Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.
DR SHASHWAT JANI 
M.s. ( gynec ) 
Assist. Prof., Smt. N.H.L. MEDICAL COLLEGE, 
AHMEDABAD. 
Mobile : +91 99099 44160. 
E- m...
WHY MONITOR? 
 The intrapartum period is probably the most 
dangerous and traumatic period – a time 
associated with a hi...
INTRODUCTION 
 A partograph is a composite graphical record 
of the observations made of a woman in labour 
on a single s...
HISTORY 
 Emanuel Friedman's partograph - 1954 
 Based on observations of cervical dilatation and 
foetal station agains...
Philpott and Castle – 1972 
 Introduced concept of "ALERT" and "ACTION" 
lines. 
 Alert line was drawn at a slope of 1 
...
Studd's labour stencils - 1972 
 Five separate patterns representing normal 
labour progression were constructed. 
 The ...
OTHER PARTOGRAPHS 
 Hand drawn – Paper & Pencil. 
 Round partograph. 
 E – partograph.
PARTOGRAPH
OBJECTIVES 
 Early detection of abnormal progress of labour. 
 Prevention of prolonged labour. 
 Recognize cephalopelvi...
OBJECTIVES (cont..) 
 Increase the quality and regularity of all observations of 
mother and fetus. 
 Early recognition ...
COMPONENTS 
 Part I : Patient Identification 
 Part II : Fetal condition 
 Part III : Progress of labour 
 Part IV : M...
Part I : PATIENT IDENTIFICATION 
 Name 
 Gravida 
 Para 
 Hospital number 
 Date and time of admission 
 Time of rup...
Part II : FETAL CONDITION 
 Monitor and assess fetal condition 
1 - Fetal heart rate 
2 - Liquor 
3 - Moulding the fetal ...
FETAL HEART RATE 
 Monitor every 30 mins in latent phase. 
 Every 15 mins in active phase. 
 Every 5 mins in 2nd stage ...
MEMBRANES AND LIQUOR 
 Intact membranes ……………………………….. I 
 Ruptured membranes + clear liquor ……………… C 
 Ruptured membra...
MOULDING THE FETAL SKULL 
BONES 
 Moulding is an important indication of how adequately 
the pelvis can accommodate the f...
Part III : PROGRESS OF LABOUR 
 Cervical dilatation 
 Descent of the fetal head 
 Uterine contractions 
 Fetal positio...
 This section of the partograph has as its central 
feature a graph with a vertical scale on the left, 
numbered in the a...
 Horizontal scale represents hours spent in 
labour. 
 Points are entered as a cross (x) for cervical 
dilatation & stat...
LATENT PHASE 
 It starts from onset of labour until the cervix 
reaches 3 cm dilatation. 
 Once 3 cm dilatation is reach...
ACTIVE PHASE 
 Contractions at least 3 / 10 min 
 Each lasting < 40 seconds 
 The cervix should dilate at a rate of 1 c...
 This can also be divided into 3 functional 
divisions – 
1. Preparatory division – Including latent & 
acceleration phas...
ALERT LINE 
 The alert line drawn from 3 cm dilatation 
represents the rate of dilatation of 1 cm/hour. 
 In a normal la...
ACTION LINE 
 The action line is drawn 4 hours to the right of 
the alert line and parallel to it. 
 This is the critica...
CERVICAL DILATATION 
 It is the most important information 
and the surest way to assess progress of 
labour. 
 When pro...
CERVICAL DILATATION (cont..) 
 When the active phase of labor begins, all 
recordings are transferred and start by plotti...
DESCENT OF THE FETAL HEAD 
 It should be assessed by abdominal examination 
immediately before doing a vaginal examinatio...
DESCENT OF THE FETAL HEAD (cont..) 
 By vaginal examination, the lowest part of vertex 
has passed or is at the level of ...
FETAL POSITIONS 
 Occiput transverse positions 
 Occiput anterior positions
UTERINE CONTRACTIONS 
Palpate number of contractions in ten 
minutes and duration of each contraction in 
seconds 
 Less ...
