Partograph.pptx basic etiology presentation

Pantograph

1. Mr. Lasgih Musukuma Maimba Dip CM, BSc CS, MSc IHPE student 14/12/2022 LMMU MAIMBA 2022 1 partograph

2. Definition Part ô s ≡partum ≈ labour Graph ≈ graphical presentation of information ≈ partograph ( labourgraph )► graphical presentation of progress of labour It represents graphical presentation of feto -maternal parameters(vertical axis) against time(horizontal axis).

3. History of the partograph 1955—Friedman – graphico -statistical analysis of first stage of labour in primigravida ( cervicograph ) ; demonstrated a slow latent phase and a quicker active phase. Had 3 phases (acceleration phase, phase of max.slope & deceleration phase) 1972---- Phipott -described first partograph ( labour graph) and management protocols for its use 1994-WHO-published their assessment of the use of the partograph—34484 women ,use of the modified partograph in all labour wards was recommended.

4. Partograph A partograph is a graphical record of the observations made of a women in labour For progress of labour and salient conditions of the mother and fetus It was developed and extensively tested by the world health organization WHO 4

5. Overview The partograph can be used by health workers with adequate training in midwifery who are able to : Observe and conduct normal labour and delivery. Perform vaginal examination in labour and assess cervical diltation accurately Plot cervical diltation accurately on a graph against time There is no place for partograph in deliveries at home conducted by attendants other than those trained in midwifery Whether used in health centers or in hospitals , the partograph must be accompanied by a program of training in its use and by appropriate supervision and follow up 5

6. 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 terminjation 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.). 6

7. Partograph function The partograph is designed for use in all maternity settings , but has a different level of function at different levels of health care Health Center, the partograph’s critical function is to: Give early warning if labour is likely to be prolonged and to indicate that the woman should be transferred to hospital (ALERT LINE FUNCTION ) Hospital settings, moving to the right of alert line serves as a warning for extra vigilance , but the action line is the critical point at which specific management decisions must be made Other observations on the progress of labour are also recorded on the partograph and are essential features in management of labour 7

8. Features of 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

9. Normal partograph

10. Fetal monitoring -FHR Normal range 120 – 160/min Listen for atleast ½ a minute Monitor and record every 30min

11. 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 11

12. 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 Caput 12

13. Fetal heart rate Basal fetal heart rate? < 160 beats/mi =tachycardia > 120 beats/min = bradycardia > 100 beats/min = severe 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 13

14. Fetal monitoring - moulding Overlapping of scalp bones Grades 1: sutures apposed 2: sutures overlapping but reducible 3: sutures overlapping and not reducible Shows degree of fetal head compression through the pelvis in CPD and obstruction

15. Fetal monitoring - liquor Record nature and colour of amniotic fluid after every V/E. I: membranes intact R: membranes ruptured C: membranes ruptured, clear liquor M: meconium stained liquor. Record grade B: blood stained liquor

16. Progress of labour – cervical dilatation 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(chosen based on research)

17. Progress of labour – descent Assessed by abdominal palpation Part of head palpable above symphysis pubis. Divided into five parts

18. Progress of labour - contractions Record number of contractions in 10min and duration <20 seconds 20 – 40 seconds > 40 seconds

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

20. Management of labour using the partograph 20

21. Latent phase is less than 8 hours Progress in active phase remains on or left of the alert line Do not augment with oxytocin if latent and active phases go normally Do not intervene unless complications develop Artificial rupture of membranes ( ARM ) No ARM in latent phase ARM at any time in active phase 21

22. Between alert and action lines In health center , the women must be transferred to a hospital with facilities for cesarean section , unless the cervix is almost fully dilated Observe labor progress for short period before transfer Continue routine observations ARM may be performed if membranes are still intact 22

23. At or beyond action line Conduct full medical assessement Consider intravenous infusion / bladder catheterization / analgesia Options - Deliver by cesarean section if there is fetal distress or obstructed labour - Augment with oxytocin by intravenous infusion if there are no contraindications 23

24. Abnormal partographs

25. Partograph – prolonged active phase of labour

26. Partograph – obstructed labour

27. Partograph- poor contractions corrected by oxytocin