In Partograph and Setting of labour room word file

In Partograph and Setting of labour room word file made By Sonal Patel

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JG COLLEGE OF NURSING,
AHMEDABAD.

SUBJECT: OBSTETRICS & GYNECOLOGICAL NURSING
TOPIC: IN PARTOGRAPH & SETTING OF DELIVERY AREA






SUBMITTED TO, SUBMITTED BY,
Ms. Rekhamol Sidhanar, Ms.Sonal Patel
Assistant Professor, S.Y.M.Sc(N).
J.G College of Nursing, J.G College of Nursing,
Ahmedabad. Ahmedabad.

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PARTOGRAPH
Introduction:
Friedman in 1954 made a cervicograph showing 4 phases of cervical dilation
Definition:
Partogram is a composite graphical record of key data (maternal and fetal) during
labour entered against time on a single sheet of paper. Relevant measurements might include
statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs.
• Women should not be admitted for labour ward until in active labour
• Active labour is when women have regular contractions (3-5 in ten minutes) and cervix is
4 cm. dilated
Components:
1. Patient identification
2. Time: It is recorded at an interval of one hour. Zero time for spontaneous labour is time
of admission in the labour ward and for induced labour is time of induction.
3. Fetal heart rate: It is recorded at an interval of thirty minutes.
4. State of membranes and colour of liquor: "I" designates intact membranes, "C" designates
clear and "M" designates meconium stained liquor.
5. Cervical dilatation and descent of head
6. Uterine contractions: Squares in vertical columns are shaded according to duration and
intensity.
7. Drugs and Fluids
8. Blood pressure: It is recorded in vertical lines at an interval of 2 hours.
9. Pulse rate: It is also recorded in vertical lines at an interval of 30 minutes.
10. Oxytocin: Concentration is noted down in upper box; while dose is noted in lower box.
11. Urine analysis
12. Temperature record.

Advantages:
 Provides information on single sheet of paper at a glance
 No need to record labour events repeatedly
 Prediction of deviation from normal progress of labour
 Improvement in maternal morbidity, perinatal morbidity and mortality.

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Original WHO Partograph

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Fetal Heart Rate:
• Assess after contraction for 60 seconds:
• Each 30 minutes in first stage (each 15 minutes if risk factors are identified
• Each 5 minutes when pushing
Cervical Dilatation
Assessed each 4 hours (or before if a crossed action line is anticipated
Alert Line:
• Start recording cervical dilatation in the alert line.
• As long as dilatation is 1 cm or more/hr the alert line is not crossed.
If cervical dilatation is < 1 cm/hr the alert is crossed and causes of prolonged labour should be
considered: always consider: artificial rupture of membranes and augmentation with oxytocin.
Cervical dilatation

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Action Line:
• If the action line is crossed the actions should be as follows in mentioned order (if not
already performed)
• ARM and oxytocin augmentation
• Correction of malposition
• Cesarean Section or Vacuum (if in second stage and descend is 1/5 or below)
Amniotic fluid:
I= Intact Membranes
C= Clear
M= Meconium stained
B= Blood stained
Remember: the diagnosis “cephalopelvic disproportion” cannot be made with intact
membranes!
Contractions:
Chart every 30 minutes
Number/10 minutes and Duration
• Weak: Lasting <20 seconds Medium: Lasting 20-40 seconds Strong: Lasting >40 seconds
Oxytocin:
• Record oxytocin (amount/volume) and drops / minute

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SETTING OF DELIVERY AREA
Labour room norm (In respect of Equipment, Medicine and others)
CIVIL INFRASTRUCTURE:
1. Labour room with attached bath.
Floor and walls to be finished by pasting with non slippery tiles and there should be space for
setting up of New Born Care Enclosure with.
a) Radient warmer
b) Foot sucker with sterilized catheter / mucous sucker
c) Ambu bag

2. One buffer room in front of labour room having provision for:
a) Wash basin
b) Instrument cabinate
c) Slipper
d) Sterilized caps, masks, gowns
e) Patient carrying trolley
f) Liquid soap
g) Nursing station
h) Wall cabinate

