WHO partograph

Modified WHO Partograph

1. WHO PARTOGRAPH Presented by Miss. Santosh M.Sc.1 st Year

2. PARTOGRAPH First introduced by E.A Friedman from New York in 1955 It is the graphic analysis of labour for clinical evaluation of the progress of labour. It plots the dilatation of cervix in centimeters against time in hour.

3. Partograph was further modified by Philpott and Castle in 1972. They added the alert line and action line. They also plotted the descent of head. They emphasized its clinical application.

4. Modified Begins in the active phase. Cervix dilated 4 cm.

5. PARTOGRAPH

6. MOTHER INFORMATION

7. FETAL INFORMATION

8. Each vertical side of the rectangle represents 10 beats per minutes. Each horizontal side of the rectangle represents 30 minutes.

9. Expectite delivery if fetal heart rate is below 100 or above 180bpm. Below 100bpm severe bradycardia and above 180bpm its severe tachycardia.

10. AMNIOTIC FLUID Record color at every vaginal examination. If thick meconium and absent of fluid at the time of rupture membrane. Note frequent fetal heart rate May be sign of fetal distress.

11. I – Intact membrane. R – Ruptured membrane. C – Clear fluid and membrane ruptured. M – Meconium- stained fluid. B – Blood stained fluid.

12. MOULDING Moulding is an important indicator of how adequately the pelvis can accommodate the fetal head. Moulding noted every 4 hourly. Note and record moulding in each pelvic examination. Palpate the suture and bones of fetal skull to determine the degree of moulding.

13. There are four ways to note the moulding If the bones are separated and sutures are felt easily, record as “ 0”. If the bones are just touching each other record as “+1”. If the bones are overlapping record as “+2”. If the bones overlapping severely record as “+3”.

14. LABOUR PROGRESS

15. Cervical Dilatation Each vertical side of the rectangle shows 1 cm of dilation. Each horizontal side of the rectangle (small) shows 30 minutes. Alone the bottom of the graphs the square shows the number of hours. Each square represent 1 hours.

16. Cervical dilation noted as per 4 hourly. Each square represent 1 hour. Two diagonal lines Alert line. Action line.

17. ALERT LINE Represents the rates of cervical dilatation 1cm per hour. Considered to be the lowest level of the norm for both nuliparae and multipare. Labor progress normally the rate of the dilation on the alert line or to the left of the alert line.

18. Cervical dilation to the right of the alert line is shows the slow progress of labour. Appropriate action should be taken. E.g. Amniotomy.

19. ACTION LINE If the cervical dilation reaches or cross the action line it means very slow progress of labour.

20. The value of dilation at admission should be immediately plotted on the alert line. It is plotted by (X). During each next vaginal examination plot the value on the graph and connect all the finding with a solid line.

21. HEAD DESCENT Descent should not takes place when the cervical dilation should not reach to 7cm. To plot the fetal head descent use the space from 5 to 0 in the same area where you record cervical dilatation.

22. Each vertical side of the rectangle, one fifth of the head above the pelvic brim. For convenience, the width of the finger is used as a practical guide. Each horizontal side of the rectangle shows 30 minute

23. Pelvic brim will accommodate the full width of 5 fingers should record the head position on the partograph with “0”. The head is engaged when the position above the brim is represented by 2 fingers or less.

24. Plot the values of the fetal head descent (0 sign) are plotted at the same vertical lines as the values of the cervical dilatation (x sign). The descent should be taken at the same time of vaginal examination or cervical dilatation.

25. e.g. At admission (10pm) Cervical dilation is 5 cm Head descent is 5/5 cm. At 2 am Cervical dilation is 9 cm. Head descent is 2/5 palpable.

26. 2:00

27. UTERINE CONTRACTION

28. Oxytocin When inadequate uterine activity is detected the use of oxytocin should be considered. Always check the membrane are ruptured before oxytocin infusion is used in labour.

29. Note the unit of oxytocin per litter in upper row. Note the number of drops per minutes in lower row. Note every half hour the oxytocin infusion

30. DRUG Sometimes there is need to administer drugs and intravenous fluid. Record the name of drug, dosage and the route of administration, just below the column of the oxytocin recorded.

31. MOTHER CONDITION

32. PULSE Record every 30 minute and mark with a dot (.)

33. BLOOD PRESSURE Record every 4 hourly and mark with arrow

34. TEMPRATURE Record every 2 hours. .

35. PROTEIN, ACETONE AND VOLUME Record when urine passed

36. EXAMPLE Astha admitted in active labor at 10:00 PM. Gradiva 1, Para 0. FHR- 130bpm Fetal descent - 5/5 palpable. Cervix dilatation- 5cm. 3 contraction in 10 minute each lasting for 30 seconds. Intact membrane. Bones are seperated and suture are felt easily. Pulse-70bpm. B.P. – 120/80mm/hg Temperature- 36.8c.

37. At 12:00 am FHR- 140bpm Fetal descent- 4/5 palpable. 4 contraction in 10 minute each lasting for 30 seconds. Pulse-80bpm. Temperature- 36.8c

38. AT 2:00 AM FHR- 140 Fetal head 2/5 palpable. Cervical dilatation- 9cm 4 contraction in 10 minutes, each lasting more than 40 seconds Membrane intact The bones still separated and sutures can be felt easily. Spontaneous vaginal delivery at 2:25 AM.

39. 2:00

40. SCENERIO At 9 AM (admitted) FHR- 130bpm. Amniotic fluid clear. Skull bones are just touching each other. Fetal head 3/5 palpable. Cervix dilated 5 cm. Four contractions in 10 minutes, each lasting 35 seconds. B.P of mother is 120/80 mm//hg. Pulse is 80bpm. Temperature of mother is 36.8°c. Volume of urine is 200ml.

41. At 11 AM Fetal head 2/5 palpable. Four contractions in 10 minutes each lasting 45 seconds.

42. At 1 AM FHR- 140bpm. Amniotic fluid clear. Sutures are overlapped and not seperated easily. Fetal head 0/5 palpable. Cervical dilation progressed at rate of more than 1 cm per hour and cervix fully dilated. Five contraction in 10 minutes each lasting 45 seconds. B.P. of mother is 120/80 mm/hg. Pulse is 90bpm. Spontaneous vaginal delivery at 1:20 PM.