College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
Partograph
1. Partogram
Associate Clinical Prof. Dr. Aisha M. El-Bareg, MD, PhD
Senior Consultant in (Obs & Gyn)/ Reproductive Medicine
Faculty of Medicine, Misurata .LIBYA
2. • The intrapartum period is probably the most
dangerous and traumatic period – a time
associated with a high mortality and morbidity
for both mother and child.
• Maternal and fetal monitoring are essential to
pick up problems early and thus institute timely
intervention.
Why Monitor ???????
3. Complication of prolonged labour
Maternal
Maternal exhaustion
Increased incidence of CS
Birth canal injuries if forceps is used
Risk of rupture uterus -MP
PPH, Puerperal sepsis
Fetal
Fetal distress, Chorioamnionitis, neonatal
sepsis.
ICH- if forceps is used.
4. Partogram- Definition
A composite graphical record of progress of labor
on a single sheet of paper.
It was developed and extensively tested by the
WHO 1994.
Can serve as an ‘early warning system’ & assist in
making decisions and interventions.
5. Advantages-Partogram
To assess labor at glance, early detection of
abnormal progress of labor.
Prevention of prolonged labor.
Recognition of CPD long before obstructed labor
Can allow time & discussion of further
management of labor (Augmentation or
termination of labor).
Make observation & recording of Feto-maternal
condition more objectively.
6. Advantages-Partogram
Early recognition of Feto-maternal problems.
Highly effective in reducing complications from
prolonged labor for the mother (postpartum
hemorrhage, sepsis, uterine rupture and its
sequelae) and for the newborn (death, anoxia,
infections, etc.)
Reduce incidence of CS rate.
Facilitates handover procedure.
7. Disadvantages-Partogram
Assumes that all women progress at same rate
– May influence intervention rate.
Clinical findings have subjective variations.
Lack of knowledge.
Non availability of printed partographs.
Duplication of recording.
8. Partogram - History
Emanuel Friedman's Partogram - 1954
Based on observations of cervical dilatation and
fetal station against time elapsed in hours from
onset of labor.
The time of onset of labor was based on the
patient's subjective perception of her contractility.
Plotting cervical dilatation against time yielded the
typical Sigmoid or 'S' shaped curve, and station
against time gave rise to the Hyperbolic curve.
12. 1972-Philpott and Castle
•Introduced the concept of “ALERT” & “ACTION”
lines.
•ALERT LINE – represent the mean rate of slowest
progress of labor (1cm/hr ) starting at zero time i.e.
time of admission.
•ACTION LINE – drawn 4 hrs. to the right of the
alert line and parallel to it. If the progress crossed
the alert line, appropriate action should be taken
within 4 hrs.
•Normal labor is plotted to the left alert line
13. The WHO Partogram has been modified in
2000 to make it simpler and easier to use.
The latent phase has been removed and
plotting on the Partogram begins in the
active phase when the cervix is 4 cms
dilated.
14.
15.
16. Stages of labor
Onset End Duration
1-First stage
Onset of true
labour pains
Full cervical
dilatation
Primi: 12-16
hrs
Multi: 6-8 hrs
2-Second stage
Full cervical
dilatation
Delivery of the
fetus
Primi: 1-2 hrs
Mutti: average
0.5 hrs
3-Third stage
After delivery
of the baby
Complete
expulsion of
placenta and
membranes
Up to 30
minutes
Fourth stage: 1- 2 hours after delivery
(observational)
24. Part IV: maternal condition
Assess maternal condition regularly by monitoring:
Pulse – Every 30 mins & marked with a dot (•).
Blood pressure – Recorded in vertical line every 4
hours & marked with arrows.
Temperature – Recorded every 2 hours.
Urine volume , analysis for protein and acetone
– Everytime urine is passed.
25. maternal conditionPart IV:
Oxytocin – Amount per volume IV fluids in drops
per minute, every 30 mins.
Drugs – Any additional drugs given.
IV Fluids – type and amount used.
28. Pattern of abnormal progress of labor
Disorders of 1st stage of labor
1. Prolonged latent phase
2. Disorders of active phase
29. A. Prolonged latent phase
B. Prolonged active phase
C. Arrested active phase
stage of laborst1Disorders of
30. Prolonged latent phase
It is prolonged when its duration exceeds 20 hrs. in
Primi & 14 hrs in Multi.
According to WHO Partogram, a prolonged latent
phase is “Cervix not dilated beyond 4cms after 8
hrs. from admission.
31. Expectant
Awaiting active labour- provided no indication
for delivery.
Simple analgesics, Mobilization, reassurance
Active
If delivery is indicated- Induction /
augmentation labor
Early ARM- increase risk of prolonged labour
with PPROM- risk of IU infection and neonatal
sepsis, risk of CS 10 folds.
Prolonged latent phase – Management:
32. Plotting of cervical dilatation will normally remain
on or to the left of the alert line.
Moves to the right of the alert line warns that labor
may be prolonged.
Happens if the rate of cervical dilatation in active
phase of labor is less than 1cm/hour within 4hrs.
At the action line, the woman must be carefully
reassessed for why labor is not progressing and a
decision made on further management.
Prolonged active phase
33.
34. • When the cervical dilatation commences
normally but stops or slows significantly for 2
hours or more prior to full dilatation of cervix.
• Abnormal progress of labor may occur with
normal progress of descent of the fetal head
then followed by secondary arrest of descent of
fetal head.
Secondary arrest of cer vical dilatation
Secondary arrest of head descent
35.
36.
37.
38.
39. 3. Prolonged 2nd stage of labour
Definition
• PG
• > 2 hrs without epidural anesthesia
• > 3 hr with anesthesia
• MG
• > 1 hr without epidural anesthesia.
• > 2 hrs with anesthesia
40. 1. Protraction of descent
Descent of presenting part during the 2nd
stage of labor occuring at
< 1cm/h in PG
< 2cm/h in MG
2. Arrest (failure) of descent- no progress of
descent for < 2 hrs.
3. Prolonged 2nd stage of labor
41. Assessment
Evaluation of uterine activity
Evaluation of maternal expulsive efforts
FHR status every 5 min
Fetal position, Clinical pelvimetry
Re-estimation of fetal wt
Management
Increasing or initiating oxytocin to improve
maternal expulsive effort
Operative vaginal delivery or CS.
46. Partogram is a Simple, clear, easy-to-use, cost-
effective tool for monitoring of labor and decisions
making.
The use of the Partogram significantly improves
perinatal outcomes.
The Partogram can be effectively used in facilities at
any level of care
Partogram- conclusions
47. Partogram- conclusions
Strictly following the rules for Partogram use
ensures its effectiveness.
The Partogram should be used for any labor, in high
and low risk women.
Documented evidence for Medico Legal purpose.
Educational value for all grades of staff.