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Uploaded byBASAVARAJ HUKKERI
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PARTOGRAPH FOR BEGINEERS

The partograph is a monitoring and decision-making tool used to monitor labor and identify complications early. It provides a single sheet that graphically records the progress of labor, as well as the maternal and fetal conditions, allowing providers to monitor labor at a glance. Key information recorded on the partograph includes cervical dilation, fetal heart rate, uterine contractions, maternal vital signs, and status of the amniotic sac. Crossing of delineated alert or action lines indicates abnormal labor requiring potential interventions or referral.

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Partograph
Partograph • Is a monitoring and decision making tool for service providers to monitor active labour • Graphic recording of the progress of labor and assessment of maternal and fetal well being • All labor record is on a single sheet of paper and gives a picture of the progress of labour maternal and foetal condition at a glance • Tool to monitor labour and identify complications early, decide to manage them or make timely referrals 2
PartographContd… Partogram tells us three things:- 1 How well is the labour progressing 2 How is mother coping with labour stress 3 How is baby coping with labour stress
PartographContd…  It is the graph of the progress of labour  Progress of labour is measured by:- 1. Contractions–duration and frequency in 10 minutes 2. Dilatation of the cervix every 4 hours
Filling a Partograph Identification data • Name • Age • Parity • Registration number • Date and time of admission • Time of rupture of membranes Partograph 5
Partograph-CervicalDilatation • ‘x’ axis is time in hours • ‘y’ axis is dilatation of cervix in cms • Two important lines in the cervical dilatation section • Alert line from 4 cms at ‘0’ hours to 10 cms after 6 hours or earlier • Action line from 4 cms at 4 hours to 10 cm at 10 hours or end of labour and delivery • Long vertical lines indicate for hour and each small square indicates half an hour
Partograph-Cervical Dilatation Progress of Labor • Begin plotting when active labour starts at 4 cms cervical dilatation or more • Plot the initial findings on the alert line • Note the time • Repeat P/V after 4 hours and plot the cervical dilatation 7
Partograph-CervicalDilatationNormal Progress • Put ‘X’ on the alert line at the level of meeting point with the line of cervical dilatation • When cervical dilatation is at the rate of 1 cm per hour or more, it is normal progress of labour and the plotting will be on the alert line or to its left if rapid dilatation. • Alert line runs at the rate 1 cm per hour
Partograph-CervicalDilatation ProgressInterpretation • If the ‘X’ goes to the left of alert line = progress is faster than 1cm/hour • If the ‘X’ goes to the right of the alert line = progress is slower than 1 cm per hour-refer • The woman should reach the FRU within 2 hours before her cervical dilatation reaches the action line • If the ‘X’ reaches the action line which is 4 hours to the right of alert line–deliver mother now
Slow Progress-Why and What To Do • Intact membranes and head < 3/5 palpable per abdomen, perform ARM • Intact membranes and head > 3/5 palpable in PHC, refer to higher facility • Clear liquor draining, but poor contractions, oxytocin infusion at higher facility
Plotting Contractions Chart the contractions every half an hour • Number of contractions in 10 mins • Duration in seconds. • Less than 20 seconds • Between 20 and 40 seconds • More than 40 seconds 11
Plotting Maternal Condition • Graphs of maternal condition • Record maternal pulse every half hour and mark with a dot ‘•’ • Record maternal BP every 4 hours using a vertical arrow, with upper end signifying systolic BP and lower end diastolic BP • Record the temperature every 4 hours and note on temperature graph in digits as degree C. 12
Plotting Foetal Condition • Count fetal heart rate every half hour for one full minute after a contraction • Plot on the meeting point of the vertical line of time and horizontal line of FHR with a ‘•’. Join the dots of new reading with the previous one • Normal heart rate 120 to 160/min • Two dark horizontal lines in the FHR section indicate the range of normal FHR. Fetal distress: FHR <120/min or >160/min-Arrange for referral 13
Partograph-RecordingStatus of Membranes Record status of membranes and amniotic fluid • Membranes intact-mark ‘I’ • Membranes ruptured-note date and time of rupture in the identification data section • Clear liquor-mark ‘C’ • Meconium stained liquor-mark ‘M’ • Blood stained liquor-mark B • Colour tell condition of foetus 14
Partograph Interpretation and Indications for Referral to FRU • FHR is <120 or > 160 beats/min • Meconium and/or blood stained amniotic fluid • When cervical dilatation plotting crosses the alert line and moves towards the right side of the alert line • Contractions not increasing in duration, intensity and frequency • Pulse rapid > 110/min or BP >140/90 mmHg or temp > 380C 15
Radha Gangaram 26 Years G3P2L2A0 XYZ1 11/06/09,5:00Hrs 11/06/09, 04:00 Hrs C C C C C C C 9 AM 1 PM 12 AM 11 AM 10 AM 36.8 C 37 C C
Thank you Skills lab – Day - 1