Partogram Partogram Partogram Partogram

brief look of Partogram

1. Partogram Prepared and presented by Ahmed Mustafa Aisha Salem Alaauldin Mohammed Yahya Abdulkarim Fatima Elmosrati Mohamed fathy Eman Emad Hanan Sami Habiba mahroos We extend our sincere gratitude to Dr. Rabia Aljadi and Dr. Asmaa Alfarsy for their guidance and support throughout this project.

2. Table of contents 01 04 02 05 03 06 Introduction & history Components of Partogram Recording the condition of mother Recording The Condition Of Fetus Recording The Progress Of Labor Comments and Important Points In Partogram 07 08 09 Advantages and Limitations of Partogram Summary and Conclusion Reference

3. Introduction and History Of Partogram By Yahya Abdulkarim 01

4. 1. Introduction Before the introduction of the partogram, maternal mortality rates during labor were notably higher, around half a million women die from pregnancy complications. The primary causes of maternal mortality are postpartum hemorrhage and sepsis, along with obstructed labor and ruptured uterus. Prolonged labor often results from cephalopelvic disproportion (CPD), leading to complications such as obstructed labor, maternal dehydration, and exhaustion. Early detection of abnormal labor progression and prevention of prolonged labor could significantly reduce these risks.

5. The partograph is a graphic recording of progress of labor and conditions of the mother and fetus, has been used since 1970 to detect labor that is not progressing normally, to indicate when augmentation of labor is appropriate and to recognize cephalopelvic disproportion long before labor becomes obstructed. The partograph serves as an “early warning system” and assists in early decision on transfer, augmentation and termination of labor. 2. What is Partogram ?

6. 3. HISTORY OF THE PARTOGRAPH In, 1954 Friedman described a normal cervical dilatation pattern. prepared the cervicogram to provide a visual representation of the progress of labor. Friedman divided first stage of labor into two parts, The latent phase, extends over 8-10 hours and up to about 3 cm dilation, followed by an active phase, with an acceleration from 3 to 10 cm.

7. In 1972 Philpott and Castle, developed the first partograph, by utilizing Friedman's cervicograph, and adding the relationship of the presenting part to the maternal pelvis. they also Introduced the concept of "ALERT" and "ACTION" lines. ALERT LINE represent the mean rate of slowest progress of labor, ACTION LINE-appropriate action should be taken.

8. WHO, gave a composite partograph in (1988) and later modified partograph was introduced in 2000 .The "modified partograph " is used widely now..

9. Components Of Partogram : the partograph is basically a graphic representation of the events of labor plotted against time in hours. It consists of three components: I. Mother Condition II. Fetus Condition III. Progress Of Labor

10. Components of Partogram By Habiba Mahroos & Hanan Sami 02

11. Fetal Condition Progress of labor Maternal Condition

12. I. Maternal Condition "monitored regularly" Personal data of pt (name, age, G:P:A, BG, time date of admission) 2. Drugs given to patient, IV fluid 3 . Vital signs: - Maternal pulse (every 30 min) - Blood pressure( every 2-4 hours) - Temperature (every 4 hours) 4. Urine output and analysis (protein, glucose, acetone)

13. II. Fetal Condition . Fetal heart rate . Status of amniotic fluid: (monitored regularly every 30 min by pinard stethoscope, normally 120-160 bt /min) (by vaginal examination) I = Intact C = Clear liquid M = Meconium stained liquid B= Blood A = Absent – . Molding of fetal skull bones : Overlapping of fetal skull bone

14. III. Progress Of Labor We have two stages : a. Latent phase : • It's initial stage of labour . • characterized by gradual onset of contractions and the beginning of cervical dilatation. • contractions may be irregular and mild. • the cervix typically dilated from (0) to (3-4) centimeters. • this phase can last for several hours to days especially for first-time mothers. refers to the series of physical changes and events that occur during the labor process as a woman prepares to give birth. It typically involves three key components: 1. Cervical Changes : This includes the dilation (opening) and effacement (thinning) of the cervix, which prepares it for the passage of the baby.

