partogram

• Partogram / Partograph


  A single graphic record designed to assess fetal condition, maternal condition and progress of labor at first stage to prevent prolonged labor. A diagrammatic representation of the labor events.

  
• Active phase of labor

  • Commences at 3 cm cervical dilatation
• Latent phase of labor

  • Should last no longer than 8 hours
• Active labor


  • Rate of cervical dilatation should not be lesser that 1 cm/hour
• Vaginal examination


  • Recommended every 4 hours at the latent phase and every one hour at the active phase of labor
• Components of the Partograph

  • Part I: Fetal Condition (at the top)
  • Part II: Progress of Labor (at the middle)
  • Part III: Maternal Condition (at the bottom)

  
• Procedure for using the Partograph

  1. Prepare the equipment

  2. Explain the procedure and way of assessment to the woman to reassure her

  3. Wash hands

  4. Record the mother's admission data (Name, age, date, time of admission, Gravida, parity, condition of membranes)

  5. Time: It is recorded at an interval of one hour. Zero time for spontaneous labour is time of admission in the labour ward and for induced labour is time of induction
• Fetal heart rate


  • Recorded at an interval of thirty minutes
  • Basal fetal heart rate = (120-160 b/m)
  • >160 beats/min = tachycardia
  • <120 beats/min = bradycardia
  • <100 beats/min = severe bradycardia
• State of membranes and color of 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
• Moulding of the fetal skull bones

  • '0' Separated bones. sutures felt easily.
  • (+) Bones are just touching each other.
  • (++) Bones are overlapping and with contraction separated.
  • (+++) Bones are overlapping and with contraction not separated.
• Cervical dilatation


  • Begins plotting when cervical dilatation 4 cm or more
  • Check cervical dilatation every 4 hours in latent phase, the vertical line is numbered 0-10 and represents cervical dilatation in centimeters
  • Plot cervical dilatation with symbol 'x'
• Latent phase


  • It starts from onset of labor until the cervix reaches 3 cm dilatation, once 3 cm dilatation is reached, labor enters the active phase
  • It lasts 8 hours or less
  • Contractions lasting < 20 seconds
  • Contractions at least 2/10 min
• Active phase

  • It starts from the cervix 3 cm dilatation until the cervix reaches to the full dilatation 10 cm
  • The cervix should dilate at a rate of 1 cm / hour or faster
  • It lasts 4 hours or less
  • Contractions lasting > 40 seconds
  • Contractions at least 3 / 10 min
• Alert line


  • A straight line drawn from (4-10 cm)
  • If the progress is satisfactory, the plotting of cervical dilatation will remain on or to the left of the alert line
• Action line


  Drawn 4 hours to the right of the alert line, if a woman's labor reaches this line, appropriate action should be taken
• Descent of the fetal head

  • Plot head descent with symbol 'O'
  • Assessed on vaginal palpation
  • Recorded every 4 hours
  • Assessed by abdominal examination immediately before doing a vaginal examination, using the rule of fifth to assess engagement
• Uterine contractions


  • Phases: Increment (Building up the contraction), Acme (the peak of the contraction), Decrement (letting up the contraction)
  • Frequency: Number of contractions in a 10 minutes period
  • Duration: Length of time a contraction lasts, measured in seconds
  • Interval: Period of time between the end of one contraction to the beginning of the next contraction
  • Intensity: Strength of the uterine contraction (mild, moderate, severe)
• Maternal Condition monitoring


  • Drugs, IV fluids, and oxytocin, if labor is augmented
  • Pulse, Blood pressure and Temperature
  • Urine volume, analysis for protein and acetone
• Oxytocin


  • Concentration is noted down in upper box; while dose is noted in lower box
  • Calculate the number of units in 500 ml Dextrose or other IV fluid
  • Adjust the rate of infusion per minute
• Maternal vital signs


  • Pulse: record every 30 minutes
  • Blood pressure: record every 4 hours
  • Temperature: record every 4 hours
• If FHR of the fetus increased or decreased (there is fetal distress and need action or need cesarean section C.S)
• If there is excessive molding (these indicate Cephalo pelvic disproportion CPD and may lead to fetal distress and need C.S)
• If the membrane ruptured and meconium present (there is fetal distress need monitoring FHS and need action C.S)
• If there is slow cervical dilatation progress ( indicate prolonged labor) or cervical dilatation stopped (identify the cause and manage it)
• If the head high & there I no head descend (CPD and need C.S)
• If there is weak contraction (indicate the need for oxytocin with monitoring FHS)
• If there is increase or decrease ( T,P,BP) it indicate maternal distress and need management
• If the urine had protein with increase BP (this case may have preeclampsia and need management and monitoring)
• Gravida 5, para 4 mother

  Has had 5 pregnancies of which 1 has not resulted in a live birth
• Gestational age of 40 weeks and 4 days


  Term (or full term)
• Cervix dilated to 5 cm, fetal head at -3 station


  Active phase of first stage labour, fetal head not yet engaged
• Fetal heart rate of 144 beats/min
• Bekelech's labour is in the active phase and her cervix has dilated to more than 4 cm
• Bekelech is a multigravida/multipara mother
• Bekelech's labor


  In the active phase, cervix dilated to more than 4 cm, experiencing stronger and more frequent contractions.
• Melkas' labor


  Progressing, but specific information about how far along she is in the labor process is not provided.