6 PARTOGRAPH

8/18/2019 6 PARTOGRAPH

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PROCESS FLOW OF ANTENATAL CARE

Quick Check & RAM Assess pregnancy status &

prepare Birth & Emergency plan

CHECK for pre-eclampsia, anemia, Sy & HIV

Respond to observed S/SX

Give PREVE!"VE #EAS$RES due

RE%R' all (indings) birth plan

And treatments given

Advise & counsel on nutrition) *P)

labor signs) danger signs) (ollo+,up visits

Ask, Check Recor

!ook, !is"en & #eel

Ien"ify si$ns

Classify

%rea" & Recor



The Partograph The Partograph

Basic Emergency Obstetric Care

Dr. ose Fabe!!a "emoria! #ospita!



OBJECTIVESOBJECTIVES

General:General:

To $n%erstan% the concept o& the W#O To $n%erstan% the concept o& the W#Opartograph.partograph.

Specifc:Specifc:

'.'. To be ab!e to recor% the obser(ations To be ab!e to recor% the obser(ationsacc$rate!y on the graph.acc$rate!y on the graph.

).). To be ab!e to interpret the recor%e% To be ab!e to interpret the recor%e%*n%ings+ recogni,e %e(iation &rom the*n%ings+ recogni,e %e(iation &rom thenorm+ an% %eci%e on time!y re&erra!norm+ an% %eci%e on time!y re&erra!



"o%$!e contents"o%$!e contents

-.-. The Partograph The Partograph

--.--. Recor%ing *n%ings in the partographRecor%ing *n%ings in the partograph

---.---. Disting$ishing norma! &rom abnorma!Disting$ishing norma! &rom abnorma!

!abor patterns!abor patterns

-.-. Other *n%ings to note /an% recor%0Other *n%ings to note /an% recor%0

%$ring -E%$ring -E



I. The PartographI. The Partograph

A too! to he!p in management o&A too! to he!p in management o&

!abor!abor1$i%es birth atten%ant to1$i%es birth atten%ant to

i%enti&y 2omen 2hose !abor isi%enti&y 2omen 2hose !abor is

%e!aye% an% there&ore %eci%e%e!aye% an% there&ore %eci%e

appropriate actionappropriate action







Monitor during laborMonitor during labor

Progre!! o" labor Cer(ica! %i!atationCer(ica! %i!atation

Contraction patternContraction pattern

Maternal #ell being P$!se+ temperat$re+ b!oo%P$!se+ temperat$re+ b!oo%

press$repress$re

3rine (oi%e%3rine (oi%e%

$etal #ell being Feta! heart rate an% patternFeta! heart rate an% pattern

Co!or o& amniotic 4$i%Co!or o& amniotic 4$i%



on on! a oon on! a o nono needneed

the u!e o" partographthe u!e o" partograph



Condition! that doCondition! that do notnot needneed

the u!e o" partographthe u!e o" partograph

Antepart$mAntepart$m

hemorrhagehemorrhage Se(ere pre5ec!ampsiaSe(ere pre5ec!ampsia

an% ec!ampsiaan% ec!ampsia

Feta! %istressFeta! %istress

Pre(io$s cesareanPre(io$s cesarean

sectionsection

"$!tip!e pregnancy"$!tip!e pregnancy

"a!presentation"a!presentation ery premat$reery premat$re

babybaby

Ob(io$s obstr$cte%Ob(io$s obstr$cte%!abor!abor



The part! o" the partographThe part! o" the partograph

Progre!! o" labor

Maternal and "etal #ell%being



&lert line

'I(&T

&TIO

)



&lert line &ction line

'I(&T

&TIO

)

Para!!e!Para!!e!

an%an% **hour! tohour! to

the rightthe right o& a!erto& a!ert

!ine!ine



II. +ecording the fnding!II. +ecording the fnding!

in the partographin the partograph

Start by !abe!ing the recor%Start by !abe!ing the recor%

2ith pertinent patient2ith pertinent patienti%enti&ying in&ormation.i%enti&ying in&ormation.



