PARTOGRAPH FOR BEGINEERS

HOW TO PLOT PARTOGRAPH, PARTOGRAPH

1. Partograph

2. Partograph Is a monitoring and decision making tool for service providers to monitor active labour Graphic recording of the progress of labor and assessment of maternal and fetal well being All labor record is on a single sheet of paper and gives a picture of the progress of labour maternal and foetal condition at a glance Tool to monitor labour and identify complications early, decide to manage them or make timely referrals 2

3. Partograph Contd … Partogram tells us three things:- 1 How well is the labour progressing 2 How is mother coping with labour stress 3 How is baby coping with labour stress

4. Partograph Contd … It is the graph of the progress of labour Progress of labour is measured by:- Contractions–duration and frequency in 10 minutes Dilatation of the cervix every 4 hours

5. Filling a Partograph Identification data Name Age Parity Registration number Date and time of admission Time of rupture of membranes Partograph 5

6. Partograph -Cervical Dilatation ‘x’ axis is time in hours ‘y’ axis is dilatation of cervix in cms Two important lines in the cervical dilatation section Alert line from 4 cms at ‘0’ hours to 10 cms after 6 hours or earlier Action line from 4 cms at 4 hours to 10 cm at 10 hours or end of labour and delivery Long vertical lines indicate for hour and each small square indicates half an hour

7. Partograph -Cervical Dilatation Progress of Labor Begin plotting when active labour starts at 4 cms cervical dilatation or more Plot the initial findings on the alert line Note the time Repeat P/V after 4 hours and plot the cervical dilatation 7

8. Partograph -Cervical Dilatation Normal Progress Put ‘X’ on the alert line at the level of meeting point with the line of cervical dilatation When cervical dilatation is at the rate of 1 cm per hour or more , it is normal progress of labour and the plotting will be on the alert line or to its left if rapid dilatation. Alert line runs at the rate 1 cm per hour

9. Partograph -Cervical Dilatation Progress Interpretation If the ‘X’ goes to the left of alert line = progress is faster than 1cm/hour If the ‘X’ goes to the right of the alert line = progress is slower than 1 cm per hour-refer The woman should reach the FRU within 2 hours before her cervical dilatation reaches the action line If the ‘X’ reaches the action line which is 4 hours to the right of alert line–deliver mother now

10. Slow Progress-Why and What To Do Intact membranes and head < 3/5 palpable per abdomen, perform ARM Intact membranes and head > 3/5 palpable in PHC, refer to higher facility Clear liquor draining, but poor contractions, oxytocin infusion at higher facility

11. Plotting C ontractions Chart the contractions every half an hour Number of contractions in 10 mins Duration in seconds. Less than 20 seconds Between 20 and 40 seconds More than 40 seconds 11

12. Plotting Maternal Condition Graphs of maternal condition Record maternal pulse every half hour and mark with a dot ‘•’ Record maternal BP every 4 hours using a vertical arrow, with upper end signifying systolic BP and lower end diastolic BP Record the temperature every 4 hours and note on temperature graph in digits as degree C. 12

13. Plotting Foetal Condition Count fetal heart rate every half hour for one full minute after a contraction Plot on the meeting point of the vertical line of time and horizontal line of FHR with a ‘•’. Join the dots of new reading with the previous one Normal heart rate 120 to 160/min Two dark horizontal lines in the FHR section indicate the range of normal FHR. Fetal distress: FHR < 120/min or > 160/min- Arrange for referral 13

14. Partograph -Recording Status of Membranes Record status of membranes and amniotic fluid Membranes intact-mark ‘I ’ Membranes ruptured-note date and time of rupture in the identification data section Clear liquor-mark ‘C ’ Meconium stained liquor-mark ‘M ’ Blood stained liquor-mark B Colour tell condition of foetus 14

15. Partograph Interpretation and Indications for Referral to FRU FHR is < 120 or > 160 beats/min Meconium and/or blood stained amniotic fluid When cervical dilatation plotting crosses the alert line and moves towards the right side of the alert line Contractions not increasing in duration, intensity and frequency Pulse rapid > 110/min or BP >140/90 mmHg or temp > 38 C 15

16. Radha Gangaram 26 Years G 3 P 2 L 2 A XYZ1 11/06/09,5:00Hrs 11/06/09, 04:00 Hrs C C C C C C C 9 AM 1 PM 12 AM 11 AM 10 AM 36.8 C 37 C C

17. Thank you Skills lab – Day - 1