Definition:A graphic representation of the progress of labour.

Parts of the Partogram:A. Identification data:

o Name:o Age:o Date:o Parity:o LMP: Expected date of Delivery:o Hospital:o Consultant name:

B. Fetal Heart Rate FHR:o Normal: 120 – 160 beats/min.

<120 → bradycardia. >160 → Tachycardia. In the 1st stage of labour, we assess the heart rate every 15 mins. In the 2nd stage of labour, we assess it every 5 mins, so a con nuous

fetal heart monitor. When membranes rupture, we should record if the heart rate is present

or not, as well as the character.C. Liquor amnii (amniotic fluid):

o When the membranes are intact, mark " I ".o When the membrane is ruptured:

If the liqour is Clear, mark " C ". If the liqour is stained with Meconium, mark "M".

Meconium: is the fetal feces (GI secretions of fetus). If the liquor is stained with Blood, mark "B". If the liquor is Absent, mark "A".

o If she comes with ruptured membranes: write the duration in the beginning; e.g., she had ruptured membrane 5 hours ago.

o Color of Liqour: Normally, the liquor is clear ( watery, or slightly yellowish or whitish). Dark greenish: if stained with meconium.

In case of hypoxia, or asphyxia of the fetus during delivery, this leads to relaxation of the anal sphincter of the fetus and the meconium is released staining the amniotic fluid.

Blood: with abnormal placental separation. Purulent: indicates infection.

Please, compare what is written with the chart on the first page to be more clear for you…

Partogram

o

D. Molding:o When the head goes through the pelvis, it gets com

skull get overlapo If the suture is still felt o If the bones are just touching each other

"approximation" o If the bones are slightly overlapped and still reducible,

→ the molding is ++.o If the bones are severely overlapped and non

+++ is a risk for intracranial hemorrhage

o Mild molding (+ or ++) are part of the normal the passage of the babyhead. However,intracranial hemorrhage.

E. Cervical Dilatation:o Measured in cm.o The first cervical

recorded at 0 me in the chart.o Further examina on are made at least every 4 hours, preferably every 2 hours

in active stage of labour until full dilatation.o The WHO put 2 lines:

Alert line. Action line.

o The cervix should be fully dilated and the head engaged before reaching the alert line.

o If the dilatation is prolonged and touches the alert line, this alerts the doctor to reassess the patient to see where the problem is.

- N.B.: The rate of cervical dilatation during the active phase is usually aroundprimipara and around 1.5cm/h in mul para.

When the head goes through the pelvis, it gets compressed. The bones of the get overlapped.

If the suture is still felt → the molding is 0.If the bones are just touching each other "approximation" → the molding is +.

bones are slightly overlapped and still reducible,→ the molding is ++.

If the bones are severely overlapped and non-reducible +++ is a risk for intracranial hemorrhage

Mild molding (+ or ++) are part of the normal labour as they help to facilitate the passage of the baby since it decreases the transverse diameter of the fetal

. However, the severe molding (+++) is harmful as it may lead to hemorrhage.

Measured in cm.cervical dilatation measured on the admission to the labour ward is

recorded at 0 me in the chart.Further examina on are made at least every 4 hours, preferably every 2 hours in active stage of labour until full dilatation.The WHO put 2 lines:

line.Action line.

The cervix should be fully dilated and the head engaged before reaching the

If the dilatation is prolonged and touches the alert line, this alerts the doctor to reassess the patient to see where the problem is.

.: The rate of cervical dilatation during the active phase is usually aroundprimipara and around 1.5cm/h in mul para.

pressed. The bones of the

bones are slightly overlapped and still reducible,

reducible → the molding is +++.

labour as they help to facilitate since it decreases the transverse diameter of the fetal

severe molding (+++) is harmful as it may lead to

dilatation measured on the admission to the labour ward is

Further examina on are made at least every 4 hours, preferably every 2 hours

The cervix should be fully dilated and the head engaged before reaching the

If the dilatation is prolonged and touches the alert line, this alerts the doctor to

.: The rate of cervical dilatation during the active phase is usually around 1 - 1.2cm/h in

o If it is prolonged till it touches the action line, the doctor should take an action: If there are no signs

If there are signs of obstruction or fetal distress

o The problem can be in: Power, Passage, or Passenger.

Power (Uterine Contraction): o The uterine contraction should be effective.o At least 3 contrac ons every 3 minutes.o Each contrac on lasts for 40 o In the first stage, only the power of contraction is needed whereas in the second

stage bearing down of the mother is also neededPassage (Pelvis):

o She may have a narrow pelvis.o Assessed by pelvimetry to see the AP diameter.

Passanger (Fetus):o The fetus may be big.o Malpresentation.o Malposition.

