Partogram

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partogram of different stag of labour with Causes of abnormal partogarm

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Partogram

  1. 1. Content • • • • • Stage of labor Content of partogram Normal partogram in multi and nuli Causes of abnormal partogram Abnormal partogram – – – – Prolong latent phase Primary dysfunctional labor Secondary arrest Prolong second stage
  2. 2. First Stage of labour • • • • Latent phase Slow Contractions irregular Cervix: – – – – shortens (effaces) Softens Moves Dilates up to 3-4 cm • 3-8h less in multi
  3. 3. First Stage of labour (2) • Active phase • Regular painful contractions • Progressive cervical dilatation greater than 4 cm • 2-6h shorter in multi
  4. 4. second stage • Full dilatation until delivery • Can allow a ‘passive’ second stage for the head to descend • Then active by assistance of mother bushing • 30min up to 1h in multi • 1h up to 2h in primi
  5. 5. Partograph and Criteria for Active Labor • Label with patient identifying information • Note fetal heart rate, color of amniotic fluid, presence of moulding, contraction pattern, medications given • Plot cervical dilation • Alert line starts at 4 cm--from here, expect to dilate at rate of 1 cm/hour • Action line: 4h from alert linne if patient does not progress as above, action is required
  6. 6. Recording cevical dilataion • At addmision • Then after 4h
  7. 7. Multi & nuli
  8. 8. Recording uterine contraction
  9. 9. Recording fetal heart rate
  10. 10. Recording of liqour &molding • • • • I: intact C : clear M : muconium B : blood stained • +1 : suture fell • +2: toutched • +3: overlapping
  11. 11. Recording of maternal condition
  12. 12. Cuases of abnormal partogarm • ‘3Ps’ – 1. passenger (excessive fetal size , malpositions ,congenital anomalies , multiple gestation, 2. passages,(pelvic contraction , soft tissue abnormalities of the birth canal , masses or neoplasia , placental previa location • CPD ?
  13. 13. 3- powers • Less than three contractions in 10 minutes, each lasting less than 40 seconds • Inco-ordanated
  14. 14. Prolong Latent Phase • Cevix not full effaced and not dialated beyond 4cm after 8h of regular contraction • Most common in primi delay in the chemical process which soften the cervix and allow effacement • Management – – – – Simple analgesia Encourage mobilization Reassurance ARM and oxytocin will cuase poor progress later
  15. 15. Primary Dysfunctional • Poor progress in the active phase <1cm/h • Primi dysfunctional uterin conti • Multi malpresintation, CPD • Management – ARM +oxcytocin primi i(in multi ,CPD may be but with cution 2.5 u in 500ml dexterose – c/s multi ,CPD,fetal comparamise, VBAC, breach
  16. 16. Secondary Arrest • Secondary arrest of cervical dilatation and descent of presenting part tapiclly after7 cm dilatation • Most common causes is CPD • Management – ARM +oxcytocin primi i(in multi ,CPD may be but with cution 2.5 u in 500ml dexterose – c/s multi ,CPD,fetal comparamise, VBAC, breach
  17. 17. Delay in the second stage • Addational cuases:– OP position: long internal rotation , persistance OP – Epidural anathesia – Secondary uterine inerta : dehydration and ketosi – Narrow med cavity (android pelvis) : deep transver arrest
  18. 18. managment • Oxytocin infusion if contraction is not stronge • In DEEP transverse arrest rotational forceps may use to brings the head to OA position • C/S is best option • Manual rotation also an option

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