Partograph

When Partograph should be initiated

When Cervical Dilatation is 4 cm Uterine contractions two or more in 10min. and last for at least 20 seconds.

Points to remember while using Partograph

It is only a tool for managing labour progress Only start partograph who dont have complications and doesn't require Referral. Progress of labour is satisfactory, if the plotting of cervical dilation remain on/to the left of the Alert line Cervical dilation plotted as X Assessing descent of the head helps in detecting progress of labour Infrequent vaginal examination (once in every 4hrs) When the woman arrives to the hospital the time of admission is O time A woman whose cervical dilation moves to the right of the Alert line must be transferred for obstetric interventions

Case A
Glenda was admitted at 12:00pm, G2 P1, BP=110mmHg,, PR = 90bpm, FHR,=130bpm, T=36.8CIE showed 5cm dilated cervix Still with (+) BOW

At 4pm, FHR=140bpm, cervix dilatation is 7cm, BP=120/90mmHg, (+)BOW

At 5:00pm, cervix was 9cm (-) BOW clear, she delivered spontaneously at 5:30pm. 10U oxytocin given IM. Placenta was delivered at 5:30pm.

Quick action warranted in labour during following conditions

Delay in cervical dilatation is 1cm/hr Delay in descent of the head FHR < 120 or > 160/min. on 3 observation ROM and Meconium stained ROM and Absence of liquor and fetal skull Moulding with bones touching each other / overlapping / severe overlapping

CONCLUSION
The partograph gives healthcare providers objective data on which to base their clinical decisions and enhances communication among members of the team of providers who are caring for the mother, so that decisions can be made in a timely manner.