F. Descent of the Head:o The descend of the head is assessed by abdominal examination

rule of fifth.Rule of Fifth:

- The number of palpable fifths felt above the symphysis pubis.

- Each finger represents 1/5.

Assessed every and recorded two hours.

If it is prolonged till it touches the action line, the doctor should take an action:If there are no signs of obstruction or fetal distress

→ Oxytocin infusion.Ventouse or forceps are used if needed.

If there are signs of obstruction or fetal distress → Cesarean sec on.

The problem can be in:

Passage, orPassenger.

The uterine contraction should be effective.At least 3 contrac ons every 3 minutes.Each contrac on lasts for 40 – 60 mins.In the first stage, only the power of contraction is needed whereas in the second stage bearing down of the mother is also needed.

She may have a narrow pelvis.Assessed by pelvimetry to see the AP diameter.

The fetus may be big.

The descend of the head is assessed by abdominal examination

Assessed every and recorded two hours.

N.B: cervical dilatation is marked with ( X ) and drawn as going up. Head descend (engagement) is marked with ( O ) and drawn as going down.

If it is prolonged till it touches the action line, the doctor should take an action:of obstruction or fetal distress

Ventouse or forceps are used if needed.If there are signs of obstruction or fetal distress

In the first stage, only the power of contraction is needed whereas in the second

The descend of the head is assessed by abdominal examination following the

: cervical dilatation is marked with ( X ) and drawn as going up.Head descend (engagement) is marked with ( O ) and drawn as going

o Assess also, the station of the head by vaginal examination: Sta on 0: at the level of ischial spine. Sta on +1: 1cm Sta on +2: 2cm above the ischial spine,…etc.

Station -1: 1cm below the ischial spine. Station -2: 2cm below

G. Uterine Contraction:o There are ver cal columns of 5 squares in the partogram for

of contractions.o Each square represents one contraction.

Assess the number of contrac ons in 10 mins period. Assess the duration of each contraction:

Measure in seconds from the time when the contraction is first felt abdominally until t

o Normally, there should be at least 3 contrac onscontraction lasts at least

o If the contractions are less

o CTG can be used to confirm the uterine contractions.o It helps to assess the amplitude, duration and number of contractions.o It also, measures the fetal heart rate.

Less than 20 seconds.

Between 20 – 40 seconds.

More than 40 seconds.

CONTRACTIONS

PER 10 MINS

Assess also, the station of the head by vaginal examination:Sta on 0: at the level of ischial spine.Sta on +1: 1cm above the ischial spine.Sta on +2: 2cm above the ischial spine,…etc.

1: 1cm below the ischial spine.2: 2cm below the ischial spine,…etc.

There are ver cal columns of 5 squares in the partogram for

Each square represents one contraction.Assess the number of contrac ons in 10 mins period.Assess the duration of each contraction:

Measure in seconds from the time when the contraction is first felt abdominally until the contraction phases off.

Normally, there should be at least 3 contrac onsevery 10 minscontraction lasts at least for 40 mins.If the contractions are less → called hypotonic uterine action

CTG can be used to confirm the uterine contractions.It helps to assess the amplitude, duration and number of contractions.It also, measures the fetal heart rate.

40 seconds.

Assess also, the station of the head by vaginal examination:

There are ver cal columns of 5 squares in the partogram for graphic recording

Assess the number of contrac ons in 10 mins period.

Measure in seconds from the time when the contraction is first he contraction phases off.

every 10 mins, and each

hypotonic uterine action.

It helps to assess the amplitude, duration and number of contractions.

H. Oxytocin: o Oxytocin is a synthetic hormone used to stimulate uterine contractions.o The concentration is recorded on the upper line and the rate of infusion

(drops/min) is recorded in the bottom line.o They are noted from the time the IV drip is started.o It is quite important to monitor oxytocin infusion because over dose may lead

to uterine rupture. So that it has a separate part in the partogram.

I. Drugs Given and IV fluids:o All given drugs and fluids during the labour should be recorded with their

dosage, and routes of administration.

J. Blood Pressure, Pulse & Temperature of the Mother:o The blood pressure is recorded every 2 hours.o The pulse is recorded every 30 mins.o The maternal temperature is also recorded in the bottom line.

K. Urine:o The amount of the urine is noted.o A urine sample is obtained and checked for the presence of ketones and

proteins.o Proteinuria and hypertension are seen with preeclampsia.o Ketones (acetones): with DKA.

Advantages of Partogram All the necessary information is on a single sheet of paper which is easier than making

detailed notes. It is a straightforward. Both nursing and medical staffs can understand the progress of

labour by looking to it and this will facilitate to them to distribute their duties. It has a good value to estimate the expected time of delivery in case of normal progress. It serves as an early warning in case of impending problems so, that a proper action is

considered.