Partograph importance in abnormal labour

About partograph

1. Page 1
Partograph
Shrooti Shah
Lecturer
National Medical College Nursing Campus

2. Page 2
Definition
•Itisacompositegraphicalrecordingofcervical
dilatationanddescentofheadagainstdurationof
labourinhours.
•Italsogivesinformationaboutfetalandmaternal
conditionthatareallrecordedonsinglesheetof
paper.

3. Page 3

4. Page 4
History
•E.A.freidmanin1954provideafoundationbasisfor
developmentofpartographonthebasisof
observationoflargenumberofwomaninlabour.
•Afterthat,thecompositepictureoflabourwas
reportedbyphilpottin1972,whocombineddetailsof
progressoflabourtogetherwithinformationabout
fetalandmaternalconditions.

5. Page 5
Advantage of using Partograph
1.Asinglesheetofpapercanprovidedetailsof
necessaryinformationataglance.
2.Noneedtorecordlaboureventsrepeatedly
3.Givesclearpictureofnormalityandabnormalityin
labour.
4.Itcanpredictdeviationfromdurationoflabour.So
appropriatestepscouldbetakenintime.

6. Page 6
Advantage of using Partograph…
5.Itfacilitateshandoverprocedureofstaffs.
6.Saveworkingtimeofstaffagainstwritinglabour
notesinlonghand.
7.Educationalvalueforallstaff.

7. Page 7
Principles of plotting partograph
•Theactivephaseoflabourcommenceat4cm
cervicaldilatation.
•Thelatentphaseoflabourshouldnotlastlongerthan
8hours.
•Duringactivelabour,therateofcervicaldilatation
shouldnotbeslowerthan1cm/hours.
•Alagtimeat4hoursbetweenaslowingoflabour
andtheneedforinterventionisunlikelyto
compromisesthefetusorthewomanandavoid
unnecessaryintervention

8. Page 8
Method of recording partograph
•Patientinformation:Filloutname,gravida,para,
hospitalnumber,dateandtimeofadmissionandtime
ofrupturedmembranes.

9. Page 9
Method of recording partograph
•Fetalheartrate:Therateofthefetalheartrate
indicatesthestateofthefetusinsidetheuterus.
Recordeveryhalfhour.

10. Page 10
Method of recording partograph
•Amnioticfluid:Recordthecolourofamniotic
fluidateveryvaginalexamination:
•I:membranesintact;
•C:membranesruptured,clearfluid;
•M:meconium-stainedfluid;
•B:blood-stainedfluid.

11. Page 11
Moulding
•Mouldingisastateofreductionorlossofspacebetween
skullbones.
•Presenceofincreasedmouldingoftheheadhighinthe
pelvisindicatesCPD.
•Recordingofdegreeofmoulding
•0:Bonesareseparatedandsuturescanbefelteasily
•1:suturesapposed
•2:suturesoverlappedbutreducible
•3:suturesoverlappedandnotreducible

12. Page 12
Cervical dilatation
•Assessedateveryvaginalexaminationandmarked
withacross(X).
•Beginplottingonthepartographat4cm.
•Thisgraphconsistsofhomogenoussquares,ten
squarevertically,eachsquareindicateonecentimeter
ofcervicaldilatation.

13. Page 13
Cervical dilatation

14. Page 14
Cervical dilatation
•Thecross(X)inthegrapharejoinedbyacontinuous
linebeginplottingonthepartographat4cm.
•Theclimbingtendencyofthislinenormallylieson
theleftofthemiddleofthegraph.
•Alertline:Alinestartsat4cmofcervicaldilatation
tothepointofexpectedfulldilatationattherateof1
cmperhour.
•Actionline:Paralleland4hourstotherightofthe
alertline

15. Page 15
Descent of the head
•Thisisassessedbyabdominalexaminationbefore
doingvaginalexamination.
•Referstothepartofthehead(dividedinto5parts)
palpableabovethesymphysispubis.
•Recordedasacircle(O)ateveryvaginal
examination.

