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Page 1
Partograph
Shrooti Shah
Lecturer
National Medical College Nursing Campus
Page 2
Definition
• It is a composite graphical recording of cervical
dilatation and descent of head against duration of
l...
Page 3
Page 4
History
• E.A. freidman in 1954 provide a foundation basis for
development of partograph on the basis of
observatio...
Page 5
Advantage of using Partograph
1. A single sheet of paper can provide details of
necessary information at a glance.
...
Page 6
Advantage of using Partograph…
5. It facilitates handover procedure of staffs.
6. Save working time of staff agains...
Page 7
Principles of plotting partograph
• The active phase of labour commence at 4 cm
cervical dilatation.
• The latent p...
Page 8
Method of recording partograph
• Patient information: Fill out name, gravida, para,
hospital number, date and time ...
Page 9
Method of recording partograph
• Fetal heart rate: The rate of the fetal heart rate
indicates the state of the fetu...
Page 10
Method of recording partograph
• Amniotic fluid: Record the colour of amniotic
fluid at every vaginal examination:...
Page 11
Moulding
• Moulding is a state of reduction or loss of space between
skull bones.
• Presence of increased moulding...
Page 12
Cervical dilatation
• Assessed at every vaginal examination and marked
with a cross (X).
• Begin plotting on the p...
Page 13
Cervical dilatation
Page 14
Cervical dilatation
• The cross (X) in the graph are joined by a continuous
line begin plotting on the partograph ...
Page 15
Descent of the head
• This is assessed by abdominal examination before
doing vaginal examination.
• Refers to the ...
Page 16
Descent of the head
Page 17
• Hours: Refers to the time elapsed since onset of
active phase of labour.
• Time: Record actual time.
Page 18
Uterine contractions
• Uterine contractions are recorded graphically on the
partograph according to their strength...
Page 19
Uterine contraction
Page 20
Uterine contraction
Page 21
Oxytocin drip
• This consists of two lines, one for the record of unit
of oxytocin per liter of intravenous fluid ...
Page 22
Drugs and other intravenous fluids
• Record any additional drug given and are
recorded at the particular point of ...
Page 23
Maternal condition
• Pulse: Record every 30 minutes and mark with a dot (.).
• Blood pressure: Record every 4 hour...
Page 24
Urine analysis
• During the course of labour, the examination of urine
is important.
• In case of maternal distres...
Page 25
Exercises
Page 26
Exercise 1
• Mrs. Sita pokharel, 25 yrs old, Primigravida was
admitted in the latent phase of labour at 5 AM
2072/...
Page 27
Exercise 1
• At 9 AM:
- Fetal heart rate; 134/min
- Membrane: intact
- Moulding : sutures are not apposed.
- Fetal...
Page 28
Exercise 1
• 9: 30 a.m: FHR 120, contraction 3/10 each 30
seconds, pulse 80/min
• 10:00 a.m.: FHR 136, contraction...
Page 29
Exercise 1
• 11:30 a.m.: FHR 136, contraction 3/10 each 40
seconds, pulse 84/min
• 12:00 p.m.: FHR 140, contractio...
Page 30
Exercise 1
• At 1 PM:
- Fetal heart rate: 140/min
- Membrane ruptured, amniotic fluid : Clear, Moulding: not
prese...
Page 31
Exercise 2
• Mrs. Rita Rai was admitted at 10 am on
2072/10/13, Membranes ruptured at 4 am,
Gravida 3, Para 2, Hos...
Page 32
Exercise 2
• Sutures apposed
• Blood pressure: 120/70 mm of Hg
• Temperature : 98° F
• Pulse: 80/minute
• Urine ou...
Page 33
Exercise 2
• 10: 30 am: FHR 130, contractions 3/10 each 35
sec, Pulse 80/minute
• 11: 00 am: FHR 136, contractions...
Page 34
Exercise 2
• 12: 30 pm: FHR 130, contractions 3/10 each 40
sec, Pulse 90/minute
• 1: 00 pm: FHR 130, contractions ...
Page 35
Exercise 2
• 2:30 p.m.: FHR 120, contraction 4/10 each 40 secs,
pulse 90/min, clear fluid
• 3:00 p.m.: FHR 120, co...
Page 36
Exercise 2
• At 5:00 p.m.:
• Fetal head 3/5 palpable above the symphysis
pubis
• Cervix 6 cm dilated
• Amniotic fl...
Page 37
Exercise 3
• Mrs. Sarita` was admitted at 10 am on 14/10/2072.
• Membrane Intact
• Gravida 1 para 0
• Hospital no....
Page 38
Exercise 3
• At 10 am: Blood pressure: 100/70 mm of Hg,
Temperature: 97, Pulse: 80/min, Urine output: 400ml,
negat...
