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Partogram
Partogram
Dr. C. Savona-Ventura
MD, DScMed, FRCOG, Accr.Cert.OG,
MRCP
The Partogram
• A graphic representation of the progress of
labour
– Cervicograph
– Descent of Head [cf moulding]
– Uterine contractions
– Features that assist progress
[membranes/augmentation/drugs]
– Maternal condition [heart rate, BP, urinalysis]
– Fetal condition [heart rate, liquor]
1
Phases in progress of Labour
• LATENT PHASE:-
» Nullipara Multipara
» 8.6-20.6 hrs 5.3-13.6 hrs
• ACTIVE PHASE:-
– Acceleration Phase ] 4.9-11.7 hrs 2.2-5.2 hrs
– Phase of Maximum Slope ]
– Deceleration Phase 54 min-3.3 hrs 14 -53 min
10
2nd Stage
8
1st Stage of Labour
6
LATENT 1 cm/hr
4
PHASE ACTIVE
2
PHASE
0
0 5 10 15 20
2
Latent Phase
3
Prolonged Latent Phase
• Management DIAGNOSIS
EVALUATE CAUSE
THERAPEUTIC REST
No Change
Active Phase
4
Partogram - cervical dilatation
10
9
CERVICAL DILATATION
8
7
6
5
4
3
2
1 ALERT LINE
0
TIME ACTION LINE
Uterine contractions
• Aim at:- strong & regular contractions
• ASSESS DURATION OF CONTRACTION
– mild moderate strong
– <20 sec 20-40 sec >40 sec
• ASSESS FREQUENCY OF CONTRATIONS
– Number of contractions in last 10 min of each ½ hr.
– increased frequency from 1:10 to 5:10 minutes
5
Descent of head in fifths per
abdomen
Vaginal assessment in
relation to ischial spines not
useful to define engagement
since position of spines
dependant on type of pelvis.
• Definition
– >6 hrs or >1.2 cm/hr [nullipara]; >5.2 hrs or >1.5 cm/hr [multipara]
• Aetiology
– CephaloPelvic Disproportion [often relative]
– Fetal head malposition: OP/OT
– Idiopathic [early ARM]
– Excessive sedation
• Outcome
– 39% Po & 13% P1+ will go into Secondary Arrest
6
Prolonged Active Phase
10
9
CERVICAL DILATATION
8
7
6
5
4
3
2 ALERT LINE
1 NORM AL
0
DYSFUNCTIONAL
TIME ACTION LINE
• Management DIAGNOSIS
EVALUATE CAUSE
HYPOTONIA HYPERTONIA
7
Secondary Arrest of Active
Phase
• Definition
– No change in cervical dilatation over a period of 2hrs+. Cervix becomes
oedematous. Can occur at 4-7 cm dilatation or as a protracted Deceleration
phase
• Aetiology
– CephaloPelvic Disproportion [often absolute]
– Fetal head malposition [OP/OT] or Malpresentation [breech]
– Insufficient uterine action
– Excessive sedation
• Outcome
– Will require LSCS. If protracted deceleration beware of shoulder
impaction
8
7
6
5
4
3
2 ALERT LINE
1 NORM AL
0 2 ARREST
PROTRACTED
TIME ACTION LINE
8
Secondary Arrest of Active
Phase
• Management DIAGNOSIS
EVALUATE CAUSE
No CPD
head 2/5-
CPD
head 3/5+ Assess Uterine Activity
Optimal Sub-Optimal
head 2/5
Augment
LSCS
No Response Good Response
Vaginal Delivery