PARTOGRAM PARTOGRAM PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK RECORDING PROGRESS OF LABOUR
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