3. One room for sterilization which should have
i) Autoclave machine (Preferably electrically operated)
ii) Instrument Sterilizer (Preferably electrically operated)
iii) Dressing drums
iv) Formal sterilizer
v) Lifter
vi) Lysol solution

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4. Labour room should have
i) Labour Table /Tables with foam mattress & legging
ii) Step per table
iii) Bucket per table
iv) Stool per table
v) Other accessories
a) Oxygen Cylinder with fittings (Mask/Hood /catheter-per table )
b) Shadow less lamp per table
c) Instrument trays.
d) Instrument Trolley
e) Baby weighing machine
t) B.P Instrument (Stand)
g) Saline set / B. T set
h) Saline stand per table
i) Baby holding Tray
j) Towel for wrapping baby
k) Foetal Doppler
I) Stethoscope
m) Outlet forceps
n) Volsellum

vi) Labour tray containing:
a) Artery forceps
b) Tooth dissecting forceps
c) Needle holder
d) Curve cutting needle
e) Scissors (Episiotomy)
f) Scissors (plain)
g) Swab holding forceps
h) Sim's Speculum
i) Catgut

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j) Sterilized gloves
k) Sterilized gauze
I) Sterilized pad
m) Sterilized Cotton Swab
n) Umbilical cord clamp
o) Draping towel (sterilized)
p) Syringe and needle (sterilized)

MEDICINE
a) Mesoprostol
b) Ing. Magnesium sulphate
c) Inj. Oxytocin.
d) Inj. Ampicilin / Gentamycin
e) Inj. Nifedepine
f) Inj. Vit-K
g) Plasma expander
h) Inj. Lignocaine
i) 25% Dextrose solution (amp)
j) 5% Dextrose solution

vii) Emergency Medicine Tray containing:
viii) Screen for door and windows
ix) Curtain in between the tables
x) Wall clock
xi) Un Interrupted power supply / Generator support
xii) Waste disposal bin with colour coded bag
xiii) Hub cutter
xiv) Sodium hypochlorite solution
xv) Partograph
xvi) Log Book
xvii) Providon Iodine

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xviii) Rectified spirit
xix) Rack / Table

SETTING OF LABOUR ROOM :
Introduction:
 The obstetric unit should be located so as to prevent unrelated traffic through the unit and
to provide for reasonable protection of mothers from infection and from cross infection.
 An emergency communication system connected to the operations and control station
shall be provided by the facility.
 Floor and walls to be finished by pasting with non slippery tiles and there should be space
for setting up of New Born Care Enclosure with.
a) Radient warmer
b) Foot sucker with sterilized catheter / mucous sucker
c) Ambu bag

Requirement :
A labour room should have meet the following requirement:
1. Minimum of 80 sq.ft. of area should be provided per labour bed.
2. The labour room should be located so as to permit visual observation of each room from
the nurse work station.
3. Labour room should afford privacy.
4. A labour room should contain facilities for medication, hand washing, charting, and
storage for supplies and equipment.
5. At least two labour beds with adjacent toilet should be provided for each delivery room.
6. No more than two labour bed may be located in one labour room.

Recovery room:
A separate recovery room may be omitted in facilities with less then 1500 births per year
Requirement:
 A recovery room should contain not less then two beds and should have charting facilities
located so as to permit visual observation of all beds.
 Provision for medicine dispensing ,hand washing, clinical sink with bedpan washer,and
storage for supplies and equipment should be provided .
 A toilet with hand washing facilities should be provided for staff.

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Labour ,delivery,recovery room:
 Each LDR room should have a minimum have a minimum of 250 square feet of floor
space exclusive of toilet or vestibule.
 Each LDR room should be provided with directly accessible shower for use by that room
only.
 Each LDR room should be equipped with oxygen ,suction,medical air,and electrical
outlets.
 Each LDR room should contain facilities for medication storage,hands-free hand washing
,charting and storage for supplies and equipment.

