PARTOGRAM
P |
artogram is the process by which the normal and
abnormal processes of labour can be identified. Partograph is a composite data
of mother and foetus during labour against the time, laid on a single sheet of
paper.
Objectives of Partograph –
1. Early
detection of abnormal labour progress.
2. Prevention
of prolonged labour.
3. Early
recognition of maternal and foetal problems.
4. To
facilitate research.
5. To
provide basis of decision making.
Importance of Partograph – It
allows instant visual assessment of the rate of cervical dilation as compared
to normal.
All women who are undergoing labour are required to have
a record of partogram; in other words, partogram recording is required for all women
who are undergoing labour.
Here we can see the components of partogram.
The topmost part indicates the maternal details which
include name, age, date of admission, time of admission, gravida score, etc.
Below it we record foetal heart rate, character of
amniotic fluid and the moulding process.
Next is the recording of the labour process itself. It
has 2 lines; one is alert line and other is action line. Other components are
cervical dilation, uterine contractions, and foetal descent.
Next is any medications which are given and when given
and at what concentration, which is followed by the maternal vitals like Blood
pressure, Heart rate, temperature, urine output and the characteristics of
urine, etc.
The following things are written while plotting
partograph –
1. Foetal
heart rate is recorded after every 30 mins.
2. Condition
of the amniotic membranes is marked as –
a. I
= Intact
b. C
= Clear amniotic fluid
c. M
= Meconium stained.
3. Cervix
part of the partograph represents the cervical dilation and presenting part of
the foetus. This forms the essential part. First line starts at 3cm mark and
ends at 10cm mark with the rate of 1cm/hr of cervical dilation.
4. Uterine
contractions are marked by colouring the boxes. If the cross-hatching is light,
it indicates contractions of 2 weak contractions in 10 minutes. If they are
properly cross-hatched, they indicate 3 moderate contractions in 10 minutes. If
the boxes are complete Black, they indicate 5 strong contractions in 10 minutes.
It was introduced by WHO in 1954 and
since then has reduced the incidences of prolonged labour and caesarean section
rates.
The concept of Alert lines and Action
lines was introduced in 1972 by Philpott and Castle. Alert line indicates mean
rate of slowest progress of labour, whereas the action line indicates the
appropriate action which is to be taken. Normal labour is plotted to the left
of this alert line.
Normal progress of labour –
1. Latent
phase: 8 hours or less
2. Active
Phase: cervical dilation is indicative and remains in between the alert lines
and action lines or left of alert line (1cm/hr).
3. Second
stage: reasonable rotation and descent of presenting part of less than 1 hour
or less.
Abnormalities of Labour that are indicated
by the partogram –
1. Disorders
of 1st stage: No cervical dilation in 2 hours after the active stage
of labour, this is called as Arrest disorder.
2. Secondary
arrest: Defined as, when the active phase of labour starts normally but, stops
or slows significantly for 2 hours or more prior to full dilation of cervix.
3. When
no progress of descent is observed, it is called as Arrest of Descent.
Management of labour using the Partograph –
1. Moving
to the RIGHT of the alert line is indicative of transfer of the patient
to higher hospital and is a warning sign.
2. When
progress of active phase remains to the left of the alert line or latent phase
is less than 8 hours; Do not involve until complications develop; or do not
administer oxytocin if the labour progresses as normal.
3. Management
of labour at or beyond ACTION line –
a. Full
medical and obstetric evaluation.
b. IV
infusions/catheterizations/analgesics
c. Perform
C-section if foetal distress or labour is obstructed.
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