Welcome to the th 11 PLGPMI National General Assembly
MIDWIVES
Embracing Development, Coping with Change Manila Hotel
GOOD MORNING
PARTOGRAPH
Made Easy LOURDES BORJA MAGBANUA, RM, RN, RT, MAN, Ph.D
Partograph Made Easy
Source : Basic Emergency Obstetric Care Dr. Jose Fabella Memorial Hospital, & WHO
I. The Partograph
A
tool to help in management of labor Guides birth attendant to identify women whose labor is delayed and therefore decide appropriate action
OBJECTIVES
I.
To understand the concept of the WHO partograph
To explain to mothers the significance of the graph
II. To record the observations accurately on the graph III. To interpret the recorded findings, recognize deviation from the norm, and decide on timely referral
Monitor during labor
Progress
of labor
Cervical dilatation Contraction pattern
Maternal
well being
Pulse, temperature, blood pressure Urine voided
Fetal
well being
Fetal heart rate and pattern Color of amniotic fluid
The parts of the partograph
Progress of labor
Maternal and fetal well-being
D I L A T A T I O N
Alert line
D I L A T A T I O N
Alert line
Action line
Parallel and 4 hours to the right of alert line
Conditions that does not need the use of partograph
Antepartum
hemorrhage Severe pre-eclampsia and eclampsia Fetal distress Previous cesarean section
Multiple
pregnancy Malpresentation Very premature baby Obvious obstructed labor
II. Recording the findings in the partograph
Start
by labeling the record with pertinent patient identifying information.
Plotting the progress of labor
Plot
only the CERVICAL DILATATION using the symbol X Start when woman is in ACTIVE LABOR (4 cm or more) and is contracting adequately (3-4 contractions in 10 minutes)
Start plotting on alert line in the intersection corresponding cervical dilatation finding
4pm
Indicate the time the IE was made (and therefore, the observation was plotted)
Write this in the vertical line itself where you plot the X, NOT the space after it
X X
4pm
8pm
10pm
Perform internal examination every 4 hours, or more often if necessary, and plot findings each time
Also, do not forget to write the time each observation was made
X X
4pm
8pm
10pm
Connect the Xs to demonstrate the pattern of labor
EXAMPLE
1am
A G1P0 is being monitored by a midwife at home. Her initial IE at 1 am showed 4 cm dilated cervix.
EXAMPLE
x
x
1am 5am
At 5 am, another IE showed 8 cm dilated cervix.
EXAMPLE
x x
x
1am 5am 7am
At 7 am, the patient is 9 cm dilated, station -1, intact BOW.
III. Distinguishing normal from abnormal labor pattern
X X X
4pm
6pm
8pm
10pm
Progress of labor is normal if plotting stays on or to the left of the alert line (green part)
X X
4pm
6pm
8pm
10pm
Note that based on the structure of the partograph as soon as 4 cm is reached the cervix should dilate normally at a rate of 1 cm/hour.
X X
4pm
6pm
8pm
10pm
12am
2am
Plotting that passes the alert line (yellow part) more so if it reaches or passes the action line (red part) indicates abnormal progress of labor
If plotting passes alert line
Reassess
woman and consider referral if facilities are not available to deal with obstetric emergencies, unless delivery is imminent Alert transport services Monitor intensively
What to do if partograph passes alert line
Reassess woman and consider criteria for referral. Alert transport services. Empty bladder. Ensure adequate hydration but omit solid foods. Encourage upright position and walking if woman wishes. Monitor intensively. If referral long, reassess in 2 hours and refer if no progress.
If partograph passes action line, refer urgently to an EmOC facility unless imminent delivery.
If plotting reaches the action line
the patient must be already in an EmOC facility, a decision made about the cause of slow progress, and appropriate action taken
The parts of the partograph
Progress of labor
Maternal and fetal well-being
IV. Other findings to note (and record) during IE
Status If
of membranes, write
I if intact
ruptured, note color of amniotic fluid, write
C if clear M if meconium stained A if absent B if bloody
Monitor every 4 hours* and record the findings
Blood
Pressure Pulse rate Temperature Urine voided (yes or no)
* More frequently, if indicated
Monitor more frequently and record the findings
Number
of contractions in 10 minute period Fetal heart rate in 1 full minute
If
woman is admitted in LATENT PHASE of labor (less than 4 cm dilated) record only other findings (BP, FHT etc). she remains in latent phase for next 8 hours (labor is prolonged), transfer her to hospital.
If
EXERCISES
Indicate
whether the progress of labor in the following partographs are normal or abnormal.
Case 1
x
10pm 2am
Case 2
X X
8pm
12mn
2am
4am
Case 3
X X
9pm
1am
3am
EXERCISES
Plot
the observations in the following cases.
Case 4:
A G2P1 was admitted at 2 am, IE showed a 4cm dilated cervix. The patient was still smiling and she was hesitant to be admitted. At 6 am, another IE was done 8 cm dilated cervix, 80% effaced, station 0. At 8 am, fetal head was bulging at the perineum.
Answer to case 4
X X
2am
6am
8am
Case 5:
A G4P2 was referred at 5 pm. The midwife said that the patient is at 4 cm cervical dilatation. At 9 pm, your IE showed 6 cm dilated cervix. At 1 am, another IE done showed 8 cm dilated cervix, 50% effaced, station -1, intact BOW.
Answer to case 5
X
5pm
9pm
1am
RECAP
Significance
and use of the partograph Parts of the partograph and information contained in it Recording or plotting of clinical observations Interpretation of the recorded findings and decision on referral
Remember this my dear Midwives A job title alone does not make a person a leader. Only a persons behavior determines if he or she occupies a leadership position.
Fellow Midwives, Colleagues Good day &
Congratulations !!!
