THE PARTOGRAM ( D SALAH REZK).pptx

describe the meaning of partogram
,component , indications and its use in management of labor

1. THE PARTOGRAM D / SALAH ELDEEN REZK MD, COSULTANT OF OBS&GYN HEAD OF OBS&GYN ,,SHERBEEN HOSPITAL

2. PARTOGRAM : DEFINITION A composite graphical record of progress of labor on a single sheet of paper. It include recording of the condition of mother, the condition of the fetus and the progress of labor. Can serve as an early warning system & assist in making decisions and interventions

3. PARTOGRAM : ADVANTAGES Early detection of abnormal progress of labor and prevention of prolonged labor. Recognition of CPD long before obstructed labor . Can allow time & discussion of further management of labor. God monitoring of feto -maternal condition .

4. PARTOGRAM : ADVANTAGES Reduction of complications from prolonged labor ; PPH. Sepsis , uterine rupture , neonatal( death,anoxia,infection ) Reduce incidence of CS rate .

5. PARTOGRAM : DISADVANTAGES Assumes that all women progress at the same rate . Clinical findings have subjective variations . Lake of knowledge .

6. Developmental history of partogram Emanwel friedmans partogram (1954) . ……..based on observation of cervical dilatation and fetal station against time elapsed in hours from onset of labor. Plotting cervical dilatation against time yielded the typical sigmoid or S shaped curve ,and station against time gave rise to the hyperbolic curve .

7. Developmental history of partogram WHO partogram ( 1994) ..the original partograph which include : latent phase of labor of up to 8 hours . Active phase of labor . Beginning when cervical dilatation reaches 3 cm .. ALERT LINE : Drawn from point of cervical dilatation on admission 3cm at the start of the active phase and propagate at 1cm per hour. ACTION LINE : drawn 4 hours to the right of the alert line and parallel to it

8. MODIFIED WHO PARTOGRAPH ( 2007) Removal of latent phase . Defined the beginning of the active phase at 4 cm cervical dilatation instead of 3 cm, The alert fine line drawn from point of cervical dilatation on admission (4 cm or more) and propagates at 1 cm per hour. The reason for introducing a modified Partogram was: Difficult diagnosis of latent phase which lead to early admission and early interventions.

9. COMPONENTS OF PARTOGRAPH Patient identification . Fetal condition . Progress of labor. Maternal condition.

10. Patient identification

11. Fetal condition Fetal heart rate . Liquor. Moulding of fetal skull bones

12. Progress of labor Cervical dilatation ( x ) . Descent of fetal head ( o ) . Uterine contractions . Fetal position .

13. Progress of labor 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.

14. Progress of labor Alert 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 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

15. Maternal condition

16. Maternal condition Oxytocin – amount per volume IV fluids in drops per minute.every 30 minute . Drugs – any additional drugs given . IV fluids - type and amount used .

17. Management of labor using the partogram One of the main functions of the partogram is to detect early deviation from normal progress of labor .

18. Management of labor using the partogram

19. Prolonged active phase

20. Prolonged 2 nd stage of labour

21. Prolonged 2 nd stage of labour

22. My great thanks