrics against alert and action lines to monitor labor progress and make decisions about interventions or transfers.
The document discusses normal labour and delivery. It describes the stages of labour including the first, second, and third stages. It explains the interaction between the powers (uterine contractions), passengers (fetus), and passages (pelvis and birth canal). It discusses assessing cervical dilation, fetal position and station, and monitoring the fetus. It also covers managing each stage of labor, identifying abnormal labour, and addressing complications.
This document provides guidance on monitoring labor using a partograph. It describes the components and use of the partograph, including recording cervical dilation, fetal descent, fetal heart rate, amniotic fluid, moulding, and other metrics every 30 minutes to 4 hours. It explains that the partograph allows monitoring of labor progress and detection of abnormalities compared to alert and action lines. Referral is indicated if measurements cross the alert line.
This document provides an anatomy overview of the foot, including its dorsum, sole, muscles, nerves, arteries, and veins. It describes the following key points:
- The extensor digitorum brevis and extensor hallucis brevis muscles originate on the dorsum of the foot and insert on the toes, acting to extend the toes.
- The sole of the foot contains 4 layers of muscles that flex the toes, with nerves like the medial and lateral plantar nerves innervating these muscles.
- Major arteries like the dorsalis pedis and plantar arch supply the foot, and veins like the great saphenous drain it.
- Joints between the tarsal
This document provides information on the anatomy of arteries and nerves in the lower leg. It describes the course, branches, and tributaries of the popliteal artery, anterior tibial artery, posterior tibial artery, fibular artery, and saphenous and tibial nerves. The popliteal artery divides into the anterior and posterior tibial arteries. The posterior tibial artery gives rise to the fibular artery. These arteries supply the leg and foot. The saphenous and tibial nerves innervate the leg.
This document discusses various methods of contraception, including natural, mechanical, chemical, hormonal, and surgical methods. It provides detailed information on several specific contraceptive options:
1. It describes intrauterine devices (IUDs) including types (copper, hormone-releasing), indications, methods of application, complications, contraindications, and investigations for missed IUDs.
2. It discusses barrier methods such as male and female condoms, diaphragms, caps, and sponges, noting effectiveness rates and disadvantages for each.
3. It explains hormonal contraception including combined and progestin-only oral contraceptive pills, injectables, implants, rings, and
Laparoscopy is a surgical procedure performed through small incisions in the abdomen using a camera to inspect or perform surgery in the abdominal or pelvic cavities. It has both diagnostic and therapeutic indications for gynecological conditions like infertility, endometriosis, adnexal masses, ectopic pregnancy, and various types of gynecological surgeries. Contraindications include coagulation disorders, diaphragmatic hernia, peritonitis, intestinal obstruction, or advanced pregnancy. Complications can include anesthesia issues, perforation of organs, failed or improper insufflation, burns, vascular or visceral injuries, infection, hernia, or hemorrhage. Proper timing depends on the type of
Copy of ANTENATAL FETAL MONITORING-Hatem.pptSherifAli90
This document discusses antenatal and intrapartum fetal monitoring. It describes the aims, techniques, and management of fetal monitoring. The key points are:
1) Antenatal monitoring aims to reduce perinatal morbidity and mortality by identifying at-risk pregnancies. Techniques include fetal movement counting, nonstress tests, biophysical profiles, and Doppler ultrasound.
2) Intrapartum monitoring aims to reduce the risk of fetal asphyxia. Continuous electronic fetal monitoring and intermittent auscultation are the main techniques used.
3) Abnormal fetal heart rate tracings include decelerations, reduced variability, and absence of accelerations. The first steps in management are changing maternal position, oxygen
The document describes several post-operative uterine specimens removed via total abdominal hysterectomy and bilateral salpingo-oophorectomy or other procedures. Many of the specimens show abnormalities such as thickened endometrium suggestive of endometrial carcinoma, huge cervical myoma, anterior wall corporeal myoma, submucous fibroid, large posterior wall myoma, myometrial hyperplasia, multiple myomata resulting in asymmetric enlargement, thickened myometrial hyperplasia suggestive of adenomyosis, areas of echymosis and necrosis suggestive of atonic postpartum hemorrhage, and a cauliflower mass projecting from the ectocervix suggestive of cancer cervix.
