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Partograph 160220134320
Partograph 160220134320
Partograph 160220134320
Shrooti Shah
Lecturer
National Medical College Nursing Campus
Page 1
Definition
• It is a composite graphical recording of cervical
dilatation and descent of head against duration of
labour in hours.
Page 2
Page 3
History
• E.A. freidman in 1954 provide a foundation basis for
development of partograph on the basis of
observation of large number of woman in labour.
Page 4
Advantage of using Partograph
Page 5
Advantage of using Partograph…
Page 6
Principles of plotting partograph
Page 8
Method of recording partograph
• Fetal heart rate: The rate of the fetal heart rate
indicates the state of the fetus inside the uterus.
Record every half hour.
Page 9
Method of recording partograph
Page 10
Moulding
• Moulding is a state of reduction or loss of space between
skull bones.
• Presence of increased moulding of the head high in the
pelvis indicates CPD.
• Recording of degree of moulding
• 0: Bones are separated and sutures can be felt easily
• 1: sutures apposed
• 2: sutures overlapped but reducible
• 3: sutures overlapped and not reducible
Page 11
Cervical dilatation
• Assessed at every vaginal examination and marked
with a cross (X).
• Begin plotting on the partograph at 4 cm.
Page 12
Cervical dilatation
Page 13
Cervical dilatation
• The cross (X) in the graph are joined by a continuous
line begin plotting on the partograph at 4 cm.
• The climbing tendency of this line normally lies on
the left of the middle of the graph.
Page 15
Descent of the head
Page 16
• Hours: Refers to the time elapsed since onset of
active phase of labour.
Page 17
Uterine contractions
• Uterine contractions are recorded graphically on the
partograph according to their strength and frequency.
Page 18
Uterine contraction
Page 19
Uterine contraction
Page 20
Oxytocin drip
Page 21
Drugs and other intravenous fluids
Page 22
Maternal condition
Page 23
Urine analysis
Page 24
Exercises
Page 25
Exercise 1
• Mrs. Sita pokharel, 25 yrs old, Primigravida was
admitted in the latent phase of labour at 5 AM
2072/10/14:
- fetal head 4/5 palpable;
- cervix dilated 2 cm;
- 3 contractions in 10 minutes, each lasting 20
seconds;
- normal maternal and fetal condition.
Page 26
Exercise 1
• At 9 AM:
- Fetal heart rate; 134/min
- Membrane: intact
- Moulding : sutures are not apposed.
- Fetal head is 3/5 palpable
- Cervix dilated 5 cm
- 4 contractions in 10 minutes, each lasting 20
seconds
- Mother’s Pulse: 80/min, BP: 110/70 mm of Hg,
Temp: 98°F
Page 27
Exercise 1
• 9: 30 a.m: FHR 120, contraction 3/10 each 30
seconds, pulse 80/min
• 10:00 a.m.: FHR 136, contraction 3/10 each 30
seconds, pulse 80/min
• 10:30 a.m.: FHR 140, contraction 3/10 each 35
seconds, pulse 88/min
• 11:00 a.m.: FHR 130, contraction 3/10 each 40
seconds, pulse 88/min, Temp: 98 F
Page 28
Exercise 1
• 11:30 a.m.: FHR 136, contraction 3/10 each 40
seconds, pulse 84/min
• 12:00 p.m.: FHR 140, contraction 4/10 each 40
seconds, pulse 88/min
• 12:30 p.m.: FHR 130, contraction 4/10 each 45
seconds, pulse 88/min
• 1:00 p.m.: FHR 140, contraction 4/10 each 45
seconds, pulse 90/min
Page 29
Exercise 1
• At 1 PM:
- Fetal heart rate: 140/min
- Membrane ruptured, amniotic fluid : Clear, Moulding: not
present
- Fetal head is 0/5 palpable;
- cervix is fully dilated;
- 4 contractions in 10 minutes each lasting 45 seconds;
- spontaneous vaginal delivery occurred at 2:20 PM.
- Alive male infant weighing 3000gms.
Page 30
Exercise 2
• Mrs. Rita Rai was admitted at 10 am on
2072/10/13, Membranes ruptured at 4 am,
Gravida 3, Para 2, Hospital number 7886.
