3 PARTOGRAPH.pptxkkkkkkkkkkkkkkkkkkkkkkkkkk

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1. Partograph PRESENTATION BY GROUP 3: Dept of obstetrics and gynaecology Lecturer:Dr David conteh

2. MEMBERS MOHAMED LAHAI MARRAH……….22065 ADAMA MORANA ……….22068

3. CONTENTS Definition Importance Advantages Uses Components

4. Definition Partograph is a composite graphical recording of progress of labour and salient condition of mother and fetus. For progress of labor and conditions of the mother and the fetus It was developed and extensively tested by the world health organization (WHO)

5. Importance l ab o u r ha s b e e n I t he l p s t o d e t e c t w h e t h e r progressing satisfactory or not. It helps to make early recognition of problem for the mother or fetus. I t h e l p s f o r t i m e l y d e c i s i o n o f t h e n e e d f o r augmentation and termination of labour

6. A d v a n t a g es A s i ng l e s h e e t o f pa p e r c a n p r ov i d e d e t a il s of necessary information at a glance. N o n e e d t o r e c o r d l a b o u r e v e n t s r ep e t ead l y in different sheet so it does not consume the time. I t c a n b e p r e d i c t d ev i a t i o n f r o m no r m a l l ab o u r so appropriate steps could be taken in time.

7. Advantages … It facilitates handover procedure Reduce the incidence of prolonged labour and caeseran section. An introduction of partograph in labour management brings improvement in reducing maternal and fetal morbidity and mortality.

8. U ses Assessment of fetal well being, maternal well being and labor. A n i m p o r t a n t t oo l f o r p r e v e n t i n g a n d d i a g n o s i n g prolonged/obstructed labor A ss o c i a t e d w i t h f e w e r o p e r a t i v e d e li v e r i e s a n d m o r e appropriate use of intrapartum oxytocin For BEOC sites, essential to predict the need for transfer for caeserian section.

9. Principles of plotting partograph Active phase is commence at 4 cm dilation Latent phase should not last longer than 8 hour. During active labour, the rate of cervical dilatation should not be slower than 1cm / hour. P/v should be performed as infrequently as it is compatible with safe practice (4 hourly recommended).

10. Components Basic recordings Fetal heart recording Amniotic fluid and moulding Dilation of cervix Descent of fetal head

11. C o m p o n e n t s… Time and hour Uterine contraction Oxytocin drip Drug and other intravenous fluid Maternal condition Urine analysis

12. Patient information Name, age, gravida, para Date and time of admission Time of membrane rupture Hospital number Time of onset of labour

13. Fetal heart recording Recorded every half hourly and each small square equals to half an hour. Plot one dot (.) in line at the level of the heart rate indicated in figure on left hand. If abnormal in 3 reading then take action.

14. Amniotic fluid and moulding Amniotic fluid Amniotic sac whether intact (+) or (-) and if it is ruptured, record the colour of amniotic fluid at every vaginal examination and time of rupture. Following abbreviation stand for: I : membrames intact C : membranes ruptured, clear liquor M: meconium stained liquor B : for blood stained liquor A : liquor absent

15. Amniotic fluid and moulding Moulding is an important finding as to know how well the pelvis will accommodate the fetal head. Bones are separated and sutures can be felt easily  + : Bones just touch each other  ++ : Bones overlap but are reducible  +++: Bones overlap but are irreversible

16. Dilatation of cervix Assessed at every vaginal examination and marked with cross ( × ). Begin plotting on the partograph when patient is in active phase of labour (4cm) . Remember, first cervical dilatation should be plotted on alert line. Subsequent cervical dilatation is plotted on alert line

17. Alert line: a line starts at 4 cm of cervical dilatation to the point of expected full dilatation at the rate 1 cm per hour. Action line: parallel and 4 hours to the right of the alert line. Any patient whose progress was slower the action line was considered suitable for intervention to expedite delivery.

18. Descent of the head It is recorded as fifths of head palpable above the brim or head (divided into 5 parts) palpable above the symphysis pubis. At 5/5, the 5 parts of the head is palpable above the symphysis pubis or brim in which the both sinciput and occiput is plpable at same level. If the head is deflexed and sinciput is higher the occiput in well flexed head. 4/5, sinciput high and occiput easily felt at above the pelvic brim.

19. Descent of Head… At 3/5th sinciput easily felt and occiput felt at the pelvic brim. At 2/5th sinciput and occiput just felt. At 1/5th sinciput felt, occiput not felt. A 0/5th no of the head is palpable.

20. Hour and time Hours: refer to the time elapsed since onset of active labour. Time: record actual time according to the hours of active phase of labour started. The time is recorded hourly intervals in the space provided. ‘O’ hour time for spontaneous labour is the time of admission to the labour ward and for induced labour is the time of induction. Then time is recorded on the basis of first vaginal examination .

21. Uterine contraction The squares in the vertical columns are shaded according to the duration and intensity. Chart every half hourly (each small vertical square equals to half an hour). Plot the number of contraction in 10 minutes and duration in seconds.

22. Uterine contraction… There are 5 verticle columns. t o d u r a t i o n of S h a d e t h e s qu a r e a c c o r d i n g contraction as follows— Less than 20 seconds: Between 20-40 seconds: More than 40 seconds:

23. f.Uterine Contractions 5 strong contractions in 10 minutes 2 weak contractions in 10 minutes 3 moderate contractions in 10 minutes

24. Dr u g s … Oxytocin: record the amount of oxytocin per volume and Intravenous fluid in drops per minute in every 30 minutes when used (on the base of escalating). Drugs given: Any drug given is recorded in the appropriate boxes.

25. Maternal condition Maternal condition is a record of pulse, blood pressure, temperature, urine, oxytocin, drug and IV fluid (if used). All the observation for the mother,s condition is written at the bottom of the partograph. Pulse: record every 30 minutes and mark with a dot (.).

26. Maternal condition… Blood pressure: record every 4 hourly and mark with record more frequently, if blood pressure is elevated. Temperature: record every 2 hourly Urine: record volume of urine, output every time as urine is passed. The protein and acetone should be tested in hospital if possible.

27. Duration of labour Date and time of True labour pain. Membrane rupture Cervix fully dilated Baby born Placenta delivered Type of delivery Delivery conducted by Time of delivery

28. Third stage Method of delivery of placenta Complete or incomplete Blood loss: …. ml approx. Post delivery BP Perineum: intact, episiotomy , laceration

29. Baby examination

30. Prolonged active phase

31. References Dutta DC, Konar H. Textbook of obstetrics. 7 th Ed. New Delhi. Jaypee Brothers Medical Publishers. 2013: P. 530- 531 Fraser DM, Cooper MA, Myles Textbook for Midwives. 14 th edition, Churchill Livingstone.2006. Tuitui R. Mannual of Midwifery B,3 rd Edition. 2005 Managing complication in pregnancy and childbirth : A guide for midwives and doctors. Integrated Management of Pregnancy and Childbirth. WHO. 2005.

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