PARTOGRAPH

Monitor during labor

1. Progress of labor – cervical dilatation;
contraction pattern
2. Maternal well being – T,P, BP, urine voided
3. Fetal well being – FHT, Pattern, Color of
Amniotic fluid
 PARTOGRAPH

Conditions that do NOT need the use of partograph:

• Antepartum hemorrhage
• Severe pre – eclampsia & Eclampsia
• Fetal distress
• Previous CS
• Multiple pregnancy
• Malpresentation
• Very premature baby
• Obvious obstructed labor
Ruptured membranes + clear liquor….……..…C
Intact membranes………………………….………..….I
Ruptured membranes + meconium – stained
liquor…………….…………………………………….…M
Ruptured membranes + blood – stained
liquor………………….………………………………..…B
Ruptured membranes + absent liquor…...…..A
 PARTOGRAPH

If plotting passes alert line…..

• Reassess woman & consider criteria referral
• Alert transport services
• Encourage woman to empty bladder
• Encourage upright position and walking as the
woman wishes
• Monitor intensively
 PARTOGRAPH

**If woman is admitted in LATENT PHASE of

labor (less than 4cm) – record only other
findings (BP,FHT etc.)

**If she remains in latent phase for the next 8

hours (labor is prolonged) transfer her to the
hospital
CASE 1
Maria, G2P1 was admitted today at 2 am, IE showed a
5cm dilated cervix, cephalic, intact BOW, BP =
110/70, PR 88/min, afebrile. FHT = 140/min.
She had moderate contractions (3 in 10 min.). At 6 am,
the BOW ruptured with clear amniotic fluid. IE
showed 8 cm dilated cervix. Vital Signs were the
same.
At 8 am, cervix was 9 cm. She delivered spontaneously
at 8:30 am. 10 u oxytocin was given. Placenta was
delivered complete at 8:35 am.
CASE 2
Lourdes, G4P1 was admitted at 1 pm today due to
watery discharge. The cervix was 3 cm, cephalic,
intact BOW (clear amniotic fluid). BP=120/80,
pr=80/ min. T=36.5
At 5 pm, contractions were moderate, 3 in 10
min.IE showed cervix 4 cm dilated. VS remained
the same.
At 9 pm, your IS showed 6 cm dilated cervix. At 1
am, another IE done showed 8 cm dilated,
meconium stained fluid. BP – 110/70. PR = 92/
min, T = 37.5, FHT = 140/ min.
CASE 3
Marites, G1P0 was admitted at 6 pm, BP = 120/80,
PR=84/min, T=36.5, FHT 150/min, cervix 5 cm
dilated (+) BOW. She had 2-3 uterine contractions in
10 min.
After 4 hours, IE showed 7 cm dilated cervix. VS and
FHT were the same.
At 12 am, another IE done showed 8 cm dilated cervix.
Negative BOW, clear amniotic fluid, FHT= 140/min.
Another IE after 2 hours was the same. FHT = 144/min,
VS = same
 ESSENTIAL INTRAPARTUM CARE
UNNECESSARY INTERVENTIONS (7 = FEERRRS)
1. FUNDAL PRESSURE

Before: helps with the Now: X

- Maternal morbidities: perineal
expulsion of the fetus tears, uterine rupture, uterine
inversion, hypotension &
respiratory distress
- Newborn: injuries to the brachial
plexus, spinal cord & liver, rib,
humeral and clavicular fractures,
hypoxemia, asphyxia, increased
ICP, cord compression &
subgeleal hemorrhage
**wait for the delivery of the baby,
allow passive fetal descent and
delayed pushing
 ESSENTIAL INTRAPARTUM CARE
UNNECESSARY INTERVENTIONS (7 = FEERRRS)
2.. EARLY AMNIOTOMY & OXYTOCIN AUGMENTATION

Before: shorten the Now: X

second stage of labor - may restrict maternal
movement; increase
risk of infection
- “ creates a sense of
urgency” ; Need to
deliver the baby 24
hours post amniotomy
 ESSENTIAL INTRAPARTUM CARE
UNNECESSARY INTERVENTIONS (7 = FEERRRS)
3. ENEMA

• Before: decrease risk of • Now: can cause

infections, shorten the discomfort for woman
duration of labor and and increase pain;
make delivery cleaner should NOT be
administered NOT
UNLESS the patient
specifically requests for
one
 ESSENTIAL INTRAPARTUM CARE
UNNECESSARY INTERVENTIONS (7 = FEERRRS)
4. RESTRICTED INTAKE OF FOOD & FLUIDS
Before: NPO = risk for Now: CAN EAT = normal low
aspiration risk birth
- a need for energy during
labor & delivery
- easy to digest food and
fluids
NPO – CS or at risk

