PARTOGRAPH.ppt

partograph

1. PARTOGRAPH
MRS. KALAIARASI
READER
OBSTETRICS AND GYNAECOLOGY NURSING

2. Partograph
Partograph is the most important tool for health workers at
any level to assess the progress of labour and take
appropriate actions
Graphic recording of the progress of labor and condition of
mother and fetus
Labor record , thus reduces paper work
Partogrpah is applicable for the active phase of first stage
of labour i.e., from cervical dilatation >=4cm to full
dilatation of cervix

3. WHO partograph

4. Objectives
•early detection of abnormal progress of a labour
•prevention of prolonged labour
•recognize cephalopelvic disproportion long before obstructed labour
•assist in early decision on transfer , augmentation , or termination of
labour
•increase the quality and regularity of all observations of mother and
fetus
•early recognition of maternal or fetal problems
•the partograph can be highly effective in reducing complications from
prolonged labor for the mother (postpartum hemorrhage, sepsis,
uterine rupture and its sequelae) and for the newborn (death, anoxia,
infections, etc.).

5. Components of the
partograph
•Part 1 : fetal condition (
at top )
•Part 11 : progress of labour
( at middle )
•Part 111 : maternal condition
( at bottom )

6. Part 1 : Fetal condition
•This part of the graph is used to monitor and assess fetal condition
•1 -Fetal heart rate
•2 -Membranes and liquor
•3 -Moulding the fetal skull bones

7. Fetal heart rate
Basal fetal heart rate?The baseline rate is best determined over a
period of 5–10 minutes
•<150 beats/min =tachycardia
•>110 beats/min = bradycardia
Decelerations? yes/no
Relation to contractions?
Early
Variable
Late –-----Auscultation -return to baseline
>30 sec contraction
-----Electronic monitoring
peak and trough (nadir)
>30 sec

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

9. Moulding the fetal skull bones
•Moulding is an important indication of how adequately
the pelvis can accommodate the fetal head
•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 ( reducible ) …………………… ...++
•severely overlapping bones ( non –reducible ) ..…..+++

11. Part11 –progress of labour
. Cervical dilatation
•Descent of the fetal head
•Fetal position
•Uterine contractions
•this section of the partograph has as its central feature: a graph of
cervical dilatation against time

12. latent phase :
•it starts from onset of labour until the cervix reaches 4 cm
diltation
•once 4 cm diltation is reached , labour enters the active
phase

13. Active phase :
•Contractions at least 3 / 10 min
•each lasting <40 sceonds
•The cervix should dilate at a rate of 1
cm / hour or faster

14. Alert line ( health facility line )
•The alert line drawn from 4 cm dilatation
represents the rate of dilatation of 1 cm / hour
•Moving to the right of the alert line means
referral to hospital for extra vigilance

15. Action line ( hospital line )
•The action line is drawn 4 hour to the right of
the alert line and parallel to it
•This is the critical line at which specific
management decisions must be made at the
hospital

16. Cervical dilatation
•It is the most important information and the surest way to assess
progress of labour , even though other findings discovered on
vaginal examination are also important
•when progress of labour is normal and satisfactory , plotting of
cervical dilatation remains on the alert line or to the left of it
•if a woman arrives in the active phase of labour , recording of
cervical dilatation starts on the alert line

17. Descent of the fetal head
•It should be assessed by abdominal
examination immediately before doing
a vaginal examination, using the rule of
fifth to assess engagement
•The rule of fifth means the palpable
fifth of the fetal head felt by abdominal
examination to be above the level of
symphysis pubis
•When 3/5 or less of fetal head is felt
above the level of symphysis pubis ,
this means that the head is engaged ,
and by vaginal examination , the
lowest part of vertex has passed or is
at the level of ischial spines

18. Assessing descent of the fetal head by vaginal examination;
0 station is at the level of the ischial spine (Sp).
floating head , -3 station : plot o at 5 (on partograph)
-2 , -1 station: plot o at 4
0 station: plot o at 3
+1 station: plot o at 2
+2 station: plot o at 1
below +2: plot o at 0

20. Occiput transverse positions
Occiput anterior positions
Fetal position

21. Uterine contractions
•Observations of the contractions are made every half-hour in
the active phase
•frequencyhow often are they felt ?
•Assessed by number of contractions in a 10 minutes period
•durationhow long do they last ?
Measured in seconds from the time the contraction is first felt
abdominally , to the time the contraction phases off
•Each square represents one contraction

