3. Partograph
It is composite graphical record of key data
(maternal and fetal) during labour entered
against time on a single sheet of paper .
PARTOGRAM
It is the process by which normal and abnormal
progress of labour and also fetal response in
labour can be identified.
4. Objectives of using partograph
O Early detection of abnormal progress of labour.
O Prevention of prolonged labour.
O Increase the quality and regularity of all
observations of mother and fetus.
O Early recognition of maternal or fetal problems.
O To provide a basis of decision making.
O To facilitate research.
O To defend one’s actions – no documentation – no
defense.
5. Importance of using partograph :
It allows an instant visual assessment of the
rate of Cervical dilatation and comparision
with an expected normal, so that abnormal
progress can be recognized .
Early and appropriate actions taken to correct
it
where possible.
8. Components of Partogram
Mother information
Fetal well-being
• Fetal heart rate
• Character of liquor
• Moulding
Labour progress
• Dilatation
• Descent
• Uterine contraction
Medications
• Oxytocin
• Pain relief (e.g. pethidine)
Maternal well-being
• BP, Pulse, Temperature
• Urine – albumin, glucose, acetone
• Urine output
9. What need to be recorded?
Begin plotting at the
“zero” hour on the
partogram
Enter the outcome
of delivery
1
2
All entries made in
relation to time when
the observations are
made
3
Notes should be
legible, dated and
timed.
4
11. b. Fetal heart rate
recorded every 30minutes.
c. The condition of the membranes and
liquor amnii.
Mark ‘I’ for intact membrane.
‘C’ for clear liquor amnii.
‘M’ for meconium stained
liquor.
d. Moulding .
12. e. Cervicogram
* It is a graphic representation of cervical
dilatation and descent of the presenting part .
* It is an essential part of the partogram .
* It offer the chance of early detection of abnormal
progess of labour.
* First, alert line starts at 3cm cervical dilatation and ends
at 10cm at the rate of 1cm/hour.
13. f.Uterine Contractions
5 strong contractions
in 10 minutes
2 weak contractions
in 10 minutes
3 moderate contractions
in 10 minutes
14. g.Assess maternal condition regularly by monitoring :
O Drugs , IV fluids , and oxytocin , if labour is augmented
O Pulse , Blood pressure
O Temperature
O Urine volume analysis for protein, acetone, glucose and
volume.
15. Benefits of a partograph
O A single sheet of paper can provide details of
necessary information at a glance.
O No need to record labour events repeatedly.
O Can predict deviation from normal progress early.
O It facilitates handover procedure.
O Introduction of partograph in management of
labour {WHO 1994} has reduced the incidence of
prolonged labour and caesarean section rates.
There is improvement in maternal morbidity,
perinatal morbidity and mortality.
16. PARTOGRAM History
Friedman's partogram - 1954
2 phases of labour (base on dilatation
of the cervix )
Latent phase (dilatation < 3 cm)
Active phase (>3 cm dilated)
Latent phase
Active phase
Philpott and Castle - 1972
Introduced the concept of “ALERT”
and “ACTION” lines.
ALERT LINE – represent the mean rate
of slowest progress of labour
ACTION LINE – appropriate action should
be taken.
Normal labour is plotted to the left alert line
17. Friedman′s Division of Labor :
The active phase is further into 3 parts :
* Acceleration phase.
* Phase of maximum slope and
* Decceleration phase.
18.
19. Normal Progress of Labor
* latent phase : 8 hours or less .
* active phase : progress of the cervical dilatation
remains on the alert line or between the alert
and
the action lines ( 1cm/hour ).
* second stage : reasonable rotation and descent of
the presenting part within 1 hour or less .
20. Abnormal progress of labour
o Disorders of 1st stage
Protracted active phase-the rate of cervical
dilatation <1.2cm/hr in primipara and
<1.5cm/hr in multipara.
Arrest disorder-no cervical dilatation in 2 hrs
after active phase of labour.
o Secondary arrest is defined when the
active phase of labour commences
normally but stops or slows significantly
for 2 hrs or more prior to full dilatation of
cervix.
21.
22. o Disorders of 2nd stage
Protraction of descent-descent of
presenting part is <1cm/hr in nullipara and
<2 cm/hr in multipara.
Arrest of descent-no progress of descent
is observed.
23.
24. Moving to the right of alert
line
O This is a warning sign.
O Transfer the woman from health center to
hospital.
O Decision needed on further
management.(usually by obstetrician or
resident )
25. When progress in active phase remains
on or left of the alert line / latent phase
is less than 8 hours
O Do not augment with oxytocin if latent
and active phases go normally
O Do not intervene unless complications
develop
O Artificial rupture of membranes
( ARM )
O No ARM in latent phase
O ARM at any time in active phase
26. MANAGEMENT OF LABOUR BETWEEN
ALERT AND ACTION LINES (Alert or
Referral zone)
1. Health facilities with Basic EmOC
O Transfer the woman to hospital unless the
cervix is almost fully dilated
O ARM may be performed if membranes are still
intact and first stage of labour is advanced and
delivery is expected soon.
27. 2. Health Facility with Comprehensive
EmOC
OPerform ARM at vaginal examination
OContinue routine monitoring
ORepeat vaginal examination 4 hrs or earlier if
delivery is expected sooner
ODo not intervene or augment – unless
complications develop
28. MANAGEMENT OF LABOUR AT OR
BEYOND THE ACTION LINE
1. Full medical and obstetric assessment
2. Consider IV infusions / catheterization / analgesics
(tramadol, pethidine, etc)
3. Options
O Perform CS - if fetal distress or obstructed labour
or operative vaginal delivery if in 2nd stage without
severe fetal distress and/or obstructed.
O Oxytocin – if no contraindications
O Supportive only – if satisfactory progress is
established and dilatation could be anticipated at
1cm/hr or faster.