 Observations of the contractions are made every 
hour in the latent phase and every half-hour in 
the active phase. 
 A...
Part IV: MATERNAL CONDITION 
Assess maternal condition regularly by monitoring: 
 Oxytocin – Amount per volume IV fluids ...
Part IV: MATERNAL CONDITION 
 Pulse – Every 30 mins & marked with a dot (•). 
 Blood pressure – Recorded in vertical lin...
MANAGEMENT OF 
LABOUR USING THE 
PARTOGRAPH
- Latent phase is less than 8 hours 
- Progress in active phase remains on or 
to the left of the alert line. 
 Do not au...
Between alert and action lines 
 In health center, the women must be 
transferred to a hospital with facilities for 
caes...
At or beyond action line 
 Conduct full medical assessment. 
 Consider intravenous infusion / bladder 
catheterization /...
ABNORMAL PROGRESS OF 
LABOR
“ One of the main functions of the 
partograph is to detect early 
deviation from normal progress of 
labor. “
LABOUR TIME FRAMES 
Phases/ Stages of labour Nulliparous Multiparous 
Latent phase Mean time 6.4 h 4.8 h 
Longest 20.1 h 1...
LATENT PHASE 
 Normal duration – 8hrs in Primi & 4hrs in 
Multi. 
 This is why there is a heavy line drawn on the 
parto...
PROLONGED LATENT PHASE 
 It is prolonged when its duration exceeds 20 hrs 
in Primi & 14 hrs in Multi. 
 According to WH...
PROLONGED ACTIVE PHASE 
 In the active phase of labor, plotting of cervical 
dilatation will normally remain on or to the...
PROLONGED DECELERATION 
PHASE 
 Deceleration phase exceeds 3 hrs for nulliparas 
& 1 hour for multiparas.
SECONDARY ARREST OF 
CERVICAL DILATATION 
 When the cervical dilatation commences 
normally but stops or slows significan...
SECONDARY ARREST OF HEAD 
DESCENT 
 Abnormal progress of labor may occur with 
normal progress of descent of the fetal he...
Diagnostic Criteria 
( In active labour) 
 For Protracted dilatation, criteria are 
less than 1.2 cm per hour for primips...
PRECIPITATE LABOUR 
- Maximum slope of dilatation of 5 cm/hr or 
more
POINTS TO REMEMBER
 It is important to realize that the partograph is a 
tool for managing labor progress only. 
 The partograph does not h...
 Only start a partograph when you have checked 
that there are no complications of pregnancy 
that require immediate acti...
 If progress of labor is satisfactory, the plotting 
of cervical dilatation will remain at or to the left 
of the alert l...
 The active phase, 3 – 10 cm dilatation, should 
progress at a rate of at least 1 cm/hour. 
 When the woman arrives in t...
 Dilatation of the cervix is plotted/recorded with 
a (x), descent of the fetal head is plotted with a 
(•) and uterine c...
 Assessing descent of the head assists in 
detecting progress of labor. 
 Increased moulding with a high head is a sign ...
 A woman whose cervical dilatation moves to the 
right of the alert line must be transferred and 
managed in an instituti...
 When a woman in labor passes the latent phase 
in less than 8 hours i.e., transfers from latent to 
active phase, the mo...
ELECTRONIC 
PARTOGRAPH
 A method of monitoring the progress of labor 
in a mother during childbirth, by attaching a 
position sensor to a predet...
 The location of the fetal presenting part may be 
indicated by a similar position sensor, or by 
imaging. Other conditio...
Full electronic capture of patient information 
during childbirth including - 
 CTG, 
 Partograph, 
 All labour events,...
 Fetal blood sampling results and cord blood 
gases direct from the blood gas analyzer. 
This information can be shown in...
COMPUTERIZED LABOUR 
MANAGEMENT 
To accurately and continuously measure cervical 
dilatation and fetal head station in lab...
 The measurements had accuracy of ≤ 5mm. 
 All parturients were comfortable throughout the 
insertion and the testing pe...
 This system provides accurate continuous 
measurements of dilatation and station. 
