PARTOGRAPH... RECORDING AND PROCESS.ppt

The partograph is a tool for monitoring maternal and foetal wellbeing during the active phase of labour, and a decision-making aid when abnormalities are detected. It is designed to be used at any level of care.
Its central feature is a graph used to record the progress of cervical dilation, as determined by vaginal examination.
Start the graph at 5 cm of dilation, and 3 contractions every 10 minutes. In certain situations, e.g. induction of labour, it is started at 4 cm of dilation.

1. TOOL FOR RECORDING THE TOOL FOR RECORDING THE
PROGRESS OF LABOURPROGRESS OF LABOUR
PARTOGRAMPARTOGRAM

2. PARTOGRAMPARTOGRAM
PARTOGRAM is a graphical information about the
progress of labour in which the salient information
about the fetal well-being, maternal well-being and
the progress of labour are recorded into a chart.

3. 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.).

4. PARTOGRAMPARTOGRAM
Friedman's partogram - 1954
2 phases of labour (base on dilatation
of the cervix )
Latent phase (dilatation < 3 cm)
Active phase (>3 cm dilated)
Latent phase
Active phase
Philpott and Castle - 1972
Introduced the concept of “ALERT”
and “ACTION” lines.
ALERT LINE – represent the mean rate
of slowest progress of labour
ACTION LINE – appropriate action should
be taken.
Normal labour is plotted to the left alert line

5. PARTOGRAMPARTOGRAM
Mother information
Fetal well-being
• Fetal heart rate
• Character of liquor
• Moulding
Labour progress
• Dilatation
• Descent
• Uterine contraction
Medications
• Oxytocin
• Pain relief (e.g. pethidine)
Maternal well-being
• BP, Pulse, Temperature
• Urine – albumin, glucose, acetone
• Urine output

6. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Mother information
 Name
 Age
 Parity
 Gestational period
 Date/time of admission
 Time of rupture membrane
 Short antenatal history

7. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Fetal information
 Fetal heart rate

 Membrane and amniotic
fluid

 Moulding

8. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Fetal information
Fetal heart rate monitoring

1.Safe and reliable way of knowing
fetus is well.
2.Listen after each contraction for
one minutes.
3.Recorded ½ hourly (each square
is ½ hour)

9. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Fetal information
Character of amniotic fluid

1.State of liquor can assess in
monitoring fetal condition.
2.Observation to be recorded
- Membrane intact record as “I”
- Membrane rupture:
a) liquor clear record as “C”
b) meconiun stained liquor “M”
c) liquor absent record as “A”

10. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Fetal information
Moulding of fetal skull

1.Provide information about the
adequacy of pelvis to
accommodate fetal head
2.Record the degree of moulding
0  bones separated
+  bones touching but can
be separated.
++  bone over lapping
+++  bones over lapping
severely

11. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Labour Progress
 Cervical dilatation

 Descent

 Uterine contraction

12. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Labour progress
Dilatation and Descent

1.Latent (0-3 cm) and Active (3-10
cm) phase.
2.Dilatation of cervix plotted as “X”
axis and Descent plotted as “O”
axis.
3.First vaginal examination done
on admission is recorded.
4.Subsequent vaginal examination
is done every 2-4 hourly.
5.Transfer from latent to active
phase.

13. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
Labour progress recording
in latent phase
At admission:
- Dilatation  2 cm
- Descent  -2
2 hours after admission:
- Dilatation  2 cm
- Descent  -1
Plot dilatation as “X”
Plot descent as “O”
++
As the dilatation is only 2 cm therefore
the labour progress is in the latent
phase

14. PARTOGRAM RECORDINGPARTOGRAM RECORDING
0 hours
(admission)
2 hours4 hours
Dilatation
“O” 2 cm 4 cm 7 cm
Descent
“X” -2 -1 +1
Latent phase
Labour progress recording
in active phase
Plot dilatation as “X”
Plot descent as “O”
+
+
+
+ Latent phase
Active phase

15. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
Cervical dilatation
+
+
+
+ If labour progress well plotting of
cervical dilatation should always
remain to the left of alert line.
If it cross to right of action line
this warns that labour may be
prolonged.

16. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Labour progress
Uterine Contractions

1.Observation is made ½ hourly
2.Assess the frequency, duration.
3.Each square represent 1
contraction felt in 10 minutes.
4.Frequency – highlight the
numbers of square.
5.Duration – shade the contraction
in the square.
< 20 sec- Mild
20-40 sec- Moderate
> 45 sec- Strong

17. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Labour progress
Recording the uterine on the
partogram
5 strong contractions
in 10 minutes
2 weak contractions
in 10 minutes
3 moderate contractions
in 10 minutes
Nos. of
Contraction
in 10 mins

18. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Mother condition
 Vital signs – BP, Pulse, TºC

 Urine analysis – acetone,
albumin, glucose
 Urine volume
 Medications or drug given

19. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Mother condition
 Vital signs recording
BP – 4 hourly or more
frequent if indicated
Pulse - ½ hourly
TºC – 4 hourly
 Urine analysis – dipstick
acetone  Nil or +
albumin  Nil or +
glucose  Nil or +

 Urine volume

20. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
Analyzing the progress of
labour from the partogram
+
+
+
+
+ If progress is satisfactory the
plotting will remain on or to the left
of the alert line.
If labour is not progressing
normally the plotting will be to the
right of the alert line.
Active phase

21. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
LABOUR PATTERNS
Normal labour
Prolonged latent phase
Primary dysfunctional
labour
Secondary arrest
Active phase

22. Management of labour using the
partograph

23. - latant 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

24. 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

25. 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

26. ABNORMAL PROGRESS OF LABOR

27. •One of the main functions of the partograph is
to detect early deviation from normal
progress of labor

28. Moving to the right of alert line
•This means warning
•Transfer the woman from health center to
hospital
• reaching the action line
•This means possible danger
•Decision needed on future management
(usually by obesteritian or resident )

29. Prolonged latent phase
•If a woman is admitted in labor
in the latent phase ( less than 3
cm diltation ) and remains in the
latent phase for next 8 hours
•Progress is abnormal and she
must br transferred to a hospital
for a decision about further
action
•This is why there is a heavy line
drawn on the partograph at the
end of 8 hours of the latent
phase

30. Polonged Active phase
•In the active phase of labor , plotting of
cervical diltation will normally remain
on or to the left of the alert line
•But some cases will move to the right
of the alert line and this warns that
labor may be prolonged
•This will happen if the rate of cervical
diltation in the active phase of labor is
not 1 cm / hour or faster
• A woman whose cervical diltation
moves to the right of the alert line
must be transferred and manged in a
hospital with adequate facilities for
obstetric intervention unless delivery is
near
• at the action line , the woman must be
carefully reassessed for why labor is
not progressing and a decision made on
further management

31. Secondary arrest of
cervical diltation
•Abnormal progress of labor may
occur in cases with normal
progress of cervical diltation then
followed by secondary arrest of
diltation

32. Secondary arrest of head descant
•Abnormal progress of labor may occur with normal progress of
descent of the fetal head then followed by secondary arrest of
desscent of fetal head

33. USING THE PARTOGRAPH
POINTS TO REMEMBER

34. •It is important to realize that the partograph is a tool for
managing labor progress only
•The partograph does not help to identify other risk factors
that may have been present before labor started

35. •only start a partograph when you have checked that there are
no complications of pregnancy that require immediate action
•a partograph chart must only be started when a woman is in
labor,-- be sure that she is contracting enough to start a
partograph
•if progress of labor is satisfactory , the plotting of cervical
diltation will remain or to the left of the alert line

36. •when labor progress well , the diltation should not move to the
right of the alert line
•the latent phase . 0 – 3 cm diltation , is accompanied by gradual
shortening of cervix . normally , the latent phase should not last
more than 8 hours
•the active phase , 3 – 10 cm diltation , should progress at rate
of at least 1 cm/hour
•when admission takes place in the active phase , the admission
diltation, is immediately plotted on the alert line

37. •when labor goes from latent to active phase , plotting of
the diltation is immediately transferred from the latent
phase area to the alert line

38. •diltation of the cervix is plotted ( recorded with an X , desent of the
fetal head is plotted with an O , and uterine contractions are
plotted with differential shading
•desent of the head should always be assessed by abdominal
examination ( by the rule of fifths felt above the pelvic brim )
immediately before doing a vaginal examination
•assessing descent of the head assists in detecting progress of labor
•increased molding with a high head is a sign of cephalopelvic
disproportion

39. •vaginal examination should be performed infrequently as this is
compatible with safe practice ( once every 4 hours is
recommended )
•when the woman arrives in the latent phase , time of admission
is 0 time
•a woman whose cervical diltation moves to the right of the alert
line must be transferred and manged in an institution with
adequate facilities for obstetric intervention , unless delivery is
near

40. •when a woman ,s partograph reaches the action line , she must be
carefully reassessed to determine why there is lack of progress ,
and a decision must be made on further management ( usually by
an obesterician or resident )
•when a woman in labor passes the latent phase in less than 8 hours
i.e., transfers from latent to active phase , the most important
feature is to transfer plotting of cervical diltation to the alert line
using the letters TR,
•Leaving the area between the transferred recording blank. The
broken transfer line is not part of the process of labor
•do not forget to transfer all other findings vertically

41. THANK YOUTHANK YOU