Partogram

PARTOGRAMPARTOGRAM

PROF DR MN MOHD AZHARROYAL COLLEGE OF MEDICINE PERAK

RECORDING PROGRESS OF LABOUR

WHY IS IT IMPORTANT TO RECORD THE WHY IS IT IMPORTANT TO RECORD THE PROGRESS OF LABOURPROGRESS OF LABOUR

To provide continuity of care. To provide a basis of decision making. To facilitate research. To allow audit and review. To defend one’s actions – no documentation – no

defense.

Documentation is important

TOOL FOR RECORDING THE TOOL FOR RECORDING THE PROGRESS OF LABOURPROGRESS OF LABOUR

PARTOGRAMPARTOGRAM

PARTOGRAMPARTOGRAM

PARTOGRAM is a graphical information about the progress of labour in which the salient information about the fetal well-being, maternal well-being and the progress of labour are recorded into a chart.

PARTOGRAMPARTOGRAM

Is a managerial tool used to record all observations made on a woman and fetus in labour in one chart.

Partogram helps to identify at an early stage those women whose labour is slow.

A managerial tool for prevention of prolonged labour.

IT’S SIGNIFICANT:

PARTOGRAMPARTOGRAM

For all women who are in labour (i.e. either low or high risk group).

WHO REQUIRE PARTOGRAM RECORDING

PARTOGRAMPARTOGRAM

Friedman's partogram - 1954

2 phases of labour (base on dilatationof the cervix )

Latent phase (dilatation < 3 cm) Active phase (>3 cm dilated)

Latent phase

Active phase

Philpott and Castle - 1972

Introduced the concept of “ALERT”and “ACTION” lines.

ALERT LINE – represent the mean rateof slowest progress of labour

ACTION LINE – appropriate action shouldbe taken.

Normal labour is plotted to the left alert line

PARTOGRAMPARTOGRAM

Mother information

Fetal well-being • Fetal heart rate• Character of liquor• Moulding

Labour progress • Dilatation• Descent• Uterine contraction

Medications• Oxytocin• Pain relief (e.g. pethidine)

Maternal well-being • BP, Pulse, Temperature• Urine – albumin, glucose, acetone• Urine output

PARTOGRAMPARTOGRAM

WHAT NEED TO BE WHAT NEED TO BE RECORDEDRECORDED

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Begin plotting at the “zero” hour on the partogram

Enter the outcomeof delivery

11

22All entries made in relation to time when the observations are made

33Notes should be legible, dated and timed.

44

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Mother information

Name Age Parity Gestational period Date/time of admission Time of rupture membrane Short antenatal history

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Fetal information

Fetal heart rate

Membrane and amniotic fluid Moulding

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Fetal information

Fetal heart rate monitoring 1. Safe and reliable way of knowing

fetus is well.

2. Listen after each contraction for one minutes.

3. Recorded ½ hourly (each square is ½ hour)

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Fetal information

Character of amniotic fluid 1. State of liquor can assess in

monitoring fetal condition.

2. Observation to be recorded

- Membrane intact record as “I”- Membrane rupture: a) liquor clear record as “C” b) meconiun stained liquor “M” c) liquor absent record as “A”

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Fetal information

Moulding of fetal skull 1. Provide information about the

adequacy of pelvis to accommodate fetal head

2. Record the degree of moulding

0 bones separated+ bones touching but can

be separated.++ bone over lapping+++ bones over lapping

severely

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Labour Progress

Cervical dilatation Descent Uterine contraction

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Labour progress

Dilatation and Descent 1. Latent (0-3 cm) and Active (3-10

cm) phase.

2. Dilatation of cervix plotted as “X” axis and Descent plotted as “O” axis.

3. First vaginal examination done on admission is recorded.

4. Subsequent vaginal examination is done every 2-4 hourly.

5. Transfer from latent to active phase.

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Latent phase

Labour progress recording in latent phase

At admission:- Dilatation 2 cm- Descent -2

2 hours after admission:- Dilatation 2 cm- Descent -1

Plot dilatation as “X”Plot descent as “O”

+ +

As the dilatation is only 2 cm thereforethe labour progress is in the latentphase

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Latent phase

Labour progress recording in active phase

Plot dilatation as “X”Plot descent as “O”

+

0 hours

(admission)

2 hours 4 hours

Dilatation

“O” 2 cm 4 cm 7 cm

Descent

“X” -2 -1 +1

+

++ Latent phase

Active phase

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Latent phase

Cervical dilatation

++

++ If labour progress well plotting of

cervical dilatation should always remain to the left of alert line.

If it cross to right of action line this warns that labour may be prolonged.

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Labour progress

Uterine Contractions 1. Observation is made ½ hourly2. Assess the frequency, duration.3. Each square represent 1

contraction felt in 10 minutes.4. Frequency – highlight the

numbers of square.5. Duration – shade the contraction

in the square.

< 20 sec - Mild

20-40 sec- Moderate

> 45 sec - Strong

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Labour progress

Recording the uterine on thepartogram

5 strong contractionsin 10 minutes

2 weak contractionsin 10 minutes

3 moderate contractionsin 10 minutes

Nos. ofContractionin 10 mins

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Mother condition

Vital signs – BP, Pulse, TºC Urine analysis – acetone, albumin, glucose Urine volume Medications or drug given

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Mother condition

Vital signs recording

BP – 4 hourly or more frequent if indicated Pulse - ½ hourly

TºC – 4 hourly

Urine analysis – dipstickacetone Nil or +

albumin Nil or +glucose Nil or +

Urine volume

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Latent phase

Analyzing the progress of labour from the partogram

++

++

+ If progress is satisfactory the plotting will remain on or to the left of the alert line.

If labour is not progressing normally the plotting will be to the right of the alert line.

Active phase

PARTOGRAM RECORDINGPARTOGRAM RECORDING

Latent phase

LABOUR PATTERNS

Normal labour

Prolonged latent phase

Primary dysfunctional

labour

Secondary arrest

Active phase

THANK YOUTHANK YOU

PROF DR MN MOHD AZHARROYAL COLLEGE OF MEDICINE PERAK

RECORDING PROGRESS OF LABOUR - PARTOGRAM