USING PARTOGRAPH.ppt student 2023 slidevvvvvvvvvvvccc

Medical

1. MANAGING LABOR USING THE PARTOGRAPH

2. Using the Partograph 2
The Partograph
Assessment of fetal well being
Assessment of maternal well being
Assessment of progress of labor

3. Using the Partograph 3
1. Measuring Fetal Well Being During Labor
Fetal heart rates and pattern
Degree of molding, caput
Color of amniotic fluid

4. Using the Partograph 4
2. Measuring Maternal Well Being
During Labor
Pulse, temperature, blood pressure,
respiration
Urine output, ketones, protein

5. Using the Partograph 5
3. Measuring Progress of Labor
Cervical dilatation
Descent of presenting part
Contractions
–Duration
–Frequency
Alert and action lines

6. Using the Partograph 6
Using the Partograph
Patient information: Name, gravida, Para, hospital
number, date and time of admission, and time of
ruptured membranes
Fetal heart rate: Record every half hour
Amniotic fluid: Record the color at every vaginal
examination:
I: membranes intact
C: membranes ruptured, clear fluid
M: meconium-stained fluid
B: blood-stained fluid

7. Using the Partograph 7
Using the Partograph (continued)
Molding:
1: sutures apposed
2: sutures overlapped but reducible
3: sutures overlapped and not reducible
Cervical dilatation: Assess at every vaginal examination, mark
with cross (X)
Alert line: Line starts at 4 cm of cervical dilatation to the point of
expected full dilatation at the rate of 1 cm per hour
Action line: Parallel and 4 hours to the right of the alert line

8. Using the Partograph 8
Using the Partograph (continued)
Descent assessed by abdominal palpation: Part of head
(divided into 5 parts) palpable above the symphysis
pubis; recorded as a circle (O) at every vaginal
examination. At 0/5, the sinciput (S) is at the level of the
symphysis pubis

9. Using the Partograph 9
Using the Partograph (continued)
Hours: Time elapsed since onset of active phase of labor (observed
or extrapolated)
Time: Record actual time
Contractions: Chart every half hour; palpate the number of
contractions in 10 minutes and their duration in seconds
Less than 20 seconds:
Between 20 and 40 seconds:

More than 40 seconds:
Oxytocin: Record amount per volume IV fluids in drops/min.
every 30 min. when used
Drugs given: Record any additional drugs given

10. Using the Partograph 10
Using the Partograph (continued)
Temperature: Record every 2 hours
Pulse: Record every 30 minutes and mark with a dot (•)
Blood pressure: Record every 4 hours and mark with
arrows
Protein, acetone and volume: Record every time urine
is passed

11. Using the Partograph 11
The Modified WHO
Partograph
(Figure C-10)

12. Using the Partograph 12
Sample Partograph for
Normal Labor
(Figure C-11)

13. Using the Partograph 13
Partograph Showing
Prolonged Active Phase of
Labor (Figure S-6)

14. Using the Partograph 14
Partograph Showing
Obstructed Labor
(Figure S-7)

15. Using the Partograph 15
Partograph Showing
Inadequate Uterine
Contractions Corrected with
Oxytocin
(Figure S-8)

16. Use of a Partograph
Case Studies

17. Case 1
●Mrs Njoroge was admitted at 5am on
25/09/2009
●The membranes had ruptured at 4am
●Gravida 3, Para 2+0 ,Hospital no. 7886
●On admission foetal head was 4/5 palpable
above the pelvic brim
●The cervix was 2cm dilated
What should be recorded on the partograph ?

18. Step 2 : 9am
●Fetal head is 3/5 palpable above the
pelvic brim
●Cervix is 5cm dilated
●There are 3 contractions in 10 min each
lasting 20-40 s
●Fetal Heart rate is 120 bpm
●Amniotic fluid is clear
●Skull bones separated sutures easily felt
●Maternal BP 120/70 mmhg,Temp 36.8C
●Pulse 80 bpm
●Urine output 200mls -ve protein or
acetone

19. questions
●What steps should you take ?
●What advice should be given ?
●What do you expect to find at 1.00pm ?
Plot the information on the partograph

