Partograph exercises
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1. The document provides information on examining patients in labor, including frequency of examinations, symbols used on partographs, and examples of completed partographs for different patients. 2. It includes details on vaginal examinations like cervical dilation, fetal position and heart rate, membrane status, and descent/moulding that should be recorded regularly during labor. 3. Examples of partographs show progression of labor over time for patients with details on vital signs and fetal/maternal status.
Partograph exercises
- 1. 1 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Usual frequency of examination Vaginal examination 4 hourly Fetal Heart Rate ½ - ¼ hourly Moulding Sutures apposed + Sutures overlapped but reducible 2+ Sutures overlapped but not reducible 3+ Symbols Cervix x Head O Breech w Fetal heart rate . Descent: Abdominal palpation1Descent: Abdominal palpation1 Amniotic fluid Membranes intact I Membranes ruptures, clear fluid C Meconium stained fluid M Blood stained fluid B 1. WHO Managing complications in pregnancy and childbirth
- 2. 1. What actions will you take? 2. How will you look after this woman? Questions Partograph Case 1Partograph Case 1 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs KA Hospital No.: 462432 XY Age (Years): 20 Parity: Para 0 +0 Gestational age (Weeks): 38 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 9am 2cm Intact longitudinal Cephalic 140 o 5/5 2 (<20 seconds) History •Lower abdominal pains •No drainage of liquor Time 9am Pulse rate (/Min.) 90 Blood pressure (mmHg) 120/80 Temperature (o C) 37.1o
- 3. 1. What actions will you take at 4pm? Questions Partograph Case 2Partograph Case 2 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs AD Hospital No.: 462432 XY Age (Years): 18 Parity: Para 2+0 Gestational age (Weeks): 38 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 4pm 4cm Intact longitudinal Cephalic 144 0 3/5 3 (35sec. each) 8pm 8cm clear longitudinal Cephalic 146 0 2/5 4 (45 sec. each) History •Lower abdominal pains for 2 hours •Drainage of liquor for 1 hour Time 4pm 8pm Pulse rate (/Min.) 88 90 Blood pressure (mmHg) 120/70 120/70 Temperature (o C) 37o 37o
- 4. 1. What actions will you take at 4pm? 2. What actions will you take at 8pm? Questions Partograph Case 2Partograph Case 2 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs AD Hospital No.: 462432 XY Age (Years): 18 Parity: Para 2+0 Gestational age (Weeks): 38 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 4pm 4cm Intact longitudinal Cephalic 144 0 3/5 3 (35sec. each) 8pm 8cm clear longitudinal Cephalic 146 0 2/5 4 (45 sec. each) History •Lower abdominal pains for 2 hours •Drainage of liquor for 1 hour Time 4pm 8pm Pulse rate (/Min.) 88 90 Blood pressure (mmHg) 120/70 120/70 Temperature (o C) 37o 37o
- 5. Questions 1. What actions are required? 2. When would the next examination be? Partograph Case 3Partograph Case 3 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs DG Hospital No.: 462432 XY Age (Years): 19 Parity: Para 0 +1 Gestational age (Weeks): 38 Time Cervix (cm) Membranes / Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each) 10am 5cm Artificial rupture of membranes: clear longitudinal Cephalic 146 0 3/5 2 (20sec. each) 12pm (noon) 8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each) 2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each) History •Lower abdominal pains for 10 hours •No drainage of liqour Time 6am 10am 12pm 2pm Pulse rate (/Min.) 80 84 88 92 Blood pressure (mmHg) 130/70 130/70 140/70 140/70 Temperature (o C) 37.3o 37 37.5 37.5
- 6. Questions 1. Comment on the partograph. What actions are required? 2. When would the next examination be? Partograph Case 3Partograph Case 3 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs DG Hospital No.: 462432 XY Age (Years): 19 Parity: Para 0 +1 Gestational age (Weeks): 38 Time Cervix (cm) Membranes / Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each) 10am 5cm Artificial rupture of membranes: clear longitudinal Cephalic 146 0 3/5 2 (20sec. each) 12pm (noon) 8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each) 2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each) History •Lower abdominal pains for 10 hours •No drainage of liqour Time 6am 10am 12pm 2pm Pulse rate (/Min.) 80 84 88 92 Blood pressure (mmHg) 130/70 130/70 140/70 140/70 Temperature (o C) 37.3o 37 37.5 37.5
- 7. Questions 1. Comment on the partograph. What actions are required? 2. When would the next examination be? Partograph Case 3Partograph Case 3 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs DG Hospital No.: 462432 XY Age (Years): 19 Parity: Para 0 +1 Gestational age (Weeks): 38 Time Cervix (cm) Membranes / Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each) 10am 5cm Artificial rupture of membranes: clear longitudinal Cephalic 146 0 3/5 2 (20sec. each) 12pm (noon) 8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each) 2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each) History •Lower abdominal pains for 10 hours •No drainage of liqour Time 6am 10am 12pm 2pm Pulse rate (/Min.) 80 84 88 92 Blood pressure (mmHg) 130/70 130/70 140/70 140/70 Temperature (o C) 37.3o 37 37.5 37.5
