Welcome to the 11th PLGPMI National
General Assembly
MIDWIVES Embracing Development,
Coping with Change Manila Hotel
GOOD MORNING
PARTOGRAPHMade Easy
LOURDES BORJA MAGBANUA,
RM, RN, RT, MAN, Ph.D
Partograph Made Easy
Source : Basic Emergency Obstetric Care
Dr. Jose Fabella Memorial Hospital, & WHO
I. The Partograph
►A tool to help in management of labor
►Guides birth attendant to identify women whose labor is delayed and therefore decide appropriate action
OBJECTIVES
I. To understand the concept of the WHO partograph
To explain to mothers the significance of the graph
II. To record the observations accurately on the graph
III. To interpret the recorded findings, recognize deviation from the norm, and decide on timely referral
Monitor during labor…
► Progress of labor Cervical dilatation Contraction pattern
► Maternal well being Pulse, temperature, blood
pressure Urine voided
► Fetal well being Fetal heart rate and pattern Color of amniotic fluid
The parts of the partograph
Progress of labor
Maternal and fetal well-being
Alert line
DILATATION
Alert line Action line
DILATATION
Parallel and 4 hours to the right of alert line
Conditions that does not need
the use of partograph
►Antepartum hemorrhage
►Severe pre-eclampsia and eclampsia
►Fetal distress►Previous cesarean
section
►Multiple pregnancy
►Malpresentation►Very premature
baby►Obvious
obstructed labor
II. Recording the findings in the partograph
►Start by labeling the record with pertinent patient identifying information.
Plotting the progress of labor
►Plot only the CERVICAL DILATATION using the symbol “X”
►Start when woman is in ACTIVE LABOR (4 cm or more) and is contracting adequately (3-4 contractions in 10 minutes)
X
Start plotting on alert line in the intersection corresponding cervical dilatation finding
X
X
X4pm
Indicate the time the IE was made (and therefore, the observation was plotted) Write this in the vertical line itself
where you plot the “X”, NOT the space after it
X
X
X
4pm 8pm 10pm
Perform internal examination every 4 hours, or more often if necessary, and plot findings each time Also, do not forget to write the time
each observation was made
X
X
X
4pm 8pm 10pm
Connect the “X”s to demonstrate the pattern of labor
1am
EXAMPLE
A G1P0 is being monitored by a midwife at home. Her initial IE at 1 am showed 4 cm
dilated cervix.
x
1am 5am
x
x
EXAMPLE
At 5 am, another IE showed 8 cm dilated cervix.
1am 5am
x
x
EXAMPLE
At 7 am, the patient is 9 cm dilated, station -1, intact BOW.
7am
x
III. Distinguishing normal from abnormal labor
pattern
X
X
X
4pm 6pm 8pm 10pm
Progress of labor is normal if plotting stays on or to the left of the alert line (green part)
X
X
X
X
X
4pm 6pm 8pm 10pm
Note that based on the structure of the partograph as soon as 4 cm is reached the cervix should dilate normally at a rate of ≥ 1 cm/hour.
X
X
4pm 6pm 8pm 10pm
Plotting that passes the alert line (yellow part) more so if it reaches or passes the action line (red part) indicates abnormal progress of labor
X
12am 2am
If plotting passes alert line …
►Reassess woman and consider referral if facilities are not available to deal with obstetric emergencies, unless delivery is imminent
►Alert transport services►Monitor intensively
What to do if partograph passes alert line ► Reassess woman and consider criteria for
referral. ► Alert transport services. ► Empty bladder. ► Ensure adequate hydration but omit solid
foods. ► Encourage upright position and walking if
woman wishes. ► Monitor intensively. If referral long,
reassess in 2 hours and refer if no progress.
If partograph passes action line, refer urgently to an EmOC facility unless imminent delivery.
If plotting reaches the action line…
the patient must be already in an EmOC facility, a decision made about the cause of slow progress, and appropriate action taken
The parts of the partograph
Progress of labor
Maternal and fetal well-being
IV. Other findings to note (and record) during IE
►Status of membranes, write “ I ” if intact
►If ruptured, note color of amniotic fluid, write “ C ” if clear “ M ” if meconium stained “ A ” if absent “ B ” if bloody
Monitor every 4 hours*and record the findings
►Blood Pressure►Pulse rate►Temperature►Urine voided (yes or no)
* More frequently, if indicated
Monitor more frequentlyand record the findings
►Number of contractions in 10 minute period
►Fetal heart rate in 1 full minute
If woman is admitted in LATENT PHASE of labor (less than 4 cm dilated) – record only other findings (BP, FHT etc).
If she remains in latent phase for next 8 hours (labor is prolonged), transfer her to hospital.
EXERCISES
►Indicate whether the progress of labor in the following partographs are normal or abnormal.
x
2am
x
10pm
Case 1
X
X8pm 12mn 2am
X
4am
X
Case 2
x
X
X
9pm 1am 3am
Case 3
EXERCISES
►Plot the observations in the following cases.
Case 4:A G2P1 was admitted at 2 am, IE
showed a 4cm dilated cervix. The patient was still smiling and she was hesitant to be admitted.
At 6 am, another IE was done … 8 cm dilated cervix, 80% effaced, station 0.
At 8 am, fetal head was bulging at the perineum.
X2am 6am
X
X
8am
Answer to case 4
Case 5: A G4P2 was referred at 5 pm. The
midwife said that the patient is at 4 cm cervical dilatation. At 9 pm, your IE showed 6 cm dilated cervix. At 1 am, another IE done showed 8 cm dilated cervix, 50% effaced, station -1, intact BOW.
X5pm
9pm
X
1am
X
Answer to case 5
RECAP►Significance and use of the partograph►Parts of the partograph and
information contained in it►Recording or plotting of clinical
observations►Interpretation of the recorded findings
and decision on referral
Remember this my dear MidwivesA job title alone does not make a person a leader.
Only a person’s behavior determines if he or she occupies a leadership position.
Fellow Midwives, Colleagues Good day &
Congratulations !!!