PARTOGRAAM 2 (1).ppt

8/12/2019 PARTOGRAAM 2 (1).ppt

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P RTOGR M


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Why was it introduced?

Ultimate goal - to reduce maternal and perinatalmortality and morbidity.

Cephalopelvic disproportion

Causing prolonged & obstructed labour

Ruptured uterus Death of fetusPost partum haemorrage Infections


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When to start ?

Only after you have checkedthere are no complications of the

pregnancy that requireimmediate action.


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Must only be started when a woman is in labour

1.In the latent phasecontractions must be two ormore in ten minutes, each

lasting 20 seconds or more.

2.In the active phasecontractions must be one or

more in ten minutes ,each lasting 20 seconds ormore.


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Components

3 components of the partogram

1. Fetal condition

2. Maternal condition

3. Progression of labour


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1.Fetal Condition.

a) Fetal heart rate

b) Membranes and liquor

c) Moulding of the fetal skull


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a) Fetal Heart Rate (FHR)

Auscultated by Pinards Stethoscope

Every 15 minutes

Immediately after a contraction

Listened for 1 minute

Auscultated in the best heard place (usually overanterior shoulder of the fetus)

Normal range 110-160 beats per minute (bpm)

If FHR remains abnormal >3 occasions, necessaryactions should be taken.


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FHR-contd

Management of fetal distress-

Stop Oxytocin.

Turn to left lateral. Pv to exclude cord prolapse & observe

amniotic fluid.

Adequate hydration.

Oxygen, if available.


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c) Moulding

It indicates the adequacy of the pelvis toaccommodate the featl head

On marking the partogram;

- Bones separated & sutures felt easily - O

- Bones just touching each other - +

- Bones are overlapping - ++

- Bones overlapping severely - +++

Increasing moulding with head high in the pelvis isa sign of cephalopelvic disproportion


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2.Maternal Condition

a) Pulse, blood pressure (BP) & temperature

b) Urine

c) Drugs & IV fluids

d) Oxytocin regime


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,a) BP pulse Temperature

Pulse

- Counted hourly

Blood Pressure

- Measured hourly- If indicated, as in PIH, hourly

Temperature

- Measured hourly

- If indicated hourly


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b) Urine

Volume of urine

Check for protein

Check for acetone


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c) Drugs IV Fluids

Any drugs given to the mother

during the process of labour shouldbe mentioned in the appropriatecolumn


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d) Oxytocin Regime

Induction 5U for primi & 2U for multi in 1pint of normal saline, at a rate of 15 dropsper minutes.


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3.Progression of Labour

a) Cervical dilatation

b) Decent of the fetal head

c) Uterine contractions


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Alert Line expected line of cervical dilatation at thetime of first pv examination in the active phase.

Line drawn from 3cm 10 cm

Represents the rate of 1cm / hour rate of dilatation

If cervical dilatation is normal, it will remain on or tothe left of the alert line

Action Line

Line drawn 4 hours to the right of the alert line

If the cervical dilatation reaches this line, appropriateactions should be taken


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WHO partogram


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b) Decent of the Fetal Head

Usually begins, when the cervix is about 7cmdilated

Measured by abdominal palpation

Always asessed immediately before doingvaginal examination

Expressed in terms of fifths, above the pelvicbrim

When the part of the head, above the pelvicbrim, is about 2 finger widths or less; Head isEngaged


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c) Uterine Contractions

2 observations are made;- Frequency -

Number of contractions per 10 minutes- Duration -

From the time contractions is 1stfeltabdominally to the time when thecontraction passes off, measured inseconds


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40 s

Time (h) 0 1 2 3

Uterine Contractions contd.


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PARTOGRAAM 2 (1).ppt

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