15. b. Active phase • this phase follows the latent phase. • contraction more regular and stronger. • the cervix dilates from (4) to (10) centimeters. • contractions become more frequent and intense, occurring every 3 to 5 minutes and lasting about 40 to 60 seconds. The movement of the fetus down the birth canal, which is assessed by the position of the baby's head in relation to the pelvic bones. 2. Fetal Descent

16. 3. Contractions The frequency, duration, and intensity of uterine contractions, which help to facilitate cervical changes and fetal descent. Monitoring the progress of labor helps healthcare providers determine if labor is proceeding normally or if interventions are needed.

17. Recording Maternal Condition By Fatima Elmosrati 03

18. Recording Maternal Condition All observation for the mother’s condition is written at the bottom of the paragraph Recording the condition of mother : mother’s information Name, age, date &time of admission, gravidity and parity , time of rupture membrane. Medications -Oxytocin drip (if labour augmented ) Oxytocin unit per volume IV fluids [ oxytocin U/L ] in drops per minute [ drops/min ] every 30 minutes -Drugs and other intravenous fluids(if used) Includes: analgesic (pain relief e.g pethidine), antibiotics , etc … Should be written the name of drug & dose in the long box at the particle point of time.

19. Vital sings Assess maternal condition regularly by By repeat the monitoring her pulse ,Bp, and temprture . - pulse : should be checked every half to 1 hour and marked with a dot [ • ] - Blood pressure : measured every 4 hours and marked with arrows [ ] if high risk case, should be measured more frequent time every half to 1 hour. Urine volume ,analysis for patien & acetone During course of labour , checking hydration by volume of urine , and check urine sample looked for proteins & ketone , is absent marked by [ _ ] In case of maternal distress the volume may be decreased. - Temperature : recorded every 4 hours.

20. Recording Maternal Condition

21. Recording Fetus Condition By Mohamed F athy 04

22. Recording Fetus Condition This part of graph is used to monitor and assess fetal condition: fetal heart rate the condition of the membrane and liquor moulding the fetal skull bone fetal heart rate The rate of the fetal heart rate indicates the state of the fetus inside the uterus * Each vertical side of the rectangle represents 10 beats per minute * Each horizontal side of the rectangle represents 30 minutes

23. Fetal heart beat Normal fetal heart rate 120_160 beat/min Abnormal fetal heart rate It is divided into 2 part: Tachycardia Bradycardia fetal tachycardia is fetal heart rate more than 160 Causes: hypoxia maternal fever chorioamnionitis

24. fetal Bradycardia is fetal heart rate less than 120 beat Causes fetal distress Amniotic fluid: Record the color at ever vaginal examination 1- intact membranes ……………….I 2- ruptured membranes + clear liquor ……….C 3- ruptured membranes + meconium- stained liquor ……..M 4- ruptured membranes + blood – stained liquor …………B 5- ruptured membranes + absent liquor ………....A

25. Moulding of skull bone: Moulding is an important indication of how adequately the pelvis can accommodate the fetal head. separated bones,sutures felt easily........ 0 bones just touching each other........ +1 overlaping bones (reducible)........ +2 severly overlaping bones (non_reducible) ........+3

26. Recording The Progress Of Labor By Eman Emad & Aisha Salem 05

27. In the center of the partograph there is an area labelled Cervix (cm) (Plot X) for recording the cervical dilatation. Alone the left side are numbers 0 – 10 against squares , Each square represents 1cm dilatation. Along the bottom of the graph are sequares (Hours) . Each square represents 1 hour . Vaginal examination and assessment of cervical dilatation are made as soon as the patient is admitted to the delivery suite and every 4 hours , unless there is some obstetric contraindication.

28. X 12:00pm 2:00pm x x 3:00pm

29. The alert line starts at 4 cm of cervical dilatation and travels diagonally upwards to the point of expected full dilatation (10 cm) at the rate of 1 cm per hour. It represents the mean rate of slowest progress of labour . if the labour curve crosses the alert line , it signals that the labour is not progress adequately.

30. The action line is parallel and 4 hours to the right of the Alert line . If the cervical dilatation crosses it, appropriate action should be taken . WARNING !