Plotting the progre!! o"Plotting the progre!! o"

laborlabor

P!ot on!y the CER-CALP!ot on!y the CER-CAL

D-LATAT-ON $sing the symbo!D-LATAT-ON $sing the symbo! ,-,-

StartStart 2hen 2oman is in ACT-E2hen 2oman is in ACT-E

LABOR /6 cmLABOR /6 cm or /oreor /ore0 an% is0 an% is

contracting a%e7$ate!y /856contracting a%e7$ate!y /856

contractions in '9 min$tes0contractions in '9 min$tes0



-

Start p!ottingStart p!otting on alert line inon alert line inthe inter!ectionthe inter!ection correspon%ing cer(ica!correspon%ing cer(ica!

%i!atation *n%ing%i!atation *n%ing



-



-



-6pm

-n%icate the time the -E 2as ma%e-n%icate the time the -E 2as ma%e

/an% there&ore+ the obser(ation 2as/an% there&ore+ the obser(ation 2as

p!otte%0p!otte%0 Write this in the (ertica! !ine itse!&Write this in the (ertica! !ine itse!&

2here yo$ p!ot the2here yo$ p!ot the ,-,-+ NOT the space+ NOT the space



-

-

-

6pm :pm '9pm

Per&orm interna! e;aminationPer&orm interna! e;amination

e(ery 6 ho$rs+ or more o&ten i&e(ery 6 ho$rs+ or more o&ten i&necessary+ an% p!ot *n%ings eachnecessary+ an% p!ot *n%ings eachtimetime

A!so+ %o not &orget to 2rite the timeA!so+ %o not &orget to 2rite the timeeach obser(ation 2as ma%eeach obser(ation 2as ma%e



-

-

-

6pm :pm '9pm

Connect theConnect the ,-!,-! toto%emonstrate the pattern o&%emonstrate the pattern o&

!abor!abor



'am

0

E-&MP(EE-&MP(E

A 1'P9 is being monitore% byA 1'P9 is being monitore% bya mi%2i&e. #er initia! -E at 'a mi%2i&e. #er initia! -E at '

am sho2e% 6 cm %i!ate%am sho2e% 6 cm %i!ate%

cer(i;.cer(i;.



'am <am

0

0

E-&MP(EE-&MP(E

At < am+ another -EAt < am+ another -Esho2e% : cm %i!ate% cer(i;.sho2e% : cm %i!ate% cer(i;.



'am <am

0

0

E-&MP(EE-&MP(E

At = am+ the patient 2as >At = am+ the patient 2as >cm %i!ate%+ intact BOW.cm %i!ate%+ intact BOW.

=am

0



III. 'i!tingui!hing nor/al"ro/ abnor/al labor

pattern



-

-

-

6pm ?pm :pm '9pm

Progress o& !abor isProgress o& !abor is nor/alnor/al i&i&

p!ottingp!otting !ta1! on or to the!ta1! on or to the

le"t o" the alert linele"t o" the alert line 2green2green

part3part3

-

-



-

-

-

6pm ?pm :pm '9pm

Note that base% on the str$ct$reNote that base% on the str$ct$re

o& the partograph as soon as 6o& the partograph as soon as 6

cm is reache% the cer(i; sho$!%cm is reache% the cer(i; sho$!%

%i!ate%i!ate nor/all1nor/all1 at a rate o&at a rate o& 4 54 5

c/6hourc/6hour..



-

-

6pm ?pm :pm '9pm

P!otting thatP!otting that pa!!e! the alertpa!!e! the alert

lineline 21ello# part321ello# part3 more somore so i" iti" itreache! or pa!!e! the actionreache! or pa!!e! the action

lineline 2red part32red part3 in%icatesin%icates

&B)O+M&(&B)O+M&( progress o& !aborprogress o& !abor

-

')am )am



I" plottingI" plotting pa!!e! alert linepa!!e! alert line

+ea!!e!! #o/an and con!ider criteria+ea!!e!! #o/an and con!ider criteria"or re"erral."or re"erral.