 The method is superior to digital e...
 The Fetal Monitoring System 
Is a computer based training system that can be 
accessed from anywhere, anytime, from with...
 The Maternal Monitoring System -
WHO PARTOGRAPH
 The WHO partograph has been modified in 
2000 to make it simpler and easier to use. 
 The latent phase has been removed...
Modified partograph - Indonesia 
 – 626 women; 20 midwives 
 – Referral rate increased 
 – Fewer vaginal exams 
 – Few...
ADVANTAGES 
 Inexpensive technology which does not 
malfunction. 
 A picture is worth a thousand words. 
 Helps in cont...
 Documented evidence for Medico Legal 
purpose. 
 Educational value for all grades of staff.
DISADVANTAGES 
 Assumes that all women progress at same rate 
– May influence intervention rate. 
 Clinical findings hav...
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI
Nächste SlideShare
Wird geladen in …5
×

LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI

29.984 Aufrufe

Veröffentlicht am

LABOUR MONITORING BY WHO PARTOGRAPH BY DR SHASHWAT JANI

Veröffentlicht in: Gesundheit & Medizin
  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • Hi! Get Your Professional Job-Winning Resume Here! 👉 http://bit.ly/rexumtop
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • very good presentation
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

LABOUR MONITORING BY PARTOGRAPH BY DR SHASHWAT JANI

  1. 1. DR SHASHWAT JANI M.s. ( gynec ) Assist. Prof., Smt. N.H.L. MEDICAL COLLEGE, AHMEDABAD. Mobile : +91 99099 44160. E- mail : drshashwatjani@gmail.com
  2. 2. WHY MONITOR?  The intrapartum period is probably the most dangerous and traumatic period – a time associated with a high mortality and morbidity for both mother and child.  Maternal and fetal monitoring are essential to pick up problems early and thus institute timely intervention.  Eternal alertness for abnormalities essential – “a labour is only said to be normal after it is over”
  3. 3. INTRODUCTION  A partograph is a composite graphical record of the observations made of a woman in labour on a single sheet of paper.  It was developed and extensively tested by the World Health Organization (WHO 1994).  Can serve as an “early warning system” & assist in making timely decisions on transfers (referrals), intervention (augmentation) &/or termination of pregnancy.
  4. 4. HISTORY  Emanuel Friedman's partograph - 1954  Based on observations of cervical dilatation and foetal station against time elapsed in hours from onset of labour.  The time of 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.
  5. 5. Philpott and Castle – 1972  Introduced concept of "ALERT" and "ACTION" lines.  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.
  6. 6. Studd's labour stencils - 1972  Five separate patterns representing normal labour progression were constructed.  The curves were transcribed onto acrylic stencils.
  7. 7. OTHER PARTOGRAPHS  Hand drawn – Paper & Pencil.  Round partograph.  E – partograph.
  8. 8. PARTOGRAPH
  9. 9. OBJECTIVES  Early detection of abnormal progress of labour.  Prevention of prolonged labour.  Recognize cephalopelvic disproportion long before obstructed labour.  Assist in early decision on transfer, augmentation, or termination of labour.
  10. 10. OBJECTIVES (cont..)  Increase the quality and regularity of all observations of mother and fetus.  Early recognition of maternal or fetal problems.  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).  Reduce incidence of CS rate.  Facilitates handover procedure.
  11. 11. COMPONENTS  Part I : Patient Identification  Part II : Fetal condition  Part III : Progress of labour  Part IV : Maternal condition  Outcome………………
  12. 12. Part I : PATIENT IDENTIFICATION  Name  Gravida  Para  Hospital number  Date and time of admission  Time of ruptured membranes.