20. Step 3
09.30 am : FHR 120 bpm,cont 3/10 each lasting 30s ,
pulse 80 bpm
10.00 am : FHR 136bpm,cont 3/10 each 30s,Pulse
80bpm
10.30 am : FHR 140 bpm,Cont 3/10 each lasting 35s ,
Pulse 88bpm
11.00 am : FHR 130bpm,cont 3/10 each lasting 40 s,
Pulse 88bpm,Temp 37 C
11.30 am : FHR 136 bpm, Cont 4/10 each lasting
40 s,pulse 84bpm
12.00 FHR 140 bpm,cont 4/10 each 40s,pulse 88 bpm
12.30 pm : FHR 130 bpm, cont 4/10 each lasting 40s
pulse 88 bpm
13.00 pm : FHR 140bpm , cont 4/10 , each lasting 45s ,
Pulse 88 bpm

21. Vaginal exam 13.00pm
foetal head 0/5 palpable above the pelvic
brim
The cervix is fully dilated
Amniotic fluid is clear
Skull bones separated , sutures easily felt
BP 100/70 mmHg
Urine output 150 mls –ve for protein and
acetone

22. Questions
Plot the findings on the partograph and
answer the following :-
1.What steps should you take ?
2.What advice should be given ?
3.What do you expect to happen next ?

23. Step 4
At 13.20 pm spontaneous vaginal delivery to a
Live Female Infant weighing 2.85kg.
Questions
1. How long was the Active phase of the first
stage of labour ?
2. How long was the active phase of Labour ?
3. How long was the second stage of labour ?

24. Case study 2
Mrs Ibrahim was admitted on 25/09/09 at
10.00am.On nursing assessment the
following information was obtained :-
Membranes intact,Gravida 1,para 0+0
Hospital No. 1443
Foetal head 5/5 palpable above pelvic
brim
Cervix 4 cm dilated
2 contractions in 10 min each lasting 20s
Foetal heart rate 140 bpm
Blood pressure 100/770 mmhg
Temperature 36.2 c, Pulse 80 bpm
Urine output 400mls,-ve protein ,acetone

25. Questions
1.What is your diagnosis ?
2. What action will you take ?

26. Step 2
10.30 am : FHR 140bpm,cont 2/10
lasting 15s,Pulse 90 bpm
11.00 am : FHR 136bpm,cont 2/10
lasting 15s,pulse 88,membranes intact
11.30 am : FHR 140bpm,cont 2/10 each
lasting 20s Pulse 84bpm
12.00 Md : FHR 236bpm,cont 2/10 each
lasting 15s,pulse 88bpm,T-36.2 C
VE done.Foetal head 5/5 above pelvic
brim,cervix 4cm dilated, membranes
intact.

27. Step 3
12.30 pm : FHR 136 bpm cont 1/10
lasting 15s Pulse 90bpm
13.00 hrs: FHR 140bpm cont 1/10
lasting 15s pulse 88bpm
13.30 hrs : FHR 130bpm cont 1/10
lasting 20s ,Pulse 88bpm
14.00 hrs : FHR 140bpm cont 2/10
lasting 20s,Pulse 90 bpm,Bp
100/70mmHg
Foetal head 5/5 above pelvic brim .VE
done at 14.00 hrs ; membranes intact
cervix 4cm dilated .Urine 400mls neg for
protein or acetone.

28. Questions
Q1.What is your diagnosis ?
Q2.What action should you take now ?

29. Nursing Diagnosis
Prolonged labour related to ineffective
uterine contractions.
Actions
A1.Artificial rupture of membrane-
amniotic fluid clear
Cervix 4cm dilated,skull bones separated
A2. Augmented with I.V oxytocin 2.5 units
in 500mls 5 % dextrose to flow at
10dpm

30. Step 4
14.30 hrs
2 contractions in 10 min each lasting 30s
Oxytocin infusion rate increased to 30 dpm
FHR 140 bpm, pulse 88 bpm,Bp 120/80
mmHg
15.00 hrs
3 contractions in 10 mins lasting 30s
Oxytocin infusion rate increased to 30dpm
FHR 140bpm,pulse 90 bpm

31. 15.30 hrs
3 contractions on 10 min lasting 30s
Oxytocin infusion rate increased to 40dpm
FHR 140 bpm , Pulse 88bpm
16.00hrs : VE
Descent 2/5 above the pelvic brim
Cervix 6cm dilated
3 contractions in 10 min each lasting 30s
Oxytocin infusion rate increased to 50 dpm