&lert tran!port !er7ice!&lert tran!port !er7ice! Encourage #o/an to e/pt1 bladderEncourage #o/an to e/pt1 bladder Encourage upright po!ition andEncourage upright po!ition and

#al8ing i" #o/an #i!he!.#al8ing i" #o/an #i!he!.

Monitor inten!i7el1.Monitor inten!i7el1. I" re"erral ta8e! a long ti/e9 re"erI" re"erral ta8e! a long ti/e9 re"er

i//ediatel1. 'O )OT &IT TO C+OSSi//ediatel1. 'O )OT &IT TO C+OSS&CTIO) (I)E.&CTIO) (I)E.

';



I" plotting reache! theI" plotting reache! the

action lineaction line

Re&er $rgent!y to hospita! $n!essRe&er $rgent!y to hospita! $n!essbirth is imminentbirth is imminent

';



The part! o" the partographThe part! o" the partograph

Progre!! o" labor

Maternal and "etal #ell%being





IV. Other fnding! to noteIV. Other fnding! to note

2and record3 during IE2and record3 during IE

Stat$s o& membranes+Stat$s o& membranes+ writewrite

,, I I i& intacti& intact

-& r$pt$re%+ note co!or o& amniotic-& r$pt$re%+ note co!or o& amniotic4$i%+4$i%+ writewrite

,, C C i& c!eari& c!ear

,, M M i& meconi$m staine%i& meconi$m staine%

,, & & i& absenti& absent

,, B B i& b!oo%yi& b!oo%y



Monitor e7er1 * hour!Monitor e7er1 * hour!@@

and record the fnding!and record the fnding!B!oo% Press$reB!oo% Press$re

P$!se rateP$!se rate Temperat$re Temperat$re

3rine (oi%e% /yes or no03rine (oi%e% /yes or no0

<< More frequently, if indicated



Monitor /ore "re=uentl1Monitor /ore "re=uentl1

and record the fnding!and record the fnding!

N$mber o& contractions inN$mber o& contractions in

'9 min$te perio%'9 min$te perio%

Feta! heart rate in ' &$!!Feta! heart rate in ' &$!!

min$temin$te



-& 2oman is a%mitte% in LATENT-& 2oman is a%mitte% in LATENTP#ASE o& !abor /!ess than 6 cmP#ASE o& !abor /!ess than 6 cm

%i!ate%0 recor% on!y other%i!ate%0 recor% on!y other

*n%ings /BP+ F#T etc0.*n%ings /BP+ F#T etc0. '>'>

-& she remains in !atent phase &or-& she remains in !atent phase &or

ne;t : ho$rs /!abor is pro!onge%0+ne;t : ho$rs /!abor is pro!onge%0+trans&er her to hospita!.trans&er her to hospita!. '>



E-E+CISESE-E+CISES

-n%icate 2hether the progress o&-n%icate 2hether the progress o&

!abor in the &o!!o2ing partographs!abor in the &o!!o2ing partographs

areare norma!norma! oror abnorma!abnorma!..



0

)am

0

'9pm

Ca!e 5



-

-:pm ')mn )am

-

8am

-

Ca!e ?



0

-

-

>pm 'am 8am

Ca!e @



0

-

-

>pm 'am 8am

Ca!e *



E-E+CISESE-E+CISES

P!ot the obser(ations in theP!ot the obser(ations in the

&o!!o2ing cases.&o!!o2ing cases.



Ca!e A:Ca!e A:

"aria+ 1)P' 2as a%mitte% to%ay at ) am+ -E"aria+ 1)P' 2as a%mitte% to%ay at ) am+ -Esho2e% a <cm %i!ate% cer(i;+ cepha!ic+sho2e% a <cm %i!ate% cer(i;+ cepha!ic+intact BOW. BP''9=9+ PR::min+intact BOW. BP''9=9+ PR::min+a&ebri!e. F#T'69min.a&ebri!e. F#T'69min.