  13. 13. Part II : FETAL CONDITION  Monitor and assess fetal condition 1 - Fetal heart rate 2 - Liquor 3 - Moulding the fetal skull bones
  14. 14. FETAL HEART RATE  Monitor every 30 mins in latent phase.  Every 15 mins in active phase.  Every 5 mins in 2nd stage of labour.  Mark it with a dot & join the lines. Basal fetal heart rate?  < 160 beats/min =tachycardia  > 110 beats/min = bradycardia  >100 beats/min = severe bradycardia
  15. 15. MEMBRANES AND LIQUOR  Intact membranes ……………………………….. I  Ruptured membranes + clear liquor ……………… C  Ruptured membranes + meconium- stained liquor.. M  Ruptured membranes + blood – stained liquor…… B  Ruptured membranes + absent liquor……………. A
  16. 16. MOULDING THE FETAL SKULL BONES  Moulding is an important indication of how adequately the pelvis can accommodate the fetal head.  Increasing moulding 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)…………………... ++  Severely overlapping bones (nonreducible) …….. +++
  17. 17. Part III : PROGRESS OF LABOUR  Cervical dilatation  Descent of the fetal head  Uterine contractions  Fetal position
  18. 18.  This section of the partograph has as its central feature a graph with a vertical scale on the left, numbered in the ascending order from 0 to 10 (Cervical dilatation in cms).  In same vertical scale – descent of the fetal head as assessed by abdominal examination.  At the right in the descending order denotes the station of the fetal presenting part.
  19. 19.  Horizontal scale represents hours spent in labour.  Points are entered as a cross (x) for cervical dilatation & station by a dot (•).  Each observation is joined to the preceding one by a straight line.  The ‘S’ shaped dilatational curve is divided into a latent phase and an active phase.
  20. 20. LATENT PHASE  It starts from onset of labour until the cervix reaches 3 cm dilatation.  Once 3 cm dilatation is reached, labour enters the active phase.  Lasts 8 hours or less.  At least 2/10 min contractions.  Each lasting < 20 seconds.
  21. 21. ACTIVE PHASE  Contractions at least 3 / 10 min  Each lasting < 40 seconds  The cervix should dilate at a rate of 1 cm / hour or faster.  Further subdivided into –  Acceleration phase – 2.5 – 4 cms.  Phase of maximum slope – 4 – 9 cms.  Deceleration phase – 9 – 10 cms.
  22. 22.  This can also be divided into 3 functional divisions – 1. Preparatory division – Including latent & acceleration phase. 2. Dilatation division – Phase of maximum slope. 3. Pelvic division – Deceleration phase.
  23. 23. ALERT LINE  The alert line drawn from 3 cm dilatation represents the rate of dilatation of 1 cm/hour.  In a normal labour, cervical dilatation should be either on the alert line or to the left of it.  Moving to the right of the alert line means it falls on zone 2, it is abnormal & needs to be critically assessed.
  24. 24. ACTION LINE  The action line is drawn 4 hours to the right of the alert line and parallel to it.  This is the critical line at which specific management decisions must be made.  When it falls in zone 3 case should be reassessed by a senior person. Decision to be made for CS or augmentation of labour.
  25. 25. CERVICAL DILATATION  It is the most important information and the surest way to assess progress of labour.  When progress of labour is normal and satisfactory, plotting of cervical dilatation remains on the alert line or to left of it.  If a woman arrives in the active phase of labour, recording of cervical dilatation starts on the alert line.
  26. 26. CERVICAL DILATATION (cont..)  When the active phase of labor begins, all recordings are transferred and start by plotting cervical dilatation on 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.
  27. 27. DESCENT OF THE FETAL HEAD  It should be assessed by abdominal examination immediately before doing a vaginal examination, using the Rule of fifth ( Crichton method ) to assess engagement.  The rule of fifth means the palpable fifth of the fetal head is felt by abdominal examination 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 engaged.
  28. 28. DESCENT OF THE FETAL HEAD (cont..)  By vaginal examination, the lowest part of vertex has passed or is at the level of ischial spines in absence of caput, is said to be engaged head.
  29. 29. FETAL POSITIONS  Occiput transverse positions  Occiput anterior positions
  30. 30. UTERINE CONTRACTIONS Palpate number of contractions in ten minutes and duration of each contraction in seconds  Less than 20 seconds:  Between 20 and 40 seconds:  More than 40 seconds:
  31. 31.  Observations of the contractions are made every hour in the latent phase and every half-hour in the active phase.  Assessed by number of contractions in a 10 minutes period.  Measured in seconds from the time the contraction is first felt abdominally, to the time the contraction passes off.  Each square represents one contraction.
