PARTOGRAM (PowerPoint)

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					PARTOGRAM
 What Is Partogram ?

Graphical recording of progression
 of labour and salient conditions of
 mother and fetus,          which
 are plotted against time, in hours.
Why was it introduced?
                            Cephalopelvic disproportion
                       Causing prolonged & obstructed labour




                                            Post partum haemorrage   Infections
  Ruptured uterus   Death of fetus




 Ultimate goal - to reduce maternal and perinatal
 mortality and morbidity.
When to start ?
 Only after you have checked
  there are no complications of the
  pregnancy that require
  immediate action.
 Must only be started when a woman is in     labour –
           1.In the latent phase
                contractions must be two or
                more in ten minutes, each
                lasting 20 seconds or more.
            2.In the active phase
               contractions must be one or
               more in ten minutes ,
               each lasting 20 seconds or
               more.
             Components

 3 components of the partogram

1. Fetal condition
2. Maternal condition
3. Progression of labour
1.Fetal Condition.
a) Fetal heart rate

b) Membranes and liquor

c) Moulding of the fetal skull
    a) Fetal Heart Rate (FHR) 
    Auscultated by Pinard’s Stethoscope
    Every 15 minutes
    Immediately after a contraction
    Listened for 1 minute
    Auscultated in the best heard place (usually over
     anterior shoulder of the fetus)
    Normal range 110-160 beats per minute (bpm)
    If FHR remains abnormal >3 occasions, necessary
     actions should be taken.
FHR-contd…
Management of fetal distress-
 Stop Oxytocin.
 Turn to left lateral.
 Pv to exclude cord prolapse & observe
  amniotic fluid.
 Adequate hydration.
 Oxygen, if available.
 b) Membranes & Liquor 
 Observations are made at each vaginal
  examination
 On marking the partogram;
  - Membranes are intact - I
  - Membranes ruptured & liquor clear - C
  - Membranes ruptured & liquor meconium
      stained - M
  - Membranes ruptured & liquor absent - A
 If the membranes are artificially ruptured it is
  mentioned in the partogram as ARM (Artificial
  Rupture of Membranes)
 If any abnormality is observed in meconium,
  necessary actions are taken
c) Moulding 
 It indicates the adequacy of the pelvis to
  accommodate the featl head
 On marking the partogram;
  - Bones separated & sutures felt easily - O
  - Bones just touching each other - +
  - Bones are overlapping - ++
  - Bones overlapping severely - +++
 Increasing moulding with head high in the pelvis is
  a sign of cephalopelvic disproportion
2.Maternal Condition
a) Pulse, blood pressure (BP) & temperature

b) Urine

c) Drugs & IV fluids

d) Oxytocin regime
, a) BP & pulse Temperature 
 Pulse 
  - Counted hourly

 Blood Pressure 
  - Measured hourly
  - If indicated, as in PIH, ½ hourly

 Temperature 
  - Measured hourly
  - If indicated ¼ hourly
b) Urine 
 Volume of urine
 Check for protein
 Check for acetone
c) Drugs & IV Fluids 

 Any drugs given to the mother
 during the process of labour should
 be mentioned in the appropriate
 column
d) Oxytocin Regime 
 Induction – 5U for primi & 2U for multi in 1
  pint of normal saline, at a rate of 15 drops
  per minutes.
3.Progression of Labour
  a) Cervical dilatation

  b) Decent of the fetal head

  c) Uterine contractions
a) Cervical Dilatation 
   Measured approximately in centimeters, using fingers
   Done during vaginal examination, every 4 hourly
   Marked against time
   Devided into 2 phases;
    1. Latent phase 
        - Duration, <8 hours
        - Upto 2cm
        - Usually not plotted in National Partogram
    2. Active phase 
        - From 3-10cm
        - Rate – 1cm/ hour
 Alert Line expected line of cervical dilatation at the
  time of first pv examination in the active phase.
 Line drawn from 3cm – 10 cm
 Represents the rate of 1cm / hour rate of dilatation
 If cervical dilatation is normal, it will remain on or to
  the left of the alert line



 Action Line 
 Line drawn 4 hours to the right of the alert line
 If the cervical dilatation reaches this line, appropriate
  actions should be taken
WHO partogram
b) Decent of the Fetal Head 
 Usually begins, when the cervix is about 7cm
    dilated
   Measured by abdominal palpation
   Always asessed immediately before doing
    vaginal examination
   Expressed in terms of fifths, above the pelvic
    brim
   When the part of the head, above the pelvic
    brim, is about 2 finger widths or less; ‘Head is
    Engaged’
c) Uterine Contractions 
 2 observations are made;
  - Frequency -
      Number of contractions per 10 minutes
  - Duration -
      From the time contractions is 1st felt
      abdominally to the time when the
      contraction passes off, measured in
      seconds
Uterine Contractions contd.



                              <20 s
                              20-40 s
                              >40 s
 Time (h) 0   ½   1   2   3