Managing Labor Using the Partograph

1. Managing Labor Using the Partograph

2. Using the Partograph 2 The Partograph Assessment of fetal well being Assessment of maternal well being Assessment of progress of labor Ask participants to list measures of assessing fetal well being and maternal well being and assessing the progress of labor. Ask them to determine which of these measures are objective and which are subjective Ask participants to list measures of assessing fetal well being and maternal well being and assessing the progress of labor. Ask them to determine which of these measures are objective and which are subjective

3. Using the Partograph 3 Measuring Fetal Well Being During Labor Fetal heart rates and pattern Degree of molding, caput Color of amniotic fluid Fetal well being: Objective: Fetal heart rate Subjective: Fetal heart rhythm, decellerations, color of liquor, caput, moulding Fetal well being: Objective: Fetal heart rate Subjective: Fetal heart rhythm, decellerations, color of liquor, caput, moulding

4. Using the Partograph 4 Measuring Maternal Well Being During Labor Pulse, temperature, blood pressure, respiration Urine output, ketones, protein Maternal well being: Objective: Temperature, maternal pulse, blood pressure, urine output, ketones in urine Subjective: Ill looking, tired, weak, exhausted, in pain Maternal well being: Objective: Temperature, maternal pulse, blood pressure, urine output, ketones in urine Subjective: Ill looking, tired, weak, exhausted, in pain

5. Using the Partograph 5 Measuring Progress of Labor Cervical dilatation Descent of presenting part Contractions Duration Frequency Alert and action lines Progress of labor: Objective: Cervical dilatation, number of contractions in 10 minutes, duration of contraction descent by abdominal route, by station Subjective: Strength of contractions Progress of labor: Objective: Cervical dilatation, number of contractions in 10 minutes, duration of contraction descent by abdominal route, by station Subjective: Strength of contractions

6. Using the Partograph 6 Using the Partograph Patient information: Name, gravida, para, hospital number, date and time of admission, and time of ruptured membranes Fetal heart rate: Record every half hour Amniotic fluid: Record the color at every vaginal examination: I: membranes intact C: membranes ruptured, clear fluid M: meconium-stained fluid B: blood-stained fluid The WHO partograph has been modified to make it simpler and easier to use. The latent phase has been removed, and plotting on the partograph begins in the active phase when the cervix is 4 cm dilated. A sample partograph is included (Figure C-10). Note that the partograph should be enlarged to full size before use. The WHO partograph has been modified to make it simpler and easier to use. The latent phase has been removed, and plotting on the partograph begins in the active phase when the cervix is 4 cm dilated. A sample partograph is included (Figure C-10). Note that the partograph should be enlarged to full size before use.

7. Using the Partograph 7 Using the Partograph (continued) Molding: 1: sutures apposed 2: sutures overlapped but reducible 3: sutures overlapped and not reducible Cervical dilatation: Assess at every vaginal examination, mark with cross (X) Alert line: Line starts at 4 cm of cervical dilatation to the point of expected full dilatation at the rate of 1 cm per hour Action line: Parallel and 4 hours to the right of the alert line

8. Using the Partograph 8 Using the Partograph (continued) Descent assessed by abdominal palpation: Part of head (divided into 5 parts) palpable above the symphysis pubis; recorded as a circle (O) at every vaginal examination. At 0/5, the sinciput (S) is at the level of the symphysis pubis

9. Using the Partograph 9 Using the Partograph (continued) Hours: Time elapsed since onset of active phase of labor (observed or extrapolated) Time: Record actual time Contractions: Chart every half hour; palpate the number of contractions in 10 minutes and their duration in seconds Less than 20 seconds: Between 20 and 40 seconds: More than 40 seconds: Oxytocin: Record amount per volume IV fluids in drops/min. every 30 min. when used Drugs given: Record any additional drugs given

10. Using the Partograph 10 Using the Partograph (continued) Temperature: Record every 2 hours Pulse: Record every 30 minutes and mark with a dot (�) Blood pressure: Record every 4 hours and mark with arrows Protein, acetone and volume: Record every time urine is passed

11. Using the Partograph 11 The Modified WHO Partograph (Figure C-10)

12. Using the Partograph 12 Sample Partograph for Normal Labor (Figure C-11)

13. Using the Partograph 13 Partograph Showing Prolonged Active Phase of Labor (Figure S-6)

14. Using the Partograph 14 Partograph Showing Obstructed Labor (Figure S-7)

15. Using the Partograph 15 Partograph Showing Inadequate Uterine Contractions Corrected with Oxytocin (Figure S-8)