PARTOGRAPH

REPRODUCTIVE HEALTH

1. PARTOGRAPH MR. JONES H.M-MBA 26-Aug-19 JONES H.M-MBA 1

2. Part o s - partum - labour Graph - graphical presentation of information The partograph is a graphic record of the progress of labour and relevant details of the mother and fetus. It was introduced as an early warning system to detect labour that was not progressing normally. 26-Aug-19 JONES H.M-MBA 2

3. This would allow for timely transfer to occur to a referral centre, for augmentation or Caesarean section as required. The partograph indicates when augmentation is needed, and can point to possible cephalopelvic disproportion before labour becomes obstructed. It increases the quality and regularity of observations made on the mother and fetus, and it also serves as a one page visual summary of the relevant details of labour . 26-Aug-19 JONES H.M-MBA 3

4. The partograph has been used in a number of countries, and has been shown to be effective in preventing prolonged labour , in reducing operative intervention , and in improving the neonatal outcome. It is important to ensure that adequate supplies of the form are always available. It is a tool which is only as good as the healthcare professional who is using it. 26-Aug-19 JONES H.M-MBA 4

5. FEATURES OF A PARTOGRAPH Maternal General information – name, age, parity, gravid, date and time of admission etc Vitals – temp., BP, pulse, R/R etc _ urinalysis input/output, drugs etc Fetal monitoring FHR Moulding liquor Progress of labour Cervical Dilatation Descent Contraction 26-Aug-19 JONES H.M-MBA 5

6. HOW TO USE A PARTOGRAPH It is opened on admission only if the cervical os is 4cm dilated and above and during management of first stage if woman is in active labour. 26-Aug-19 JONES H.M-MBA 6

7. MATERNAL WELLBEING Record pulse rate every 30 minutes, blood pressure and temperature 4hourly, Urinalysis - Testing for protein, ketones (if available) and glucose after voiding, and record all fluids and drugs administered. If the findings become abnormal, increased frequency of observation and testing will be required, and intervention may be implemented. 26-Aug-19 JONES H.M-MBA 7

8. FETAL WELLBEING FETAL MONITORING -FHR Monitor and record every 30min Listen to fetal heart immediately after the strongest part of a contraction, with the woman lying on her back. The range for the fetal heart rate during labor is 120 to 160 beats per minute. 26-Aug-19 JONES H.M-MBA 8

9. FETAL MONITORING - MOULDING Moulding is a defined as the shaping of the fetal head to the size of the birth canal. Record moulding of the fetal skull, after each vaginal examination. 1: sutures apposed 2 : sutures overlapped but reducible 3: sutures overlapped and not reducible Note if moulding is present and assess the degree of moulding such as o, +1, +2, +3 26-Aug-19 JONES H.M-MBA 9

10. FETAL MONITORING - LIQUOR Record nature and colour of amniotic fluid after every Vaginal Examination I: membranes intact R: membranes ruptured C: membranes ruptured, clear liquor M: meconium stained liquor. Record grade B: blood stained liquor 26-Aug-19 JONES H.M-MBA 10

11. NORMAL PARTOGRAPH 26-Aug-19 JONES H.M-MBA 11

12. PROGRESS OF LABOUR – CERVICAL DILATATION Plot cervical dilatation with an ‘ X’ in the space provided assessed at every vaginal examination Begin plotting at 4cm Join ‘ Xs’ with a solid line When labor progresses normally, plotting of cervical dilatation remains on or to the left of the alert line. 26-Aug-19 JONES H.M-MBA 12

13. If plotting of cervical dilatation moves to the right of the alert line labor may be prolonged and plans must be made for appropriate intervention, if need. Plot decent of the fetal head with a ‘O’ in the space provided. 26-Aug-19 JONES H.M-MBA 13

14. Open partograph when in active phase of labour at 4 cm dilatation Alert line - a line starts at 4cm of cervical dilatation to the point of expected full dilatation at the rate of 1cm per hour. Action line – parallel and 4 hours to the right of alert line. 26-Aug-19 JONES H.M-MBA 14

15. PROGRESS OF LABOUR – DESCENT Assessed by abdominal palpation Descent is assessed on abdominal examination. Descent refers to the part of the head {divided into 5 parts} palpable above the symphysis pubis. Join ‘ Os’ with a solid line. 26-Aug-19 JONES H.M-MBA 15

16. PROGRESS OF LABOUR - CONTRACTIONS Record number of contractions in 10min and duration Fill in one horizontal square for each contraction felt in a 10 minutes period Use dots to fill in the square for mild contractions lasting for 20 seconds Use diagonal lines to fill in the square for moderate contractions lasting 20 to 40 seconds Use solid color to fill in the square for strong contractions lasting for longer 40 seconds 26-Aug-19 JONES H.M-MBA 16

17. LIQUOR Clear, meconium stained (thick or thin), bloody or absent. Thick meconium suggests fetal distress, and closer monitoring of the fetus is indicated. Check every 30 minutes. 26-Aug-19 JONES H.M-MBA 17

18. MEDICATION Record drugs such as oxytocin,and intravenous fluid, if used, in the space provided. Record the woman’s blood pressure, every four hours, in the space provided. 26-Aug-19 JONES H.M-MBA 18

19. SATISFACTORY PROGRESS Progressive cervical dilatation at least 1cm per hour during the active phase Progressive regular uterine contractions Progressive descent of presenting part with progress of labour . Cervix well applied to presenting part Onset of expulsive (pushing) phase Normal FHR and stable maternal condition 26-Aug-19 JONES H.M-MBA 19

20. THE END! 26-Aug-19 JONES H.M-MBA 20