13 partogram

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

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

PARTOGRAM 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.

PARTOGRAM 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:

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

PARTOGRAM Friedman's partogram - 1954 2 phases of labour (base on dilatation of 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 rate of slowest progress of labour ACTION LINE – appropriate action should be taken. Normal labour is plotted to the left alert line

PARTOGRAM 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

PARTOGRAM WHAT NEED TO BE RECORDED

PARTOGRAM RECORDING Begin plotting at the “zero” hour on the partogram Enter the outcome of delivery 1 2 All entries made in relation to time when the observations are made 3 Notes should be legible, dated and timed. 4

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

PARTOGRAM RECORDING Fetal information Fetal heart rate Membrane and amniotic fluid Moulding

PARTOGRAM RECORDING Fetal information Fetal heart rate monitoring Safe and reliable way of knowing fetus is well. Listen after each contraction for one minutes. Recorded ½ hourly (each square is ½ hour)

PARTOGRAM RECORDING Fetal information Character of amniotic fluid State of liquor can assess in monitoring fetal condition. 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 RECORDING Fetal information Moulding of fetal skull Provide information about the adequacy of pelvis to accommodate fetal head Record the degree of moulding 0  bones separated +  bones touching but can be separated. ++  bone over lapping +++  bones over lapping severely

PARTOGRAM RECORDING Labour Progress Cervical dilatation Descent Uterine contraction

PARTOGRAM RECORDING Labour progress Dilatation and Descent Latent (0-3 cm) and Active (3-10 cm) phase. Dilatation of cervix plotted as “X” axis and Descent plotted as “O” axis. First vaginal examination done on admission is recorded. Subsequent vaginal examination is done every 2-4 hourly. Transfer from latent to active phase.

PARTOGRAM 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 therefore the labour progress is in the latent phase

PARTOGRAM RECORDING Latent phase Labour progress recording in active phase Plot dilatation as “ X ” Plot descent as “ O ” + + + + Latent phase Active phase +1 -1 -2 Descent “ X ” 7 cm 4 cm 2 cm Dilatation “ O ” 4 hours 2 hours 0 hours (admission)

PARTOGRAM 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 RECORDING Labour progress Uterine Contractions Observation is made ½ hourly Assess the frequency, duration. Each square represent 1 contraction felt in 10 minutes. Frequency – highlight the numbers of square. Duration – shade the contraction in the square. < 20 sec - Mild 20-40 sec - Moderate > 45 sec - Strong

PARTOGRAM RECORDING Labour progress Recording the uterine on the partogram 5 strong contractions in 10 minutes 2 weak contractions in 10 minutes 3 moderate contractions in 10 minutes Nos. of Contraction in 10 mins

PARTOGRAM RECORDING Mother condition Vital signs – BP, Pulse, T ºC Urine analysis – acetone, albumin, glucose Urine volume Medications or drug given

PARTOGRAM RECORDING Mother condition Vital signs recording BP – 4 hourly or more frequent if indicated Pulse - ½ hourly T ºC – 4 hourly Urine analysis – dipstick acetone  Nil or + albumin  Nil or + glucose  Nil or + Urine volume

PARTOGRAM 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 RECORDING Latent phase LABOUR PATTERNS Normal labour Prolonged latent phase Primary dysfunctional labour Secondary arrest Active phase

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

13 partogram

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