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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