3. One room for sterilization which should have
i) Autoclave machine (Preferably electrically operated)
ii) Instrument Sterilizer (Preferably electrically operated)
iii) Dressing drums
iv) Formal sterilizer
v) Lifter
vi) Lysol solution

EQUIPMENT AND ARTICLES NEEDED IN LABOUR ROOM :
ARTICLES:

Delivery table
Head light
Warmer /Table with 200 watt bulb
Kally’s pad
Linen
White sheets
Green sheet
Mackintosh
Gloves
Cotton pad
Gauze pieces
Perineal pads
Big bucket
Plastic apron

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Labour tray containing:
a) Artery forceps
b) Tooth dissecting forceps
c) Needle holder
d) Curve cutting needle
e) Scissors (Episiotomy)
f) Scissors (plain)
g) Swab holding forceps
h) Sim's Speculum
i) Catgut
j) Sterilized gloves
k) Sterilized gauze
I) Sterilized pad
m) Sterilized Cotton Swab
n) Umbilical cord clamp
o) Draping towel (sterilized)
p) Syringe and needle (sterilized)

Miscellaneous (instruments)
Cervical dilator
Uterine sound
Uterine curettage
Allis forceps
Multiple tooth vulsellum
Ventose cup
Forceps
Syringe
Sterile drums
Oxygen cylinder
Boiler
Suction machine
Weighting machine
Infantomer
BP instrument
Almirah
Liquid soap
Hand towel
Sterilizer

EQUIPMENT REQUIRED FOR BABY CARE:
 Mucus extracter
 Cord clamp
 Feeding tube
 Fetoscope
 Stethoscope

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Emergency Medicine Tray containing:
a) Mesoprostol
b) Ing. Magnesium sulphate
c) Inj. Oxytocin.
d) Inj. Ampicilin / Gentamycin
e) Inj. Nifedepine
f) Inj. Vit-K
g) Plasma expander
h) Inj. Lignocaine
i) 25% Dextrose solution (amp)
j) 5% Dextrose solution

Record in labour room:
1. Birth record
2. Death record
3. Admission record
4. Abnormal birth record
5. IUD insertion record

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BIBLIOGRAPHY:-
BOOKS
1. Basvanthappa B.T : “TEXT BOOK OF MIDWIFERY AND REPRODUCTIVE
HEALTH NURSING”; first edition 2006, Jaypee brother publication, New Delhi.
Page no; 210-218.
2. Dawn.C. S. ”TEXTBOOK OF OBSTETRICS AND NEONATOLOGY” 13th
edition,Calcutta: Dawn books, 1997,P.P. 162-171.
3. Draftary S.N. and Chakravati S.“HALLND AND BREWS MANNUAL OF
OBSTETRICS.” 16th edition, New Delhi: B.I.Chruchill Livingstone pvt. Ltd.,
1998, P.P.136-224.
4. Dutta D.C : “TEXT BOOK OF OBTETRICS ” ; 6
TH
Edition , 2004; New central book
agency publication, Calcutta. Page no: 179-190.
5. Jacob Anamma : “A COMPREHENSIVE TEXT BOOK OF MIDWIFEREEY”;
1
st
edition 2005; Jaypee brother medical publication; New Delhi, page no:164-
172.
6. Kumari Neelam; (2010); 1
st
edition; “MIDWIFERY AND GYNAECOLOGICAL
NURSING”;S.vikas and company; Jalandhar city; Page no :156-164.
7. Myles : “ TEXT BOOK OF MIDWIVES ” ; Fourteenth edition,2003 ; Elsevier
publisher, Philadelphia. Page no; 285-287.
8. Rao Kamini “TEXT BOOK OF MIDWIFERY AND OBSTETRICS FOR NURSES”;
First edition, 2011, Elsevier publisher, Philadelphia. Page no: 277-281.
WEBSITES
1. http://www.en.wikipedia.org/wiki
2. http://www.medscape.com/viewarticle/551032_4
3. http://www.healthline.com
4. http://www.uptodate.com/contents
5. http://www.ncbi.nlm.nih.gov/pubmed/19089770
6. http://www.empowher.com/media/reference
7. http://www.pregmed.org/.htm
8. http://www.stanfordchildrens.org/ens-90-P02430
9. http://www.moh.gov.om/nursing/
10. http://www.uams.edu/

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11. http://www.med.nyu.edu/patientcare/library/article.html