She ha% mo%erate contractions /8 in '9She ha% mo%erate contractions /8 in '9min0. At ? am+ the BOW r$pt$re% 2ithmin0. At ? am+ the BOW r$pt$re% 2ithc!ear amniotic 4$i%. -E sho2e% : cmc!ear amniotic 4$i%. -E sho2e% : cm%i!ate% cer(i;. ita! signs 2ere the same.%i!ate% cer(i;. ita! signs 2ere the same.

At : am+ cer(i; 2as > cm. She %e!i(ere%At : am+ cer(i; 2as > cm. She %e!i(ere%spontaneo$s!y at :89 am. '9 $ o;ytocinspontaneo$s!y at :89 am. '9 $ o;ytocin2as gi(en -". P!acenta 2as %e!i(ere%2as gi(en -". P!acenta 2as %e!i(ere%comp!ete at :8< am.comp!ete at :8< am.



-

)am ?am

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-

:am

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Ca!e D:Ca!e D:

Lo$r%es+ 16P) 2as a%mitte% at ' pm to%ayLo$r%es+ 16P) 2as a%mitte% at ' pm to%ay%$e to 2atery (agina! %ischarge. The cer(i;%$e to 2atery (agina! %ischarge. The cer(i;2as 8 cm+ cepha!ic+ /50 BOW 2ith c!ear2as 8 cm+ cepha!ic+ /50 BOW 2ith c!earamniotic 4$i%. BP')9:9+ PR:9min+ T5amniotic 4$i%. BP')9:9+ PR:9min+ T58?.<.8?.<.

At <pm+ contractions 2ere mo%erate+ 8 in '9At <pm+ contractions 2ere mo%erate+ 8 in '9min. -E sho2e% cer(i; 6 cm %i!ate%. ita!min. -E sho2e% cer(i; 6 cm %i!ate%. ita!signs remaine% the same.signs remaine% the same.

At > pm+ yo$r -E sho2e% ? cm %i!ate% cer(i;.At > pm+ yo$r -E sho2e% ? cm %i!ate% cer(i;.

At ' am+ another -E %one sho2e% : cm %i!ate%At ' am+ another -E %one sho2e% : cm %i!ate%cer(i;+ meconi$m staine% 4$i%. BP5''9=9+cer(i;+ meconi$m staine% 4$i%. BP5''9=9+PR5>)min+ T58=.<+ F#T5'69minPR5>)min+ T58=.<+ F#T5'69min



-<pm

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Ca!e D:Ca!e D:

"arites+ 1'P9 2as a%mitte% at ? pm."arites+ 1'P9 2as a%mitte% at ? pm.BP')9:9+ PR5:6min+ T8?.<.BP')9:9+ PR5:6min+ T8?.<.

F#T'<9min+ cer(i; < cm %i!ate%+ /0 BOW.F#T'<9min+ cer(i; < cm %i!ate%+ /0 BOW.

She ha% )58 $terine contractions in '9 min.She ha% )58 $terine contractions in '9 min.

A&ter 6 ho$rs+ -E sho2e% = cm %i!ate% cer(i;.A&ter 6 ho$rs+ -E sho2e% = cm %i!ate% cer(i;.ita! signs an% F#T 2ere the same.ita! signs an% F#T 2ere the same.

At ') am+ another -E %one sho2e% : cm %i!ate%At ') am+ another -E %one sho2e% : cm %i!ate%

cer(i;+ negati(e BOW+ c!ear AF. F#Tcer(i;+ negati(e BOW+ c!ear AF. F#T

'69min.'69min.

Another -E a&ter ) ho$rs 2as the same.Another -E a&ter ) ho$rs 2as the same.

F#T'66min+ ita! signs sameF#T'66min+ ita! signs same



-

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+EC&P

Signi*cance an% $se o& thepartograph

Parts o& the partograph an%in&ormation containe% in it

Recor%ing or p!otting o& c!inica!obser(ations

-nterpretation o& the recor%e%*n%ings an% %ecision on re&erra!



I (o7e ou9

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6 PARTOGRAPH