[36] Partograms Flashcards
What is a partogram?
A single sheet of paper on which there is a graphic representation of progress in labour
What things care recorded on a partogram?
- Frequency and duration of contractions
- Fetal heart rate
- Colour of liquor
- Caput and moulding
- Station or descent of head
- Maternal heart rate, BP and temp
What is the purpose of a partogram?
To enable early recognition of labour that is non-progressive
When should a partogram be started?
As soon as the mother is admitted to the delivery suite
What is the time of admission to delivery suite recorded as on a partogram?
Zero time
What does the point of entry onto a partogram depend on?
Vaginal assessment at the time of admission
How does the partogram help prevent serious obstruction?
It draws visual attention to any aberration from normal progress of labour
What can prevention of serious obstruction due to partogram use lead to a reduction in?
- Uterine rupture
- Sepsis
- Post-partum haemorrhage
- Vesico or rectovaginal fistula
Where is the reduction of obstetric complications due to partogram use particularly prominent?
Africa
What parameters of the partogram help to give an indication of the fetal condition?
- Fetal heart rate
- Time of rupture of membranes
- Nature of amniotic fluid
- Moulding of fetal head and presence of caput
How are decelerations of the fetal heart rate recorded on the partogram?
As an arrow down to the lowest heart rate recorded on the partogram
What are partogram records of fetal heart rate an adjunct to?
- Recording of auscultated FHR in notes
- Electrical fetal monitoring by CTG
What aspect of the nature of the amniotic fluid is important to record on the partogram?
Clear or meconium stained
What do moulding of the fetal head and presence of caput indicate?
Possible obctructed labour
What is moulding of the fetal head classified as?
- Suture lines meeting = +
- Over-riding but reducible with gentle pressure = ++
- Over-riding but not reducible with gentle pressure = +++
What is caput of the fetal head?
Soft tissue swelling of the fetal scalp
What partogram parameters give an indication of the progress of labour?
- Rate of cervical dilation
- Descent of presenting part
- Nature and frequency of uterine contractions
How is the rate of cervical dilation measured?
Assessed by vaginal examination on admission and every 3-4 hours during first stage of labour
How is rate of cervical dilation plotted on a partogram?
In cm along a 0-10 scale on a cervicograph
How long is the cervix expected to take to efface and dilate from 0-3cm in multipara?
5 hours
How long is the cervix expected to take to efface and dilate from 0-3cm in nullipara?
8 hours
At what rate is the cervix expected to dilate from 3-10cm?
Approximately 1cm/hour
How is expected progress plotted on the cervicograph?
As a line at a rate of 1cm/hour from admission
What is the line of expected progress on a cervicograph called?
Alert line
What is the action line on the cervicograph?
A line 2 hours parallel with the alert line used to decide when to actively intervene with ARM or oxytocin infusion
How is the descent of the presenting part plotted on the partogram?
- The station of the head is plotted on 0-5 gradation of the partogram OR
- As the level of the presenting part in cm above or below the ischial spines
How is the level of the presenting part relative to the ischial spines recorded?
-1, -2, or -3 when above and +1, +2 or +3 when below ischial spines
How is the nature and frequency of contractions recorded on the partogram?
Shading in the number of contractions per 10 minutes
What squares are used to indicate contractions <20 seconds on a partogram?
Dotted squares
What squares are used to indicate contractions of 20-40 seconds on a partogram?
Cross hatched squares
What squares are used to indicate contractions of >40 seconds on a partogram?
Completely shaded
How can frequency and duration of contractions be measured?
- Clinical palpation
- External tocography