16. Page 16
Descent of the head

17. Page 17
•Hours:Referstothetimeelapsedsinceonsetof
activephaseoflabour.
•Time:Recordactualtime.

18. Page 18
Uterine contractions
•Uterinecontractionsarerecordedgraphicallyonthe
partographaccordingtotheirstrengthandfrequency.
•Observationofcontractionismadehalfhourlyinthe
activephase.
•Palpatethenumberofcontractionsin10minutesand
theirdurationinseconds

19. Page 19
Uterine contraction

20. Page 20
Uterine contraction

21. Page 21
Oxytocindrip
•Thisconsistsoftwolines,onefortherecordofunit
ofoxytocinperliterofintravenousfluidandother
oneisfordropoffluidperminute.
•Therecordingcanbemadeattheintervalof30
minutesastheuterinecontraction

22. Page 22
Drugs and other intravenous fluids
•Recordanyadditionaldruggivenandare
recordedattheparticularpointoftime.
•Thisincludessedatives,antibiotics,IVfluids
etc.Thenameofthedrugsanddosesgiven
shouldbewrittenclearlyinthelongbox.

23. Page 23
Maternal condition
•Pulse:Recordevery30minutesandmarkwithadot(.).
•Bloodpressure:Recordevery4hoursandmarkwith
arrows.
•Temperature:Recordevery2hours.

24. Page 24
Urine analysis
•Duringthecourseoflabour,theexaminationofurine
isimportant.
•Incaseofmaternaldistressthevolumeofurinemay
decreaseanditmaycontainketonebodies.

25. Page 25
Exercises

26. Page 26
Exercise 1
•Mrs.Sitapokharel,25yrsold,Primigravidawas
admittedinthelatentphaseoflabourat5AM
2072/10/14:
-fetalhead4/5palpable;
-cervixdilated2cm;
-3contractionsin10minutes,eachlasting20
seconds;
-normalmaternalandfetalcondition.

27. Page 27
Exercise 1
•At9AM:
-Fetalheartrate;134/min
-Membrane:intact
-Moulding:suturesarenotapposed.
-Fetalheadis3/5palpable
-Cervixdilated5cm
-4contractionsin10minutes,eachlasting20
seconds
-Mother’sPulse:80/min,BP:110/70mmofHg,
Temp:98°F

28. Page 28
Exercise 1
•9:30a.m:FHR120,contraction3/10each30
seconds,pulse80/min
•10:00a.m.:FHR136,contraction3/10each30
seconds,pulse80/min
•10:30a.m.:FHR140,contraction3/10each35
seconds,pulse88/min
•11:00a.m.:FHR130,contraction3/10each40
seconds,pulse88/min,Temp:98F

29. Page 29
Exercise 1
•11:30a.m.:FHR136,contraction3/10each40
seconds,pulse84/min
•12:00p.m.:FHR140,contraction4/10each40
seconds,pulse88/min
•12:30p.m.:FHR130,contraction4/10each45
seconds,pulse88/min
•1:00p.m.:FHR140,contraction4/10each45
seconds,pulse90/min

30. Page 30
Exercise 1
•At1PM:
-Fetalheartrate:140/min
-Membraneruptured,amnioticfluid:Clear,Moulding:not
present
-Fetalheadis0/5palpable;
-cervixisfullydilated;
-4contractionsin10minuteseachlasting45seconds;
-spontaneousvaginaldeliveryoccurredat2:20PM.
-Alivemaleinfantweighing3000gms.

31. Page 31
Exercise 2
•Mrs.RitaRaiwasadmittedat10amon
2072/10/13,Membranesrupturedat4am,
Gravida3,Para2,Hospitalnumber7886.
•Fetalhead3/5palpableabovethesymphysis
pubis
•Cervix4cmdilated
•3contractionsin10minutes,eachlasting30
seconds
•FHR:140/min
•Amnioticfluid:Clear

32. Page 32
Exercise 2
•Suturesapposed
•Bloodpressure:120/70mmofHg
•Temperature:98°F
•Pulse:80/minute
•Urineoutput:200ml,negativeproteinand
acetone

33. Page 33
Exercise 2
•10:30am:FHR130,contractions3/10each35
sec,Pulse80/minute
•11:00am:FHR136,contractions3/10each40
sec,Pulse90/minute
•11:30am:FHR140,contractions3/10each40
sec,Pulse88/minute
•12:00MD:FHR140,contractions3/10each40
sec,Pulse90/minute,Temperature97°F

34. Page 34
Exercise 2
•12:30pm:FHR130,contractions3/10each40
sec,Pulse90/minute
•1:00pm:FHR130,contractions3/10each45
sec,Pulse88/minute
•1:30pm:FHR130,contractions3/10each50
sec,Pulse90/minute
•2:00pm:FHR130,contractions4/10each45
sec,Pulse90/minute,Temperature97°F,Blood
pressure100/70mmofHg
•Fetalhead:3/5palpab;e,cervix:6cmdilated,
suturesoverlappedbutreducible

