25. Partograph

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© Springer Nature Singapore Pte Ltd. 2020
A. Sharma (ed.)Labour Room Emergencieshttps://doi.org/10.1007/978-981-10-4953-8_25



25. Partograph



Geetika Gupta Syal1  


(1)
Obstetrics & Gynaecology, Kamla Nehru State Hospital for Mother & Child, Indira Gandhi Medical College, Shimla, India

 



 

Geetika Gupta Syal


25.1 Introduction


In developing countries, prolonged and obstructed labour is one of the leading causes of maternal and neonatal morbidity and mortality. The causes may lie in the passage, the passenger or the power. It is therefore important not only to identify the cause of prolonged labour but to take timely steps to prevent and manage prolonged labour.


Partograph or partogram is a simple graphical record showing progress of labour and maternal and fetal conditions during labour. It helps to identify any delay in the progress of labour and signs of maternal or fetal distress easily so that early interventions can be taken.


25.1.1 History


Partograph was originally designed by Friedman in 1954. It was called the Friedman’s curve (Fig. 25.1) [1]. It had a sigmoid shape and consisted of latent, acceleration and deceleration phases. Later Philpott and Castle improvised it by including the alert and action lines in it [2–4]. Since then various partographs have been introduced to monitor the progress of labour. The WHO partograph which was modified in 2000 is currently used in most of the centres.

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Fig. 25.1

Friedman curve


25.2 Components of Partograph (WHO-Modified Partograph)


The modified WHO partograph (WHO removed the latent phase in the now recommended “modified partograph”) begins at the active phase of labour where the dilatation of the cervix is 4 cm or more (Figs. 25.2 and 25.3).

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Fig. 25.2

WHO partograph


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Fig. 25.3

WHO-modified partograph


At the top part of the partograph, there is an identification part where the name of the parturient, her gravid and para status, the hospital registration number, the date and time of admission of the labouring woman and time of rupture of membranes are to be recorded. The three main components of the graph are:


  1. 1.

    Fetal record.


     

  2. 2.

    Record of progress of labour.


     

  3. 3.

    Maternal record.


     

  4. 1.

    Fetal record


    This is the part just below the patient identification data. It consists of fetal heart rate record, condition of liquor and degree of moulding, one below the other.


    1. (a)

      Fetal heart rate (FHR): the range of the graph is from 80 beats per minute to 200 beats per minute. Each square signifies half an hour. The FHR is recorded every 15 min to half an hour in the first stage of labour and every 5 min in the second phase. It should be auscultated with stethoscope for full 1 min after the contraction, or continuous electronic fetal heart rate monitoring can be used. The normal FHR is between 110 and 160 beats per minute [5]. If abnormalities are noted, immediate action is to be taken.


       

    2. (b)

      Liquor: the colour of the liquor is to be noted in the squares. It can give an indication of fetal distress. If the amniotic membrane is intact, it is indicated with the letter “I”. If the membranes have ruptured, then the letters “A”, “C”, “B” and “M” are used to denote absent liquor, clear liquor, blood-stained liquor and meconium-stained liquor, respectively.


       

    3. (c)

      Moulding: this is an important indicator of the adequacy of the passage (pelvis) for the passenger (fetus). The degrees of moulding are to be noted in the squares after every vaginal examination.



      • 0 The sutures can be easily felt as the skull bones are separated.



      • 1+ The bones are just touching each other.



      • 2+ The bones are overlapping but reducible, i.e. can be easily separated with pressure of the finger.



      • 3+ The bones are overlapping and irreducible.

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Mar 28, 2021 | Posted by in OBSTETRICS | Comments Off on 25. Partograph

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