Topic: PARTOGRAPH

Subject : Midwifery & Obs Nsg-1

Introduction

Partograph is a graphic display of progress of labor. The concept of recording the progress of labor on a chart was introduced by Friedman (1952). Partograph is a most useful graphical record of the course of labor. Once labor has become established or the membranes have ruptured, all events during labour should be noted on a partograph.

Definition

The partograph is a record of all the observation made on a woman in labor. It is a graphical representation of progress of labor, maternal condition and fetal condition.

Or

It is a composite graphical record of cervical dilatation and descent of head against duration of labor in hours. It also gives information about fetal and maternal conditions that are all recorded on a single sheet of paper.

Importance / Advantages of parto-graph plotting: The importance of plotting the partograph in labor are given bellow-

  1. Partograph can provide details necessary information about maternal and fetal condition at a glance.
  2. It helps early detection of normal and abnormal progress of labor. So, that appropriate steps can be taken in time.
  3. It is possible to estimate the expected time of delivery, in case of everything is normal.
  4. It serves an early warning in case of impending problem.
  5. It helps to detect prolonged and obstructed labor and cephalo-pelvic disproportion earlier.
  6. It facilitates handover formalities of medical and nursing staff.
  7. It helps to detect the timing of transfer, augmentation and termination of labor if needed.
  8. It helps to transfer the high risk clients during labor immediately from community to hospital.
  9. It helps to reduce the incidence of caesarean section rate.
  10. Ultimately, it helps to reduce the incidence of maternal and perinatal mortality and morbidity.

Equipment’s needed for partograph plotting

  1. Partograph sheet
  2. Stethoscope or Doppler machine
  3. Gloves
  4. Blood pressure cup or sphygmomanometer
  5. Thermometer
  6. Drug if prescribed
  7. Watch
  8. Pen

Component of partograph: The component of partograph are given bellow-

  1. Particulars of patients: includes name, para, gravida, registration/hospital number, date and time of admission, time of rupture membrane is written at the top of the graph.
  2. Fetal condition/fetal part
  3. Fetal heart rate: Fetal heart rate is recorded half hourly and plotted by
  4. Colour and amount of liquor: Record the colour at every vaginal examination. Amniotic fluid is observed and recorded by-
  5. If membranes are intact then marked I
  6. When membranes are ruptured then marked by-
  7. Clear fluid then marked by -C
  8. Meconium stained -M
  • Blood stained – B
  1. Absent -A
  2. Intact – I
  3. Molding of the fetal skull: This is the extent to which the bones of the fetal skull are overlapping each other as the baby’s head. You should assess the degree of moulding initially and every 4 hours. The degree of moulding recorded as-

 

0

Cranial bones are separated and the suture can be felt easily

+

Bones are just touching each other

++

Bones are little overlapping

+++

Bones are overlapping severely and cannot be pushed level with the fingers

  1. Progress of labor/ Labor part:
  2. Cervical dilatation: The dilation are plotted with X. When the cervical dilatation is 4 cm then the partograph will be started and further examination made every 4 hourly. The first plotting should be on the alert line.
  3. Time: Recorded at hourly interval.
  4. Descend of the head: The descend of the head is plotted with . Descent of head measured in fifth by bimanual abdominal palpation. The descent of the head recorded as-
5/5 4/5 3/5 2/5 1/5 0/5
“Floating”above the brim “Fixing” Not engaged Just engaged Engaged Deeply engaged

Figure: Descent of the head, measured in fifths by bi-manual abdominal palpation.

  1. Uterine contraction: Shade one squire for each contraction recorded. Plotted every half an hour. Plotted the number of contraction per 10 minutes and their duration with seconds.
  2. Mild contraction- duration if less than 20 seconds then plotted by
  3. Moderate contraction- If duration is 20-40 seconds the plotted by oblique line ( zebra crossing)
  4. Strong contraction: If more than 40 seconds filled by dark shade
  5. Maternal condition/ part
  6. Oxytocin: The concentration of oxytocin is noted on the upperline and the rate of infusion in drops/min. on the bottom line.
  7. Drugs and I.V fluid: All drugs and I.V fluid given during labor, their dosage and route of administration are recorded.
  8. Pulse and blood pressure: The pulse is recorded every 30 minutes and the BP every 2 hourly.
  9. Temperature: The maternal temperature is recorded in the bottom line.
  10. Urine: The amount of urine passes is measured and recorded. If catheterization performed it is recorded as “C”.

 

Edit By ,

Hasibul Hasan (Santo)

B.Sc in Nursing 

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