Page 39
Exercise 3
• 12:30 p.m: FHR: 136, contraction 1/10 each 20 sec,
pulse 90/min
• 1:00 p.m: FHR: 140, contraction 2/1...
Page 40
Exercise 3
• 2:30p.m: 2 contractions in 10 minutes, each lasting 30
seconds, infused rate increased to 20 dpm, FHR...
Page 41
Exercise 3
• At 4:30 p.m: 3 contractions in 10mins,each lasting
45secs, FHR;140/min, Pulse:90/min, infusion remain...
Page 42
Exercise 3
• At 7:00 p.m.: Fetal head 0/5 palpable, 4 contractions in
10 minutes, each lasting 50 seconds, FHR; 14...
Page 43
Practice doesn’t make man perfect,
perfect practice makes man perfect, so
keep practising….
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Partograph

It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.

It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.

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Partograph

  1. 1. Page 1 Partograph Shrooti Shah Lecturer National Medical College Nursing Campus
  2. 2. Page 2 Definition • It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours. • It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
  3. 3. Page 3
  4. 4. Page 4 History • E.A. freidman in 1954 provide a foundation basis for development of partograph on the basis of observation of large number of woman in labour. • After that, the composite picture of labour was reported by philpott in 1972, who combined details of progress of labour together with information about fetal and maternal conditions.
  5. 5. Page 5 Advantage of using Partograph 1. A single sheet of paper can provide details of necessary information at a glance. 2. No need to record labour events repeatedly 3. Gives clear picture of normality and abnormality in labour. 4. It can predict deviation from duration of labour. So appropriate steps could be taken in time.
  6. 6. Page 6 Advantage of using Partograph… 5. It facilitates handover procedure of staffs. 6. Save working time of staff against writing labour notes in long hand. 7. Educational value for all staff.
  7. 7. Page 7 Principles of plotting partograph • The active phase of labour commence at 4 cm cervical dilatation. • The latent phase of labour should not last longer than 8 hours. • During active labour, the rate of cervical dilatation should not be slower than 1cm/hours. • A lag time at 4 hours between a slowing of labour and the need for intervention is unlikely to compromises the fetus or the woman and avoid unnecessary intervention
  8. 8. Page 8 Method of recording partograph • Patient information: Fill out name, gravida, para, hospital number, date and time of admission and time of ruptured membranes.
  9. 9. Page 9 Method of recording partograph • Fetal heart rate: The rate of the fetal heart rate indicates the state of the fetus inside the uterus. Record every half hour.
  10. 10. Page 10 Method of recording partograph • Amniotic fluid: Record the colour of amniotic fluid at every vaginal examination: • I: membranes intact; • C: membranes ruptured, clear fluid; • M: meconium-stained fluid; • B: blood-stained fluid.
  11. 11. Page 11 Moulding • Moulding is a state of reduction or loss of space between skull bones. • Presence of increased moulding of the head high in the pelvis indicates CPD. • Recording of degree of moulding • 0: Bones are separated and sutures can be felt easily • 1: sutures apposed • 2: sutures overlapped but reducible • 3: sutures overlapped and not reducible
  12. 12. Page 12 Cervical dilatation • Assessed at every vaginal examination and marked with a cross (X). • Begin plotting on the partograph at 4 cm. • This graph consists of homogenous squares, ten square vertically, each square indicate one centimeter of cervical dilatation.
  13. 13. Page 13 Cervical dilatation
  14. 14. Page 14 Cervical dilatation • The cross (X) in the graph are joined by a continuous line begin plotting on the partograph at 4 cm. • The climbing tendency of this line normally lies on the left of the middle of the graph. • Alert line: A 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
  15. 15. Page 15 Descent of the head • This is assessed by abdominal examination before doing vaginal examination. • Refers to the part of the head (divided into 5 parts) palpable above the symphysis pubis. • Recorded as a circle (O) at every vaginal examination.
  16. 16. Page 16 Descent of the head
  17. 17. Page 17 • Hours: Refers to the time elapsed since onset of active phase of labour. • Time: Record actual time.
  18. 18. Page 18 Uterine contractions • Uterine contractions are recorded graphically on the partograph according to their strength and frequency. • Observation of contraction is made half hourly in the active phase. • Palpate the number of contractions in 10 minutes and their duration in seconds
  19. 19. Page 19 Uterine contraction
  20. 20. Page 20 Uterine contraction
  21. 21. Page 21 Oxytocin drip • This consists of two lines, one for the record of unit of oxytocin per liter of intravenous fluid and other one is for drop of fluid per minute. • The recording can be made at the interval of 30 minutes as the uterine contraction
  22. 22. Page 22 Drugs and other intravenous fluids • Record any additional drug given and are recorded at the particular point of time. • This includes sedatives, antibiotics, IV fluids etc. The name of the drugs and doses given should be written clearly in the long box.