UNNECESSARY INTERVENTIONS (7 = FEERRRS)
Before – for hydration, provide
a quick access in case of
emergency
ESSENTIAL INTRAPARTUM CARE
5. ROUTINE IVF
Now – only for high risk
- life threatening emergencies are
rare for “low risk” women
- painful and stressful and it
disrupts the natural birthing
process since it hinders the
woman’s freedom for movement
in labor
***adverse effects w/ IVF use since
infusions of glucose solutions to
the mother will interfere w/
glucose & insulin levels in both
the mother & baby
***risk for fluid overload & adverse
effects on the baby
 ESSENTIAL INTRAPARTUM CARE
UNNECESSARY INTERVENTIONS (7 = FEERRRS)
6. ROUTINE EPISIOTOMY

Before – to protect the Now – X

perineum, the pelvic - episiotomy is associated
floor and the fetus from with more pain,
injury during child birth, incontinence and sexual
prevent incontinence problems than
spontaneous tearing of
the perineum
 ESSENTIAL INTRAPARTUM CARE
UNNECESSARY INTERVENTIONS (7 = FEERRRS)
7. SHAVING

Before: routine = hygienic • Now: may protect

practice to minimize risk against bacterial
of infection if there is colonization but no
spontaneous perineal effect on perineal
tear and facilitates
repair of these tears wound infection. No
significant difference in
the incidence of
- common feedback of postpartum maternal
pain, embarrassment
and discomfort during febrile morbidity.
hair regrowth
 Every Newborn Has Needs

• To breathe
normally
• To be warm
• To be protected
• To be fed
 What
Immediate
Newborn
Care
Practices
Save Lives?
Antenatal Steroids
 Antenatal Steroids

• Betamethasone
12 mg IM q 24 hrs x 2 doses
May be the preferred drug – less PVL
• Dexamethasone
6 mg IM q 12 hrs x 4 doses
Have dexamethasone available in the E-cart
• No additional benefit to using higher or more
frequent doses
• Prednisone, methylprednisolone, cortisol are
unreliable
 Providing Warmth: Check the
Environment

• Check temperature of
the delivery room*
• deal temp: 25 – 28°C
• Check for air drafts
• Turn air conditioner
off at time of delivery
• *non-mercury
thermometer
• A. Clamp and cut the cord
• B. Dry the baby
• C. Suction the baby’s mouth and nose
• D. Do foot printing
• A. Clamp and cut the cord
• B. Dry the baby
• C. Suction the baby’s mouth and nose
• D. Do foot printing
• A. Suction the baby’s mouth and nose
• B. Clamp and cut the cord
• C. Do skin-to-skin contact
• D. Do early latching on
• A. Suction the baby’s mouth and nose
• B. Clamp and cut the cord
• C. Do skin-to-skin contact
• D. Do early latching on
• A. When the cord pulsations stop
• B. Between 1 and 3 minutes
• C. Not less than 1 minute in terms
and preterms not needing PPV
• D. All of the above are appropriate
• A. When the cord pulsations stop
• B. Between 1 and 3 minutes
• C. Not less than 1 minute in terms
and preterms not needing PPV
• D. All of the above are appropriate
• A. True
• B. False
• A. True
• B. False
A

B
C
D
A

B
C
D
• A. Immediately
• B. 5-9 minutes
• C. 10-19 minutes
• D. 20-60 minutes
• A. Immediately
• B. 5-9 minutes
• C. 10-19 minutes
• D. 20-60 minutes
 UNECESSARY INTERVENTION
(5= FERRG)
1. FOOTPRINTING
Now – X
Before – yes
- EINC practice of non –
= risks of cross separation from the
contamination mother minimizes risks
- DNA genotyping and
human leukocyte
antigen tests are better
methods for
identification
 UNECESSARY INTERVENTION
(5= FERRG)
2. EARLY BATHING & WASHING

Before – bathe immediately Now – wait for 6 hours after delivery

- early bathing causes hypothermia
= increased risk for infection,
coagulation defects, acidosis,
delayed fetal – to- newborn
circulatory adjustment, hyaline
membrane disease & intracranial
hemorrhage
- Washes away the vernix caseosa
(anti – microbial properties)
- Washing makes the baby
disorganized = hinders crawling
reflex during the first hour of life
 UNECESSARY INTERVENTIONS
(5 = FERRG)
3. ROUTINE SUCTIONING

Before – to clear Now - X

airways
= bradycardia, apnea,
delays in achieving
normal O2
saturations,
mucosal trauma,
infection
 UNECESSARY INTERVENTION
(5 = FERRG)
4. ROUTINE SEPARATION
Before – even normal Now – skin to skin contact
deliveries are placed in the
nursery immediately after birth
- can postpone latching on, - babies stay warm, cry
rooming in, restrictions on less, more likely to
BF (compromise skin
colonization of the newborn
breastfeed
with maternal skin flora,
ummunoprotection, milk
production)
 UNECESSARY INTERVENTION
(5 = FERRG)
5. GIVING GLUCOSE WATER OR ARTIFICIAL
SUBSTITUES

Now – BF
Before – trial feeding
- delays milk
letdown, ease of
feeding from the
bottle decreases
the urge to suckle
- Exposed to
different kinds of
infection
http://www.wpro.who.int/philippines/areas/
maternal_child_nutrition/newborn_mother
_care/en/