Partograph Case

Mrs. R, G1:P0:A0, 23 years old, came to the Maternity Home delivered by her family to get care
from Midwife Ita at RT 001/RW 04, Tebet Timur Village on March 20, 2023 at 13.00 WIB. Mrs. R
told the midwife that she had felt contractions since 05.00 WIB.
Midwife Ita performed a thorough history and physical examination and concluded:
 Full-term pregnancy , back of the head presentation (vertex), head presentation with 4/5
decrease, uterine contractions 3x in 10 minutes, each contraction lasts 18 seconds, and DJJ
124x/minute.
 The opening of the cervix is 3 cm, there is no intrusion and the amniotic membrane is intact
 Blood pressure 110/70 mmHg, HR 80x/min, Body temperature 36.80C
 Bu urinated 200 ml before being examined inside, the results of urine examination did not
detect the presence of protein and acetone.

1. Based on the data at 13.00, Ita's midwife made a diagnosis: primigravida, full-term pregnancy,
inpartu in the latent phase, the baby lives with normal DJJ, cervical opening is 3 cm, three
contractions in 10 minutes, and contraction duration is less than 20 seconds. The
midwife calmed Mrs. R's heart and encouraged her to go for a walk with her husband and
consume enough fluids.
2. Midwife Ita writes down the date, time, all findings and care given on the delivery progress
record. Midwife Ita continued monitoring DJJ, Mrs. R's pulse and uterine contractions
every hour, DJJ, pulse and contractions remained normal. The midwife measured the
amount of R's mother's urine production each time she urinated. All findings and results
of the examination are recorded in the labor progress sheet . Midwife Ita must also
continue to provide support and encouragement for Mrs. R in undergoing labor and
preparing for the birth of her baby.
3. The second inspection is conducted at 17.00. Mrs. R. reported that her contractions felt
stronger and painful. The midwife did an abdominal examination and checked in the
second and the results occurred 4 contractions in 10 minutes, the duration was between
20-40 seconds, DJJ 134 x / minute, head drop 3/5, cervical opening 5 cm, no infiltration
of the fetal head and amniotic membranes were intact. His blood pressure was 120/70
mmHg, pulse 88x/min, temperature 370C and he urinated 100 ml before the examination
was done.

At 5:00 p.m., Mrs. R. entered the active phase and midwife Ita began recording her findings on a
partograph. The opening of the cervix is listed on the alert line and all other findings on the
corresponding timeline . Midwife Ita began assessing DJJ, uterine contractions and Mrs. R's pulse
every 30 minutes and her body temperature every 2 hours. All findings are recorded on the
partograph.

 5:30 PM DJJ 144x/minute Contractions 4 times in 10 minutes for 30 seconds Pulse

80x/min.
 6: 00 PM DJJ 144x/minute Contractions 4 times in 10 minutes for 45 seconds Pulse
88x/min
 6:30 p.m . DJJ 140x/minute Contractions 4 times in 10 minutes for 45 seconds Pulse
90x/min
 At 19.00 DJJ 134x/minute Contractions 4 times in 10 minutes for 45 seconds Pulse
97x/minute Temperature 36.80C and urine 150 cc
 7:30 PM DJJ 128x/minute Contractions 4 times in 10 minutes for 45 seconds Pulse
88x/min
 :00 DJJ 128x/min Contractions 5 times in 10 minutes for 45 seconds pulse88x/min
 20:00 DJJ 128x/min Contractions 5 times in 10 minutes for 45 seconds Pulse 90x/min
Urine 80 cc
 4. At 21.00, ita midwife conducted abdominal and deep examinations. The result was DJJ
130x / minute, 5 contractions in 10 minutes, longer than 15 seconds, head drop 1/5,
cervical opening 10 cm, no fetal head infiltration, amniotic membranes rupture before
examination (20.45) and clear amniotic fluid. Blood pressure 120/70 mmHg, body
temperature 370C, and pulse 80x/minute.

5. At 21.30, a baby girl was born, weighing 3000 grams and body length 48 cm, the baby
cried spontaneously. Active management is carried out when three and the placenta is
born 5 minutes after the baby is born . No episiotomy was performed and no lacerations
occurred . The estimatedblood loss is approximately 150 ml.

6. During the first 15 minutes of four times (until 9.45pm) and the next 15 minutes in the first
hour after the placenta was born, midwife Ita's notes showed everything was proceeding
normally.

 21.50 : TD 120/70 mmHg, pulse 80 x/min, body temperature 37.20C, fundus height 3 fingers
below the center, good uterine tone (hard), empty bladder , amount of blood pervagina is still
within normal limits
 22.05 : TD 120/70 mmHg, pulse 76 x/min, fundus height 3 fingers below center, good
uterine tone (hard), empty bladder, amount of blood per vagina is still within normal limits
 22:20 : TD 110/70 mmHg, pulse 76 x/min, fundus height 3 fingers below center, good
uterine tone (hard), empty bladder, amount of blood per vagina is still within normal limits
 22:35 : TD 110/70 mmHg, pulse 76 x/min, fundus height 3 fingers below center, good
uterine tone (hard), empty bladder, amount of blood per vagina is still within normal limits

7. Findings during the second 1 hour (every 30 minutes) at four times as follows:
 23.05 : TD 110/70 mmHg, Pulse 80 x/min, body temperature 37.00C, fundus height 2fingers
below center, good uterine tone, Mrs. R. Urination and urine output 250 cc, slight vaginal
bleeding.
 11:35 p.m. : TD 110/70 mmHg, pulse 80 x/min, fundus height 2 fingers below center, good
uterine tone, empty bladder , little vaginal bleeding.