- 8. Questions 1. Comment on the partograph. What actions are required? Partograph Case 3Partograph Case 3 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs DG Hospital No.: 462432 XY Age (Years): 19 Parity: Para 0 +1 Gestational age (Weeks): 38 Time Cervix (cm) Membranes / Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each) 10am 5cm Artificial rupture of membranes: clear longitudinal Cephalic 146 0 3/5 2 (20sec. each) 12pm (noon) 8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each) 2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each) History •Lower abdominal pains for 10 hours •No drainage of liqour Time 6am 10am 12pm 2pm Pulse rate (/Min.) 80 84 88 92 Blood pressure (mmHg) 130/70 130/70 140/70 140/70 Temperature (o C) 37.3o 37 37.5 37.5
- 9. 1. Plot the information on a partograph. 2. What action will you take? 3. When would you perform the next vaginal examination? Questions Partograph Case 4Partograph Case 4 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs HA Hospital No.: 462432 XY Age (Years): 16 Parity: Para 0 + 0 Gestational age (Weeks): 39 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 10am 4cm Spontaneous rupture, clear L Cephalic 150 1 + 3/5 3 (30 sec. each) 2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec. each) 4pm 6cm Meconium stained L Cephalic 164 3 + 3/5 4 (45 sec. each) History •Labour at home for 6 hours •Membrane ruptured 4 hours before admission Time 10am 2pm 4pm Pulse rate (/Min.) 80 86 92 Blood pressure (mmHg) 120/70 130/70 130/70 Temperature (o C) 37 37.2 37.2
- 10. 1. Comment on the partograph 2. When would you perform the next vaginal examination? Questions Partograph Case 4Partograph Case 4 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs HA Hospital No.: 462432 XY Age (Years): 16 Parity: Para 0 + 0 Gestational age (Weeks): 39 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 10am 4cm Spontaneous rupture, clear L Cephalic 150 1 + 3/5 3 (30 sec. each) 2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec. each) 4pm 6cm Meconium stained L Cephalic 164 3 + 3/5 4 (45 sec. each) History •Labour at home for 6 hours •Membrane ruptured 4 hours before admission Time 10am 2pm 4pm Pulse rate (/Min.) 80 86 92 Blood pressure (mmHg) 120/70 130/70 130/70 Temperature (o C) 37 37.2 37.2
- 11. 1. Comment on the partograph. 2. What action will you take in a BEOC and CEOC health facility Questions Partograph Case 4Partograph Case 4 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs HA Hospital No.: 462432 XY Age (Years): 16 Parity: Para 0 + 0 Gestational age (Weeks): 39 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 10am 4cm Spontaneous rupture, clear L Cephalic 150 1 + 3/5 3 (30 sec. each) 2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec. each) 4pm 6cm Meconium stained L Cephalic 164 3 + 3/5 4 (45 sec. each) History •Labour at home for 6 hours •Membrane ruptured 4 hours before admission Time 10am 2pm 4pm Pulse rate (/Min.) 80 86 92 Blood pressure (mmHg) 120/70 130/70 130/70 Temperature (o C) 37 37.2 37.2
- 12. 1. You are called. What would you do? 2. When will you do another vaginal examination? Questions Partograph Case 5Partograph Case 5 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs SA Hospital No.: 462432 XY Age (Years): 24 Parity: Para 3+1 Gestational age (Weeks): 39 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 10am 4cm Spontaneous rupture 2 hours ago, clear L Cephalic 140 0 3/5 3 (30 seconds) 2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds) 4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds) History •Lower abdominal pains 3 hours •Drainage of liquor 2 hours Time 10am 2pm 4pm Pulse rate (/Min.) 86 90 92 Blood pressure (mmHg) 130/70 130/70 130/70 Temperature (o C) 37o 37o 37
- 13. 1. Comment on the partograph. 2. What action would you take? Questions Partograph Case 5Partograph Case 5 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs SA Hospital No.: 462432 XY Age (Years): 24 Parity: Para 3+1 Gestational age (Weeks): 39 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 10am 4cm Spontaneous rupture 2 hours ago, clear L Cephalic 140 0 3/5 3 (30 seconds) 2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds) 4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds) History •Lower abdominal pains 3 hours •Drainage of liquor 2 hours Time 10am 2pm 4pm Pulse rate (/Min.) 86 90 92 Blood pressure (mmHg) 130/70 130/70 130/70 Temperature (o C) 37o 37o 37
- 14. 1. Comment on the partograph? 2. What action will you take? 3. What are the options for delivery? Questions Partograph Case 5Partograph Case 5 Maternal and Newborn Health Unit Liverpool School of Tropical Medicine LSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and Newborn Care Name: Mrs SA Hospital No.: 462432 XY Age (Years): 24 Parity: Para 3+1 Gestational age (Weeks): 39 Time Cervix (cm) Membranes/ Liquor Lie Presentation FHR (/Min.) Moulding Descent Contractions (/10 Min.) 10am 4cm Spontaneous rupture 2 hours ago, clear L Cephalic 140 0 3/5 3 (30 seconds) 2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds) 4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds) History •Lower abdominal pains 3 hours •Drainage of liquor 2 hours Time 10am 2pm 4pm Pulse rate (/Min.) 86 90 92 Blood pressure (mmHg) 130/70 130/70 130/70 Temperature (o C) 37o 37o 37