  32. 32. Part IV: MATERNAL CONDITION Assess maternal condition regularly by monitoring:  Oxytocin – Amount per volume IV fluids in drops per minute, every 30 mins. Conc in upper box & dose (mIU/min) in lower box.  Drugs – Any additional drugs given.  IV Fluids – used.
  33. 33. Part IV: MATERNAL CONDITION  Pulse – Every 30 mins & marked with a dot (•).  Blood pressure – Recorded in vertical line every 4 hours & marked with arrows.  Temperature – Recorded every 2 hours.  Urine volume , analysis for protein and acetone – Everytime urine is passed.
  34. 34. MANAGEMENT OF LABOUR USING THE PARTOGRAPH
  35. 35. - Latent phase is less than 8 hours - Progress in active phase remains on or to the left of the alert line.  Do not augment with oxytocin if latent and active phases go normally.  No ARM in latent phase.  ARM at any time in active phase.
  36. 36. Between alert and action lines  In health center, the women must be transferred to a hospital with facilities for caesarean 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.
  37. 37. At or beyond action line  Conduct full medical assessment.  Consider intravenous infusion / bladder catheterization / analgesia.  Options - Deliver by caesarean section if there is fetal distress or obstructed labour. - Augment with oxytocin by intravenous infusion if there are no contraindications.
  38. 38. ABNORMAL PROGRESS OF LABOR
  39. 39. “ One of the main functions of the partograph is to detect early deviation from normal progress of labor. “
  40. 40. LABOUR TIME FRAMES Phases/ Stages of labour Nulliparous Multiparous Latent phase Mean time 6.4 h 4.8 h Longest 20.1 h 13.6 h Active phase Mean rate 3 cm/h 5.7cm/h Slowest 1.2cm/h 1.5cm/h 2nd Stage Mean time 1.1 h 0.4 h Longest 2.9 h 1.1 h
  41. 41. LATENT PHASE  Normal duration – 8hrs in Primi & 4hrs in Multi.  This is why there is a heavy line drawn on the partograph at the end of 8 hours of the latent phase.
  42. 42. PROLONGED LATENT PHASE  It is prolonged when its duration exceeds 20 hrs in Primi & 14 hrs in Multi.  According to WHO partograph, a prolonged latent phase is “Cervix not dilated beyond 4cms after 8hrs from admission & with any changes in cervical effacement or dilatation.”
  43. 43. PROLONGED ACTIVE PHASE  In the active phase of labor, plotting of cervical dilatation will normally remain on or to the left of the alert line.  Moves to the right of the alert line warns that labor may be prolonged.  Happens if the rate of cervical dilatation in active phase of labor is less than 1cm/hour for a minimum of 4hrs.  At the action line, the woman must be carefully reassessed for why labor is not progressing and a decision made on further management.
  44. 44. PROLONGED DECELERATION PHASE  Deceleration phase exceeds 3 hrs for nulliparas & 1 hour for multiparas.
  45. 45. SECONDARY ARREST OF CERVICAL DILATATION  When the cervical dilatation commences normally but stops or slows significantly for 2 hours or more prior to full dilatation of cervix.
  46. 46. SECONDARY ARREST OF HEAD DESCENT  Abnormal progress of labor may occur with normal progress of descent of the fetal head then followed by secondary arrest of descent of fetal head.
  47. 47. Diagnostic Criteria ( In active labour)  For Protracted dilatation, criteria are less than 1.2 cm per hour for primips and less than 1.5 cm per hour for multips.  For Protracted descent, the criteria are less than 1.0 cm per hour in primips and less than 2.0 cm per hour for multips.
  48. 48. PRECIPITATE LABOUR - Maximum slope of dilatation of 5 cm/hr or more
  49. 49. POINTS TO REMEMBER
  50. 50.  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.