22. Methods of assessment of uterine
contractions:
1. Manual assessment
2. Cardiotocography
The above methods measure the frequency and
duration of contractions
3. Intrauterine catheters to measure intrauterine
pressure in Montevido units
This method will measure the intensity in addition
to frequency and duration

23. Palpate number of contraction in ten
minutes and duration of each contraction in
seconds
•Less than 20 seconds:
•Between 20 and 40 seconds:
•More than 40 seconds:

24. Part111: maternal condition
Assess maternal condition regularly by monitoring :
•drugs , IV fluids , and oxytocin , if labour is augmented
•pulse , blood pressure
•Temperature
•Urine volume , analysis for protein and acetone

25. Maternal pulse / 0.5 hr
blood pressure / 4hrs
urine evaluation \4 hrs

26. 26
Radha(wife of Gangaram), 26 years of age, third gravida, was admitted at 5:00 am on 11 June 2009 with the complaint
of labourpains since 2:00 am. Her membranes had ruptured at 4:00 am. She has two children of the ages of 5 and 2
years. On admission, her cervix was 2 cm dilated.
Plot the following findings on the partograph:
At 09:00 am:• The cervix is dilated 5 cm.
• She had 3 contractions in 10 minutes, each lasting 20–40 seconds.
• The FHR is 120 beats per minute.
• The membranes have ruptured and the amniotic fluid is clear.
• Her BP is 120/70 mmHg.
• Her temperature is 36.8°C.
• Her pulse is 80 per minute.
9:30 am: FHR 120, contractions 3/10 each 30 seconds, pulse 80/minute, amniotic fluid clear
10:00 am: FHR 136, contractions 3/10 each 35 seconds, pulse 80/minute, amniotic fluid clear
10:30 am:FHR 140, contractions 3/10 each 40 seconds, pulse 88/minute, amniotic fluid clear
11:00 am: FHR 130, contractions 3/10 each 40 seconds, pulse 88/minute, amniotic fluid clear
11:30 am: FHR 136, contractions 4/10 each 45 seconds, pulse 84/minute, amniotic fluid clear
12:00 noon:FHR 140, contractions 4/10 each 45 seconds, pulse 88/minute, amniotic fluid clear
12:30 pm: FHR 130, contractions 4/10 each 50 seconds, pulse 88/minute, amniotic fluid clear
1:00 pm: FHR 140, contractions 4/10 each 55 seconds, pulse 90/minute, temp. 37°C, BP 100/70 , amniotic fluid clear
At 1:00 pm:
• Cervix fully dilated
• Amniotic fluid clear and BP 100/70 mmHg
1:20 pm: Spontaneous birth of a live female infant weighing 2.85 kg.
PARTOGRAPH –CASE STUDY 1

27. Radha Gangaram 26 Years G
3P
2L
2A
0 XYZ1
11/06/09,5:00Hrs 11/06/09, 04:00 Hrs
C CCCCCC
9 AM 1 PM12 PM11 AM10 AM
36.8 C 37 C
C
Spontaneous birth of a live female
infant weighing 2.85 kg at 1.20 PM
Cervix dilated =
5cm
FHR =
120
3
CONTRACTIO
N
AMNIOTIC FLUID
CLEAR
BP 120/70mmhg
Temp –36.8
C
Pulse –80/min
FHR =
120
3
CONTRACTIO
N
AMNIOTIC FLUID
CLEAR
FHR =
136
3
CONTRACTIO
N
Pulse –80/min
AMNIOTIC FLUID
CLEAR
FHR =
140
3
CONTRACTIO
N
Pulse –88/min
AMNIOTIC FLUID
CLEAR
FHR =
130
3
CONTRACTIO
N
Pulse –88/min
AMNIOTIC FLUID
CLEAR
FHR =
136
4
CONTRACTIO
N
Pulse –84/min
AMNIOTIC FLUID
CLEAR
FHR =
140
4
CONTRACTIO
N
Pulse –88/min
AMNIOTIC FLUID
CLEAR
FHR =
130
4
CONTRACTIO
N
Pulse –88/min
AMNIOTIC FLUID
CLEAR
Pulse –80/min
AMNIOTIC FLUID
CLEAR
C
Cervix fully dilated
FHR =
140
4 CONTRACTION
Pulse –90/min
Temp –37 C
BP 100/70mmhg
AMNIOTIC FLUID
CLEAR
AMNIOTIC FLUID
CLEAR

28. Thank you