PARTOGRAM

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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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