  51. 51.  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.  Fill up the patient details. Note the FHR & colour of liquor.
  52. 52.  If progress of labor is satisfactory, the plotting of cervical dilatation will remain at or to the left of the alert line.  When labor progresses well , the dilatation should not move to the right of the alert line.  The latent phase 0 – 2 cm dilatation, is accompanied by gradual shortening of cervix. Normally, the latent phase should not last more than 8 hours.
  53. 53.  The active phase, 3 – 10 cm dilatation, should progress at a rate of at least 1 cm/hour.  When the woman arrives in the latent phase, time of admission is 0 time.  When admission takes place in the active phase , the admission dilatation, is immediately plotted on the alert line.
  54. 54.  Dilatation of the cervix is plotted/recorded with a (x), descent of the fetal head is plotted with a (•) and uterine contractions are plotted with differential shading.  Descent of the head should always be assessed by abdominal examination ( by the rule of fifths felt above the pelvic brim).
  55. 55.  Assessing descent of the head assists in detecting progress of labor.  Increased moulding with a high head is a sign of cephalopelvic disproportion.  Vaginal examination should be performed infrequently as this is compatible with safe practice (once every 4 hours is recommended).
  56. 56.  A woman whose cervical dilatation moves to the right of the alert line must be transferred and managed in an institution with adequate facilities for obstetric intervention, unless delivery is near.  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.
  57. 57.  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 dilatation to the alert line using the letters TR.  Note down the oxytocin conc & dose, drugs & iv fluids. Pulse, BP, Urine examination & Temperature.
  58. 58. ELECTRONIC PARTOGRAPH
  59. 59.  A method of monitoring the progress of labor in a mother during childbirth, by attaching a position sensor to a predetermined point on the mother's pelvic bones; monitoring the location of the position sensor in three- dimensional space relative to a reference; and monitoring the location of the fetal presenting part with respect to the predetermined point on the mother's pelvic bones.
  60. 60.  The location of the fetal presenting part may be indicated by a similar position sensor, or by imaging. Other conditions, such as effacement, cervical dilatation, and cervical position may also be monitored in a similar manner.
  61. 61. Full electronic capture of patient information during childbirth including -  CTG,  Partograph,  All labour events,  Outcome information.
  62. 62.  Fetal blood sampling results and cord blood gases direct from the blood gas analyzer. 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 from anywhere, anytime, from within a hospital or from home..
  63. 63. COMPUTERIZED LABOUR MANAGEMENT To accurately and continuously measure cervical dilatation and fetal head station in labor and the fetal monitoring and maternal monitoring. An ultrasound–based computerized labor management system was designed - The Fetal Monitoring System and The Maternal Monitoring System with The system´s in-vivo generated individual Partographs with real time dilatation and head station measurements.
  64. 64.  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.
  65. 65.  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 with multiple vaginal examinations..
  66. 66.  The Fetal Monitoring System Is a computer based training system that can be accessed from anywhere, anytime, from within a hospital or from a home.
  67. 67.  The Maternal Monitoring System -
  68. 68. WHO PARTOGRAPH
  69. 69.  The WHO partograph has been modified in 2000 to make it simpler and easier to use.  The latent phase has been removed and plot t ing on the par tograph begins in the act ive phase when the cervix is 4 cms di lated.
  70. 70. Modified partograph - Indonesia  – 626 women; 20 midwives  – Referral rate increased  – Fewer vaginal exams  – Fewer augmented labour  – Fewer obstructed labour (World Bank Tokyo April , 2010)
  71. 71. ADVANTAGES  Inexpensive technology which does not malfunction.  A picture is worth a thousand words.  Helps in continuity of care and providing information.  Easy Handover Procedure.  No major capital investment other than skilled attendant.
  72. 72.  Documented evidence for Medico Legal purpose.  Educational value for all grades of staff.
  73. 73. DISADVANTAGES  Assumes that all women progress at same rate – May influence intervention rate.  Clinical findings have subjective variations.  Loss of clinical autonomy.  Lack of knowledge.  Non availability of printed partographs.  Duplication of recording.

×