35. Page 35
Exercise 2
•2:30p.m.:FHR120,contraction4/10each40secs,
pulse90/min,clearfluid
•3:00p.m.:FHR120,contraction4/10each40secs,
pulse88/min,bloodstainedfluid
•3:30p.m.:FHR100,contraction4/10each45secs,
pulse100/min
•4:00p.m.:FHR90,contraction4/10each50secs,pulse
100/min,Temperature97°F
•4:30p.m.:FHR96,contraction4/10each50secs,pulse
100/min
•5:00p.m.:FHR90,contraction4/10each50secs,pulse
110/min

36. Page 36
Exercise 2
•At5:00p.m.:
•Fetalhead3/5palpableabovethesymphysis
pubis
•Cervix6cmdilated
•Amnioticfluidmeconiumstained
•Suturesoverlappedandnotreducible
•Urineoutput100ml;proteinnegative,acetone
1+
•Ceseareansectionat5:30p.m.,livefemale
infant,weight:4500gms

37. Page 37
Exercise 3
•Mrs. Sarita` was admitted at 10 am on 14/10/2072.
•Membrane Intact
•Gravida1 para0
•Hospital no. 1443
•The fetal head is 5/5 palpable above the symphysis
pubis
•The cervix is 4 cm dilated
•2 contractions in10 minutes, each lasting less than 20
seconds
•FHR 140/min
•Membrane -Intact

38. Page 38
Exercise 3
•At10am:Bloodpressure:100/70mmofHg,
Temperature:97,Pulse:80/min,Urineoutput:400ml,
negative:Proteinandacetone
•10:30am:FHR:140,contraction2/10each15sec,Pulse
90/min
•11:00am:FHR:136,contraction2/10each15sec,
pulse88/min
•11:30am:FHR:140,contraction2/10each20sec,
pulse84/min
•12:00MD:FHR:136,contraction2/10each20sec,
pulse88/min,temperature:98F,fetalhead:5/5palpable,
cervix:4cm,membrane:intact

39. Page 39
Exercise 3
•12:30p.m:FHR:136,contraction1/10each20sec,
pulse90/min
•1:00p.m:FHR:140,contraction2/10each20sec,pulse
84/min
•1:30p.m:FHR:130,contraction2/10each20sec,pulse
88
•2:00p.m:FHR:140,contraction2/10each20sec,pulse
90/min,Temperature98F,Bloodpressure:100/70mmof
Hg.Thefetalheadis5/5palpable,urineoutput:300ml,
negativeproteinandacetone,cervix:4cm,sutures
apposed,Labouraugmentedwith5unitsoxytocinin
500mlRL@10d/min,Membranesartificiallyruptured,
clearfluid

40. Page 40
Exercise 3
•2:30p.m:2contractionsin10minutes,eachlasting30
seconds,infusedrateincreasedto20dpm,FHR;140,
pulse90/min.
•3:00p.m.:3contractionsin10minutes,eachlasting30
seconds,infusionrate:30d/min,FHR:140,Pulse:
88/min
•3:30p.m.:3contractionsin10minutes,eachlasting30
seconds,infusionrate:40d/min,FHR:140,Pulse:
88/min
•4:00p.m:Fetalhead2/5palpable,cervix6cm,sutures
apposed,3contractionsin10minutes,eachlasting30
seconds,FHR;144/min,Pulse:92/min,Amnioticfluid:
Clear

41. Page 41
Exercise 3
•At4:30p.m:3contractionsin10mins,eachlasting
45secs,FHR;140/min,Pulse:90/min,infusionremainsat
50d/min
•At5:00p.m:FHR138,Pulse92/min,contractions3/10
each40sec,Maintainat50d/min.
•At5:30p.m:FHR140,Pulse94/min,contractions3/10
each45sec,Maintainat50d/min.
•At6:00p.m:FHR140,Pulse96/min,contractions4/10
each50sec,Maintainat50d/min.
•At6:30p.m:FHR144,Pulse94/min,contractions4/10
each50sec,Maintainat50d/min.

42. Page 42
Exercise 3
•At7:00p.m.:Fetalhead0/5palpable,4contractionsin
10minutes,eachlasting50seconds,FHR;144/min,
pulse:90/min,cervixfullydilated
•At8:10p.m.:Spontaneousvaginaldelivery.alivemale
infantweighing2,600gms

43. Page 43
Practice doesn’t make man perfect,
perfect practice makes man perfect, so
keep practising….