- Ring forceps are used to grasp the soft cervix during abortions and cerclage procedures. They can also be used to remove contents during an abortion or explore for traumatic postpartum hemorrhage.
- Ovum forceps are used to remove contents during an abortion.
- A vacuum extractor (ventouse) can be used for fetal or maternal indications like distress, malposition, or prolonged second stage of labor. Contraindications include non-vertex presentation, high head, intact membranes, or disproportion. Complications include fetal laceration or hemorrhage and maternal laceration.
- Obstetric forceps have similar indications and contraindications as the vacuum extractor.
This document provides information and instructions for performing a semen analysis test. It outlines the normal parameters according to WHO guidelines, including semen volume, sperm concentration, total sperm count, motility, morphology, and pH. It describes the proper collection method of 2-3 days abstinence and examines factors that can affect the results like temperature during collection and transport. Various abnormalities are defined, such as oligospermia, asthenozoospermia, and azoospermia. Causes of low semen volume and azoospermia include problems with collection, obstruction, hypogonadism, and retrograde ejaculation.
An obstetric examination involves examining the pregnant woman's abdomen and pelvis to determine fetal presentation, position, and station, as well as cervical dilation during labor. Abdominal examination techniques include inspection, palpation using the Leopold maneuvers to determine fetal lie, attitude, and position. Auscultation is used to assess fetal wellbeing. During labor, cervical dilation, effacement, consistency, and position are evaluated along with uterine contractions and whether membranes have ruptured. Scores like the Bishop score are used to determine labor induction likelihood.
Implantation of a fertilized egg in the uterus occurs 6-7 days after ovulation. Home pregnancy tests work by detecting human chorionic gonadotropin (hCG) levels in urine or serum, with positive results indicated at 50 mIU/ml in urine and 10-25 mIU/ml in serum. While such tests are highly accurate, false negatives can occur if the pregnancy is too early or the sample is too diluted or concentrated, and false positives from tumors, high LH, or blood in the urine are possible. Home tests are useful for detecting pregnancy and diagnosing conditions like ectopic pregnancy, molar pregnancy, or choriocarcinoma.
Posterior urethral valves are abnormal congenital membranes in the male urethra that obstruct normal bladder emptying. They are the most common cause of bladder outlet obstruction in boys. Type I valves, which account for 95% of cases, involve a bicuspid valve that radiates from the posterior urethra. A voiding cystourethrogram is the best way to diagnose valves and shows valve leaflets and other signs of obstruction. Treatment involves primary valve ablation or creating vesicostomies or uretrostomies to bypass the obstruction. Long term sequelae like renal disease are significant, so monitoring is important.
Endometriosis can present in subtle forms that lack the typical black-blue lesions. These subtle lesions include red or white patches that resemble other abnormalities. Subtle endometriosis is more common in adolescents with pain and may be present in visually normal tissue. Diagnosis relies on detailed inspection, hydroflotation, biopsy, or markers like PP14. Treatment includes drugs like dienogest or Mirena IUD to reduce pain and delay recurrence while avoiding repeated surgery when possible.
- Splenic Salvage procedure is indicated in haemodynamically stable patients with splenic injuries and involves non-operative or operative treatments.
- Management consists of non-operative treatment or operative treatments like splenorraphy, splenectomy, or splenic autotransplantation.
- Splenic salvage operations include techniques like topical haemostasis, suturing repair, partial splenectomy, or mesh splenorraphy to preserve splenic tissue and function.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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1. WHO Partograph
For Beginner
• Dr Muhammad El Hennawy
• Ob/gyn specialist
• Rass el barr central hospital and
dumyat specialised hospital
• Dumyatt – EGYPT
• www.mmhennawy.8k.com
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.