  23. 23. Page 23 Maternal condition • Pulse: Record every 30 minutes and mark with a dot (.). • Blood pressure: Record every 4 hours and mark with arrows. • Temperature: Record every 2 hours.
  24. 24. Page 24 Urine analysis • During the course of labour, the examination of urine is important. • In case of maternal distress the volume of urine may decrease and it may contain ketone bodies.
  25. 25. Page 25 Exercises
  26. 26. Page 26 Exercise 1 • Mrs. Sita pokharel, 25 yrs old, Primigravida was admitted in the latent phase of labour at 5 AM 2072/10/14: - fetal head 4/5 palpable; - cervix dilated 2 cm; - 3 contractions in 10 minutes, each lasting 20 seconds; - normal maternal and fetal condition.
  27. 27. Page 27 Exercise 1 • At 9 AM: - Fetal heart rate; 134/min - Membrane: intact - Moulding : sutures are not apposed. - Fetal head is 3/5 palpable - Cervix dilated 5 cm - 4 contractions in 10 minutes, each lasting 20 seconds - Mother’s Pulse: 80/min, BP: 110/70 mm of Hg, Temp: 98°F
  28. 28. Page 28 Exercise 1 • 9: 30 a.m: FHR 120, contraction 3/10 each 30 seconds, pulse 80/min • 10:00 a.m.: FHR 136, contraction 3/10 each 30 seconds, pulse 80/min • 10:30 a.m.: FHR 140, contraction 3/10 each 35 seconds, pulse 88/min • 11:00 a.m.: FHR 130, contraction 3/10 each 40 seconds, pulse 88/min, Temp: 98 F
  29. 29. Page 29 Exercise 1 • 11:30 a.m.: FHR 136, contraction 3/10 each 40 seconds, pulse 84/min • 12:00 p.m.: FHR 140, contraction 4/10 each 40 seconds, pulse 88/min • 12:30 p.m.: FHR 130, contraction 4/10 each 45 seconds, pulse 88/min • 1:00 p.m.: FHR 140, contraction 4/10 each 45 seconds, pulse 90/min
  30. 30. Page 30 Exercise 1 • At 1 PM: - Fetal heart rate: 140/min - Membrane ruptured, amniotic fluid : Clear, Moulding: not present - Fetal head is 0/5 palpable; - cervix is fully dilated; - 4 contractions in 10 minutes each lasting 45 seconds; - spontaneous vaginal delivery occurred at 2:20 PM. - Alive male infant weighing 3000gms.
  31. 31. Page 31 Exercise 2 • Mrs. Rita Rai was admitted at 10 am on 2072/10/13, Membranes ruptured at 4 am, Gravida 3, Para 2, Hospital number 7886. • Fetal head 3/5 palpable above the symphysis pubis • Cervix 4 cm dilated • 3 contractions in 10 minutes, each lasting 30 seconds • FHR :140/min • Amniotic fluid: Clear
  32. 32. Page 32 Exercise 2 • Sutures apposed • Blood pressure: 120/70 mm of Hg • Temperature : 98° F • Pulse: 80/minute • Urine output: 200ml, negative protein and acetone
  33. 33. Page 33 Exercise 2 • 10: 30 am: FHR 130, contractions 3/10 each 35 sec, Pulse 80/minute • 11: 00 am: FHR 136, contractions 3/10 each 40 sec, Pulse 90/minute • 11: 30 am: FHR 140, contractions 3/10 each 40 sec, Pulse 88/minute • 12: 00 MD: FHR 140, contractions 3/10 each 40 sec, Pulse 90/minute, Temperature 97°F
  34. 34. Page 34 Exercise 2 • 12: 30 pm: FHR 130, contractions 3/10 each 40 sec, Pulse 90/minute • 1: 00 pm: FHR 130, contractions 3/10 each 45 sec, Pulse 88/minute • 1:30 pm: FHR 130, contractions 3/10 each 50 sec, Pulse 90/minute • 2:00 pm: FHR 130, contractions 4/10 each 45 sec, Pulse 90/minute, Temperature 97°F, Blood pressure 100/70 mm of Hg • Fetal head: 3/5 palpab;e, cervix : 6cm dilated, sutures overlapped but reducible
