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Partograph

1. THE PARTOGRAPH MR NKOLE J.

2. Definitions Part ô s - L abour Graph - graphical presentation of information Partograph is a tool or chart on which features of labour are entered in a graphic form providing an opportunity for early identification of deviations from normal. A partograph is a tool on which graphic recording of progress of labour, and conditions of the mother and fetus is written

3. USES OF PARTOGRAM It gives assessment of labour at a glance, It provides early recognition of deviation from normal, It alerts the staff to the need for medical assistance, It provides correct continuity for all nursing staff.

4. COMPONENTS OF THE PARTOGRAPH 1 . G eneral information – name, age, parity, gravid, date and time of admission 2 . Fetal well being FHR Membranes/liquor (amniotic fluid) Moulding(head configuration) 2 . Progress of labour Cervical Dilatation Descent Contractions 3 . Maternal well being Vitals - temp ., BP, pulse, R/R , urine(intake and output), drugs, Oxytocin

5. General information – name, age, parity, gravid, date and time of admission Mrs X 3 2 31/8/2010 04.35 am “I”, “C” “M”, “B”, “A” “O”, “+” “++”, “+++” 03.10 Amniotic liqour Moulding

6. Partograph A partograph is opened when the cervical dilatation is 4cm or more . It has two diagonal lines ; Alert line This is the line that represents the active stage of labour. It is drawn from 4cm dilatation to a point at the top of the graph which will represent full dilatation . The cervix dilates to a minimum of 1cm/hr in prim. This alerts the midwife and medical officer that the progress of labour is abnormal when the reading crosses this line.

7. Partograph

8. Partograph Action line Is the second line drawn parallel to the 4cm line right of alert line. It indicates the need for something to be done about the lack of progress of labour . Descent of presenting part is assessed on V/E or on abdominal palpation. V/E is done 4hourly or whenever necessary.

9. Progress of labour 1. Dilatation of the cervix It is measured in cm and every after 4 hours This is recorded with an X in the center of the partograph, at the intersection of vertical and horizontal lines . The vertical scale represents dilatation by 10 squares of 1 cm each. A finger represents 2cm The horizontal scale represents time by 24 squares of one hour each

10. Partograph

11. Progress of labour On admission, cervical dilatation is recorded on the alert line at the place equal to her dilatation and time recorded under space for times . If labour is progressing well, the plotting of the cervical dilatation will remain plotted on or to the left of the alert line . 2. Descent of the foetal head The cervix dilates as the foetal head descends into the mother’s pelvis. Descent is determined abdominally as the midwife/nurse places her hand over the foetal head every fours.

12. Progress of labour If all fingers cover the head, it is said to be 5/5 above the brim. Assess the descent of the head at every V/E that is conducted, it is plotted at O sign. This means that every time you mark an “ X” for cervical dilatation, you must also mark an “ O” for level of fetal head.

13. Progress of labour

14. Progress of labour

15. Progress of labour

16. Progress of labour 3. Uterine contraction Abdominal examination should be carried out to assess the length , strength and frequency of the uterine contractions . They are observed every 30 minutes . 1 square= 1 contraction Monitor the contractions by placing your hand on the abdominal uterine fundus for at least ten minutes in order to determine the type of contractions and number of contraction. Contractions can be described as; Mild - lasting 20sec with 2contractions in 10min, Moderate - lasting 20-40sec with 3contractions in 10min. Strong - lasting 40-60sec with 4 contractions in 10min.

17. Recording contractions strength i.e. duration in seconds < 20 secs duration 20-40 secs duration > 40 secs duration

18. Fetal well being 1. Fetal heart rate Normal range 120 – 160/min Monitor and record every 30min Counted in a full minute. FHR should be Regular Don’t check during a contraction 2. Amniotic fluid/ liquor I – the membranes intact C – clear amniotic fluid (normal) В – blood-stained amniotic fluid A – absence of amniotic fluid M – meconium-stained amniotic fluid (grade – old =OM, Fresh =FM)

19. Information about fetal status in labour Mrs X 3 2 31/8/2010 04.35 am “I”, “C” “M”, “B”, “A” “O”, “+” “++”, “+++” 03.10 Amniotic liqour Moulding

20. Fetal well being 3. Moulding Overlapping of cranial bones is assessed on each VE (4hrly) Grades = bones separated + = Bones just touching each other/ T he bones are slightly adjoined/in apposition ++ = Bones overlapping but can be easily separated on digital pressure +++ = Bones overlapping & can't be separated . T he bones overlap significantly Shows degree of fetal head compression through the pelvis in CPD and obstruction

21. 21 Mrs X 3 2 12. 12.07 04.35 am “I”, “C”“M” “B”, “A” Information about fetal status in labor 03.10 Amniotic liqour

22. Maternal well being Blood pressure : Record every 4 hours and mark with arrows. Temperature : Record every 2 hours . Pulse : Record every 30 minutes and mark with a dot ( ●). Urine protein, ketones and volume: Record every time urine is passed. Oxytocin : Record the amount of oxytocin per volume IV fluids in drops per minute every 30 minutes when used. Drugs and IV fluids given : Record any additional drugs and fluids given. 22

23. SCENARIO Mrs. V.M, Gravida 4 para 3 admitted on 30/04/15 at 02:00hrs,was given a file no of 092. Fetal heart rate on admission was 130b/m regular, membranes were intact and Moulding was +. Fetal heart rate was within the normal range. 1 st VE done at 02:00hrs. Cervical dilatation was 5cm, descent 4/5 while contractions were mild-2 in 10min lasting 19 sec. At 04:00hrs the contraction were moderate – 3 in 10min lasting 35 sec until 06:00hrs 23

24. SCENARIO Vitals on admission: temp 36 and then 37 after 2hours ,pulse 80b/m, BP 120/70mmhg. 200mls of urine was passed, proteins and acetones were negative. pulse was within the normal ranges At 06:00hrs FHR was 142b/m regular, FHR remained within the normal range and 08:00 it was 140b/m. membranes also raptured at 06:00hrs,liqour was clear while Moulding was 2+ 24

25. SCENARIO VE done at 06:00hrs, cervical dilatation was 8cm while descent was 2/5.contractions were strong,4 in10min lasting 50 sec until delivery Again at 06:00hrs, DNS 1000mls was commenced while the vitals were temp 36.4 and was within the normal range until delivery. pulse was 78 b/m and BP 120/70mmhg and both remained normal until delivery. 250mls was passed and proteins and k etones were negative. 25

26. SCENARIO Patient became fully dilated at 08:00hrs and descent was 0, at 08:30hrs labour progressed were to a live mature male infant A/S 9/10, WT 3kg. 26

27. THE END