[11] PARTOGRAPH

Question 1

Is a graphical presentation of the progress of labor, and of fetal and maternal condition during labor

Answer 1

PARTOGRAPH

Question 2

PARTOGRAPH

• Detect whether ____
• It warns if there are signs of ____ or if the ____ deviate from the normal range

Answer 2

• Detect whether labor is progressing normally or abnormally
• It warns if there are signs of fetal distress or if the mother’s vital signs deviate from the normal range

Question 3

PLOTTING THE PROGRESS OF LABOR

• Plot only the ____ using symbol ____
• Start when woman is in ____ & is ____

Answer 3

• Plot only the CERVICAL DILATATION using symbol “X”
• Start when woman is in ACTIVE LABOR (4 cm or more) & is contracting adequately (3-4 contractions in 10 mins)

Question 4

Start plotting on ____ in the intersection corresponding ____ (e.g. patient came in at 4 cms)

Answer 4

Start plotting on alert line in the intersection corresponding cervical dilatation findings (e.g. patient came in at 4 cms)

Question 5

Indicate the ____ (& therefore, the observation was plotted). Write this in the ____ itself where you plot ____, not the space after it.

Answer 5

Indicate the time the IE was made (& therefore, the observation was plotted). Write this in the vertical line itself where you plot “X”, not the space after it.

Question 6

Perform internal examination ____, or more often if necessary, & plot findings each time.

*Do not forget to write the time each observation was made.

Answer 6

Perform internal examination every 4 hours, or more often if necessary, & plot findings each time.

*Do not forget to write the time each observation was made.

Question 7

Progress of labor is ____ if plotting stays on or to the ____

Plotting that passes the ____ more so if it reaches or passes the ____ indicates ____ progress of labor.

Answer 7

Progress of labor is normal if plotting stays on or to the left of the alert line (green part)

Plotting that passes the alert line (yellow part) more so if it reaches or passes the action line (red part) indicates ABNORMAL progress of labor.

Question 8

If plotting passes alert line…
* ____ woman & consider criteria for ____.
* Alert ____.
* Encourage woman to ____.
* Encourage ____ if woman wishes.
* ____.
* ____! Refer immediately.

Answer 8

If plotting passes alert line…
* Reassess woman & consider criteria for referral.
* Alert transport services.
* Encourage woman to empty the bladder.
* Encourage upright position & walking if woman wishes.
* Monitor intensively.
* DO NOT WAIT TO CROSS ACTION LINE! Refer immediately.

Question 9

If the plotting reaches the action line…
* ____

Answer 9

If the plotting reaches the action line…
* Refer urgently to hospital unless birth is imminent

Question 10

Other findings to note & record during internal examination
Status of membranes, write:
* “I” if ____
* “C” if ____
* “M” if ____
* “A” if ____
* “B” if ____

Answer 10

Other findings to note & record during internal examination
Status of membranes, write:
* “I” if intact
* “C” if clear
* “M” if meconium stained
* “A” if absent
* “B” if bloody

Question 11

Monitor every ____ & record the findings:

• B____
• U____
• N____
• F____

Answer 11

Monitor every 4 hours & record the findings:

• Blood pressure, pulse rate & temperature
• Urine voided (yes or no)
• Number of contractions in 10 minute period
• Fetal heart rate in 1 full minute

Question 12

• If a woman is admitted in ____ – record only other findings (BP, FHT, etc.)
• If woman is admitted in ____, transfer her to the hospital

Answer 12

• If a woman is admitted in LATENT PHASE of labor (less than 4 cm dilated) – record only other findings (BP, FHT, etc.)
• If woman is admitted in LATENT PHASE for the next 8 hours (labor is prolonged), transfer her to the hospital

Question 13

P1 - LABOR CARE GUIDE

• The ____ and its corresponding ‘action’ line have been replaced with evidence-based time limits at each centimeter of cervical dilatation during active first stage of labor; the starting point of active first stage of labor is a ____
• It includes a section for monitoring the ____
• It includes a section to assess and promote the use of ____ to improve overall childbirth experience
• It no longer records strength of ____, which is difficult to clinically quantify and standardize; and it requires deviation from expected observations of any labor parameter to be highlighted and the corresponding response to be recorded by the provider.

Answer 13

• The 1cm/hour ‘alert’ line and its corresponding ‘action’ line have been replaced with evidence-based time limits at each centimeter of cervical dilatation during active first stage of labor; the starting point of active first stage of labor is a cervical dilatation of 5cm
• It includes a section for monitoring the second stage of labor
• It includes a section to assess and promote the use of supportive interventions to improve overall childbirth experience
• It no longer records strength of uterine contractions, which is difficult to clinically quantify and standardize; and it requires deviation from expected observations of any labor parameter to be highlighted and the corresponding response to be recorded by the provider.

Question 14

P2 - LABOR CARE GUIDE

• Includes assessment of ____, ____, ____, and ____, with the aim of promoting the use of these evidence-based yet often neglected practices.
• Prompts the comprehensive recordings of ____, ____, and ____, and contains reference values for maternal and fetal observations.

Answer 14

• Includes assessment of labor companionship, oral hydration, maternal position and mobility, and pain management, with the aim of promoting the use of these evidence-based yet often neglected practices.
• Prompts the comprehensive recordings of maternal vital signs, fetal wellbeing and labor progression, and contains reference values for maternal and fetal observations.