The Partograph

The Partograph

PARTOGRAPH

  • Managerial tool for the prevention of prolonged labour
  • Measuring progress of labour in relation to time. Observations charted on partograph

Definition-

  • It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
  •  It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.

Objectives of using partograph

  • Early detection of abnormal progress of labour.
  • Prevention of prolonged labour.
  • Increase the quality and regularity of all observations of mother and fetus.
  • Early recognition of maternal or fetal problems.
  • To provide a basis of decision making.
  • To facilitate research.
  • To defend one’s actions no documentation  no defense.

Advantage of using Partograph

  • A single sheet of paper can provide details of necessary information at a glance.
  • No need to record labour events repeatedly
  • It can predict deviation from duration of labour. So appropriate steps could be taken in time.
  • It facilitates handover procedure of staffs.
  • Gives clear picture of normality and abnormality in labour.
  • Save working time of staff against writing labour notes in long hand.
  • Educational value for all staff.

a. The progress of labour with time

  • Cervical dilatation
  • Descent of fetal head

Descent: abdominal palpation of fifths of head felt above the pelvic brim.

Uterine contraction

  • Frequency per 10 min
  • Duration /shown by different shading/

b. The fetal condition

  • Fetal heart rate
  • Memberanes & liquor
  • Moullding of the fetal skull

Grading-

 1.Normal- space felt between the edged of parital bone in the sagital suture.

 2.Mild - the egde of parital bone comes very closer at the sagital suture.

3. Moderate- the edge of the parital bone over lap at sagital suture but can be easly separated

 4. Severe- overlap of the bones and not separable.

 c. The maternal condition

  • Pulse, B/P temperature
  • Drug and IV fluids
  • Urine /volume, protein, acetone/
  • Oxytocin regime

The progress of labour

The 1st stage is divided in to the latent and active phases

  • Latent phase- slow period of cervical dilatation from 0-.2cms and also it is the period of gradual shortening of the cervix.
  •  Active phase-faster period of cervical dilatation from 3-10cms or full cervical diltation.

 Starting the partograph

  • A partograph chart must only be started when a woman is in labour you must be sure that she is contracting enough to start a partograph.
  •  In the latent phasec truction must be 2 or more in 10 minute each lasting 20 second or more.
  • In the active phase contractions must be 2 or more /10minutes each lasting 20 second or more. There difference is in dilatation of cervix.
  •  In the center of the partograph there is a graph. Along the left side are numbers 0-10 against squares. Each square represents 1cm dilatation. Along the bottom of the graph are numbers 0-24: each square represents 1 hour.
  • Dilatation of the cervix is measured in centmeter. The dilatation of the cenvix is plotted with an "x". The 1st V.E on admission includes a pelvic assessment & the findings are recorded. The V.E are made ever 4 hrs unless contraindicated. However in advanced labour women may be assessed more quickly, particularly the multipara.
  • Plotting cevical diatation when admission is in the active phase.When a woman is admitted in the active phase the dilatation of the cervix is plotted on the alert line and the time written directly under the X in the space for time. If progress is setisfeutory, the plotting of cervical dilatation will remain or to the left of the alert line.
  • The latent phase normally should not take longer than 8hrs. When admission is in the latent phase, diltation of the cervix is plotted at O time.

Transfer from latent to Active phase

  • Plotting cervical dilatation when admission is in the latent phase & goes in to active phase.When labour goes in to the active phase plotting must be transferred by a broken line to the alert line.
  • The recordings of cervical dilatition and time are plotted 4 hrs after admission then transferred immediately 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 labour.

Points to remember

 1. The latent phase is from 0-2cm dilatation & is accompanied by gradual shortening of cencix. It should normally not last longer than 8 hrs.

 2. The active phase is from 3-10cms & dilatation should be at the rate of at least 1cm/hr.

 3. When labour progresses well, the dilatation should not move to the rt of the alert line.

4. When admission to hospital takes place in the active phase the cervical dilatation is immediately plotted in the alert line

5. When labour goes from latent to active phase plotting of the dilatation is immediately transferred from the latent phase to the alert line.

Key points on plotting the partograph

 Memberane-

  • I - Intact
  • R-Ruptured
  • A.R.M - Artificial Rupture of memberane

 Colour of liquer:

  • M- Meconium stained
  • C-clear
  • A – Absent

 Moullding - degree of overlap

  • Normal separation /can feel sutures/ -
  •  Bones meeting +
  • Over lapping can be pushed back ++
  • Over lapping can't be separated +++

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