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PartogramBy Mohamed Al_mobarek

Content

• Stage of labor • Content of partogram• Normal partogram in multi and nuli• Causes of abnormal partogram• Abnormal partogram – Prolong latent phase – Primary dysfunctional labor– Secondary arrest – Prolong second stage

First Stage of labour

• Latent phase• Slow• Contractions

irregular• Cervix:– shortens (effaces)– Softens – Moves– Dilates up to 3-4 cm

• 3-8h less in multi

First Stage of labour (2)

• Active phase• Regular painful

contractions• Progressive cervical

dilatation greater than 4 cm

• 2-6h shorter in multi

second stage

• Full dilatation until delivery• Can allow a ‘passive’ second stage for the

head to descend• Then active by assistance of mother bushing• 30min up to 1h in multi• 1h up to 2h in primi

Partograph and Criteria for Active Labor

• Label with patient identifying information

• Note fetal heart rate, color of amniotic fluid, presence of moulding, contraction pattern, medications given

• Plot cervical dilation• Alert line starts at 4 cm--from

here, expect to dilate at rate of 1 cm/hour

• Action line: 4h from alert linne if patient does not progress as above, action is required

Recording cevical dilataion

• At addmision • Then after 4h

Multi & nuli

Recording uterine contraction

Recording fetal heart rate

Recording of liqour &molding

• I: intact• C : clear• M : muconium• B : blood

stained

• +1 : suture fell• +2: toutched • +3:

overlapping

Recording of maternal condition

Cuases of abnormal partogarm

• ‘3Ps’ –1. passenger (excessive fetal size ,

malpositions ,congenital anomalies , multiple gestation,

2. passages,(pelvic contraction , soft tissue abnormalities of the birth canal , masses or neoplasia , placental previa location

• CPD ?

3- powers• Less than three contractions in 10 minutes,

each lasting less than 40 seconds • Inco-ordanated

Prolong Latent Phase

• Cevix not full effaced and not dialated beyond 4cm after 8h of regular contraction

• Most common in primi delay in the chemical process which soften the cervix and allow effacement

• Management – Simple analgesia– Encourage mobilization – Reassurance– ARM and oxytocin will cuase poor progress later

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Primary Dysfunctional

• Poor progress in the active phase <1cm/h• Primi dysfunctional uterin conti• Multi malpresintation, CPD

• Management– ARM +oxcytocin primi i(in multi ,CPD may

be but with cution 2.5 u in 500ml dexterose– c/s multi ,CPD,fetal comparamise, VBAC,

breach

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Secondary Arrest

• Secondary arrest of cervical dilatation and descent of presenting part tapiclly after7 cm dilatation

• Most common causes is CPD• Management– ARM +oxcytocin primi i(in multi ,CPD may

be but with cution 2.5 u in 500ml dexterose– c/s multi ,CPD,fetal comparamise, VBAC,

breach

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Delay in the second stage

• Addational cuases:-– OP position: long internal rotation , persistance OP– Epidural anathesia– Secondary uterine inerta : dehydration and ketosi– Narrow med cavity (android pelvis) : deep transver

arrest

managment

• Oxytocin infusion if contraction is not stronge • In DEEP transverse arrest rotational forceps

may use to brings the head to OA position• C/S is best option• Manual rotation also an option

THANK YOU