Partograph

This is Vanitha.Ch , working as a Assistant professor. I prepared the content related to new simplified partograph which is using in government hospitals as routine in labour room... most of the people not aware about different types of partogram as well as new partograph..even in the BSc nursing 3rd and 4th year curriculum it is mentioned , it will help the students to enhance their knowledge.

1. PARTOGRAPH PRACTICE Ch.Vanitha , M.Sc Nursing,Ph.D . Obstetrics and Gynecological Nursing Mamata college of nursing.

2. PARTOGRAPH Partograph is a Greek word which means “ Labour Curve”. Partograph or Partogram is a simple, Inexpensive tool which gives continuous pictorial overview of labour Partograph is a single sheet of paper

3. DEFINITION Partograph is a chart in which the salient features of labour are entered in a graphic form and it provides the opportunity for early identification of deviations from normal . Partograph is a composite graphical record of key data (maternal and fetal) during labour , entered against time on a single sheet of paper

4. WHO Partographs : Original and Modified Original WHO Partograph Modified WHO Partograph Modified WHO Partograph

5. OBJECTIVES Early detection of abnormal progress of a labour prevention of prolonged labour Recognize cephalo pelvic disproportion long before obstructed labour Assist in early decision on transfer , augmentation , or termination of labour Early recognition of maternal or fetal problems

6. Indications All primigravida High risk pregnancy Malpresentations and malpositions Trial of labour in contacted pelvis

7. Components of partograph Fetal condition Fetal heart rate Amniotic fluid and Membranes Moulding Labour Cervical Dilatation Uterine contraction Interventions Drugs and IV fluids Maternal condition BP, Pulse, Temperature

8. Membranes and liquor Intact membranes ……………………………………….I R uptured membranes + clear liquor …………………….C R uptured membranes + meconium- stained liquor ……..M R uptured membranes + blood – stained liquor …………B R uptured membranes + absent liquor…………………....A I :

9. Moulding Increasing moulding with the head high in the pelvis is an ominous sign of Cephalopelvic disproportion. separated bones . sutures felt easily……….O bones just touching each other……………..+ overlapping bones …………… …………...++ severely overlapping bones ( notable ) ……..+++

10. Active phase Active phase labor is a time of rapid change in cervical dilatation, effacement, and station . Alert line ( health facility line ) Plotting should be started when the women enters the active stage with 1 or more uterine contractions per 10 mins . Write the time accordingly in the row .

11. If labor progress normal P lotting of cervical dilatation remains on the alert line or to the left of it. In between Alert and Action Lines This means “warning ” : Refer as soon as alert line is crossed and do not wait for referral till the action line is crossed. Observation and ARM . If At or Beyond Action Line This means “danger” : decision needed on management by obstetrician .

12. Cervical dilatation It is the surest way to assess progress of labour .

13. Decent of fetal head by abdominal and Vaginal examination

14. Interventions &Maternal condition Drugs , IV fluids , and oxytocin , if labour is augmented P ulse -1/2hourly Blood pressure and temperature-4 th hourly Urine volume

15. ADVANTAGES A picture is worth a thousand words Helps in continuity of care and providing information Easy Handover Procedure No major capital investment other than skilled attendant Documented evidence for Medico Legal purpose Educational value for all grades of staff

16. DISADVANTAGES Assumes that all women progress at same rate – May influence intervention rate Clinical findings have subjective variations Lack of knowledge Non availability of printed partograph Duplication of recording.

17. Example Mrs.Radha was admitted at 5:00 am on 12.5.2015 Membranes ruptured at 4:00 am.Gravida - 3 , para 2 Hospital number 7886.On admission, the cervix was 2 cm dilated 09:00 am :The cervix is 5 cm dilated 3 contractions in 10 minutes, each lasting 20-40 seconds,FHR-120,Membranes ruptured, amniotic fluid is clear and Skull bones separated, sutures easily felt. BP- 120/70, Temp- is 36.8 C and PR-80 per minutes 01:20 pm: spontaneous delivery of a live female infant and weighing 2.850 grams