  35. 35. Page 35 Exercise 2 • 2:30 p.m.: FHR 120, contraction 4/10 each 40 secs, pulse 90/min, clear fluid • 3:00 p.m.: FHR 120, contraction 4/10 each 40 secs, pulse 88/min, blood stained fluid • 3:30 p.m.: FHR 100, contraction 4/10 each 45 secs, pulse 100/min • 4:00 p.m.: FHR 90, contraction 4/10 each 50 secs, pulse 100/min, Temperature 97°F • 4:30 p.m.: FHR 96, contraction 4/10 each 50 secs, pulse 100/min • 5:00 p.m.: FHR 90, contraction 4/10 each 50 secs, pulse 110/min
  36. 36. Page 36 Exercise 2 • At 5:00 p.m.: • Fetal head 3/5 palpable above the symphysis pubis • Cervix 6 cm dilated • Amniotic fluid meconium stained • Sutures overlapped and not reducible • Urine output 100 ml; protein negative, acetone 1+ • Cesearean section at 5:30 p.m., live female infant, weight: 4500gms
  37. 37. Page 37 Exercise 3 • Mrs. Sarita` was admitted at 10 am on 14/10/2072. • Membrane Intact • Gravida 1 para 0 • Hospital no. 1443 • The fetal head is 5/5 palpable above the symphysis pubis • The cervix is 4 cm dilated • 2 contractions in10 minutes, each lasting less than 20 seconds • FHR 140/min • Membrane - Intact
  38. 38. Page 38 Exercise 3 • At 10 am: Blood pressure: 100/70 mm of Hg, Temperature: 97, Pulse: 80/min, Urine output: 400ml, negative: Protein and acetone • 10:30 am: FHR:140, contraction 2/10 each 15 sec, Pulse 90/min • 11:00 am: FHR: 136, contraction 2/10 each 15 sec, pulse 88/min • 11:30 am: FHR: 140, contraction 2/10 each 20 sec, pulse 84/min • 12:00 MD: FHR: 136, contraction 2/10 each 20 sec, pulse 88/min, temperature: 98F, fetal head: 5/5 palpable, cervix: 4cm, membrane: intact
  39. 39. Page 39 Exercise 3 • 12:30 p.m: FHR: 136, contraction 1/10 each 20 sec, pulse 90/min • 1:00 p.m: FHR: 140, contraction 2/10 each 20 sec, pulse 84/min • 1:30 p.m: FHR: 130, contraction 2/10 each 20 sec, pulse 88 • 2:00 p.m: FHR: 140, contraction 2/10 each 20 sec, pulse 90/min, Temperature 98F, Blood pressure :100/70 mm of Hg. The fetal head is 5/5 palpable, urine output: 300ml, negative protein and acetone, cervix: 4cm, sutures apposed, Labour augmented with 5 units oxytocin in 500ml RL @10d/min, Membranes artificially ruptured, clear fluid
  40. 40. Page 40 Exercise 3 • 2:30p.m: 2 contractions in 10 minutes, each lasting 30 seconds, infused rate increased to 20 dpm, FHR;140, pulse 90/min. • 3:00 p.m.: 3 contractions in 10 minutes, each lasting 30 seconds, infusion rate: 30d/min, FHR: 140, Pulse: 88/min • 3:30 p.m.: 3 contractions in 10 minutes, each lasting 30 seconds, infusion rate: 40d/min, FHR: 140, Pulse: 88/min • 4:00 p.m: Fetal head 2/5 palpable, cervix 6cm, sutures apposed, 3 contractions in 10 minutes, each lasting 30 seconds, FHR; 144/min, Pulse: 92/min, Amniotic fluid: Clear
  41. 41. Page 41 Exercise 3 • At 4:30 p.m: 3 contractions in 10mins,each lasting 45secs, FHR;140/min, Pulse:90/min, infusion remains at 50d/min • At 5:00 p.m: FHR 138, Pulse 92/min, contractions 3/10 each 40 sec, Maintain at 50d/min. • At 5:30 p.m: FHR 140, Pulse 94/min, contractions 3/10 each 45 sec, Maintain at 50d/min. • At 6:00 p.m: FHR 140, Pulse 96/min, contractions 4/10 each 50 sec, Maintain at 50d/min. • At 6:30 p.m: FHR 144, Pulse 94/min, contractions 4/10 each 50 sec, Maintain at 50d/min.
  42. 42. Page 42 Exercise 3 • At 7:00 p.m.: Fetal head 0/5 palpable, 4 contractions in 10 minutes, each lasting 50 seconds, FHR; 144/min, pulse: 90/min, cervix fully dilated • At 8:10 p.m.: Spontaneous vaginal delivery. alive male infant weighing 2,600 gms
  43. 43. Page 43 Practice doesn’t make man perfect, perfect practice makes man perfect, so keep practising….

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