31. For labor to progress well, dilatation of the cervix should be accompanied by descent of the fetal head. The descent of the fetal head is measured by ‘’station’’ which indicates its position in relation to the ischial spine of the mother’s pelvis. Station can only be determined by vaginal examination

32. On a partograph, the descent of the fetal head is plotted using an ‘’O’’ Cross ponding mark on the partograph The station of the fetal head 5 -4 or -3 4 -2 or -1 3 2 +1 1 +2 +3 Plotting the descent of the head 2pm 4pm 7pm X X X O O O

33. Plotting the descent of the head

34. ●Observation every half an hour for 10 minutes during active phase ●Assess the frequency, duration and amplitude in each 10 min ● Frequency : number of contractions in 10 min ( each square represent one contraction ) ● Duration : measuring the time when the contraction starts to were it ends in seconds( the shade of each square ) ●What’s the effective contraction? 3 to 5 contractions Every 10 min For 40-60 sec with an amplitude of 50-60 mmhg ●More than 5 contractions per 10 minutes in 2 consecutive intervals indicate 《 Uterine tachysystole 》 ●If the contraction are less than 3 it’s called hypotonic uterine contraction

35. Comments and Important Points In Partogram By Alaauldin Mohammed 06

36. 1. If there is slow cervical dilatation progress ( indicate prolonged labor) may the defect in passage or passenger, or power so may need induction of labor or S/c. 2-If the urine had protein with increase BP (this case may have preeclampsia and need management and monitoring) and need C.S)

37. 3. If there is excessive molding (this indicate Cephalo pelvic disproportion CPD and may lead to fetal distress 4. If FHR of the fetus increased or decreased (there is fetal distress and need for cesarean section C.S)

38. 5. If the membrane ruptured and meconium present (there is fetal distress need monitoring FHS and need action of C.S) 6_remember that if we do induction of labor and we give oxytocin we should give 5unit in 500ml dextrose and dose should be increased ever 30min until reach to 3_4contraction every 10min continue to 50_60min .but remember that most common side effect is hyper stimulation

39. Advantages And Limitations Of Partogram By Ahmed Mustafa 07

40. Advantages Of Partogram Early identification of labor abnormalities Improved decision-making Enhanced communication Improved documentation Increased patient awareness Reduced risk of maternal and fetal complications

41. Limitations Of Partogram Subjectivity in assessment Limited sensitivity Dependency on accurate data Cultural and linguistic barriers Lack of standardization Limited applicability in certain situations

42. Summary and Conclusion By Ahmed Mustafa 08

43. Summary The partogram is an essential tool in obstetric care that visually tracks labor progress and maternal and fetal conditions. Introduced in the 1970s, it helps identify labor abnormalities early, reducing complications. Key components include monitoring maternal vital signs, fetal heart rates, and cervical dilation, using alert and action lines for timely interventions. Conclusion In conclusion, the partogram is vital for modern childbirth practices, promoting early detection of complications. While it offers advantages like improved decision-making, it also has limitations, such as subjective assessments. Overall, its effective use is crucial for enhancing maternal and infant safety during labor.

44. Reference 09

45. References 1.World Health Organization (WHO). (1988). "Partograph in Management of Labour ." Available at: [WHO Partograph Guidelines](https://www.who.int/publications/i/item/partograph-in-management-of-labour) 2.Friedman, E. A. (1954). "Labor and Delivery." American Journal of Obstetrics and Gynecology. 3.Philpott, R. H., & Castle, W. M. (1972). "The Partograph: A New Tool for the Management of Labor." Journal of Obstetrics and Gynaecology . 4.Roberts, J. A., & Morrison, J. (2020). Textbook of Obstetrics. 3rd Edition. Elsevier. 5.Wikipedia. "Partogram." Available at: [Wikipedia Partogram Page](https://en.wikipedia.org/wiki/Partogram) 6.Khan, K. N., et al. (2016). "The Use of Partogram in Labor Management: A Review." International Journal of Obstetric Anesthesia, 25(2), 89-94. 7.Madhuri, R. M., et al. (2017). "Evaluation of Partogram in the Management of Labor." Journal of Clinical and Diagnostic Research, 11(7), QC05-QC08. 8.Choudhury, R., & Singh, R. (2019). "Role of Partograph in Labor Management: A Review." Journal of Obstetrics and Gynaecology , 39(4), 477-481.

46. Thanks