• Fetal head 3/5 palpable above the symphysis
pubis
• Cervix 4 cm dilated
• 3 contractions in 10 minutes, each lasting 30
seconds
• FHR :140/min
• Amniotic fluid: Clear
Page 31
Exercise 2
• Sutures apposed
• Blood pressure: 120/70 mm of Hg
• Temperature : 98° F
• Pulse: 80/minute
• Urine output: 200ml, negative protein and
acetone
Page 32
Exercise 2
• 10: 30 am: FHR 130, contractions 3/10 each 35
sec, Pulse 80/minute
• 11: 00 am: FHR 136, contractions 3/10 each 40
sec, Pulse 90/minute
• 11: 30 am: FHR 140, contractions 3/10 each 40
sec, Pulse 88/minute
• 12: 00 MD: FHR 140, contractions 3/10 each 40
sec, Pulse 90/minute, Temperature 97°F
Page 33
Exercise 2
• 12: 30 pm: FHR 130, contractions 3/10 each 40
sec, Pulse 90/minute
• 1: 00 pm: FHR 130, contractions 3/10 each 45
sec, Pulse 88/minute
• 1:30 pm: FHR 130, contractions 3/10 each 50
sec, Pulse 90/minute
• 2:00 pm: FHR 130, contractions 4/10 each 45
sec, Pulse 90/minute, Temperature 97°F, Blood
pressure 100/70 mm of Hg
• Fetal head: 3/5 palpab;e, cervix : 6cm dilated,
sutures overlapped but reducible Page 34
Exercise 2
• 2:30 p.m.: FHR 120, contraction 4/10 each 40 secs,
pulse 90/min, clear fluid
• 3:00 p.m.: FHR 120, contraction 4/10 each 40 secs,
pulse 88/min, blood stained fluid
• 3:30 p.m.: FHR 100, contraction 4/10 each 45 secs,
pulse 100/min
• 4:00 p.m.: FHR 90, contraction 4/10 each 50 secs, pulse
100/min, Temperature 97°F
• 4:30 p.m.: FHR 96, contraction 4/10 each 50 secs, pulse
100/min
• 5:00 p.m.: FHR 90, contraction 4/10 each 50 secs, pulse
110/min
Page 35
Exercise 2
• At 5:00 p.m.:
• Fetal head 3/5 palpable above the symphysis
pubis
• Cervix 6 cm dilated
• Amniotic fluid meconium stained
• Sutures overlapped and not reducible
• Urine output 100 ml; protein negative, acetone
1+
• Cesearean section at 5:30 p.m., live female
infant, weight: 4500gms
Page 36
Exercise 3
• Mrs. Sarita` was admitted at 10 am on 14/10/2072.
• Membrane Intact
• Gravida 1 para 0
• Hospital no. 1443
• The fetal head is 5/5 palpable above the symphysis
pubis
• The cervix is 4 cm dilated
• 2 contractions in10 minutes, each lasting less than 20
seconds
• FHR 140/min
• Membrane - Intact
Page 37
Exercise 3
• At 10 am: Blood pressure: 100/70 mm of Hg,
Temperature: 97, Pulse: 80/min, Urine output: 400ml,
negative: Protein and acetone
• 10:30 am: FHR:140, contraction 2/10 each 15 sec, Pulse
90/min
• 11:00 am: FHR: 136, contraction 2/10 each 15 sec, pulse
88/min
• 11:30 am: FHR: 140, contraction 2/10 each 20 sec, pulse
84/min
• 12:00 MD: FHR: 136, contraction 2/10 each 20 sec,
pulse 88/min, temperature: 98F, fetal head: 5/5 palpable,
cervix: 4cm, membrane: intact
Page 38
Exercise 3
Page 41
Exercise 3
• At 7:00 p.m.: Fetal head 0/5 palpable, 4 contractions in
10 minutes, each lasting 50 seconds, FHR; 144/min,
pulse: 90/min, cervix fully dilated
• At 8:10 p.m.: Spontaneous vaginal delivery. alive male
infant weighing 2,600 gms
Page 42
Practice doesn’t make man perfect,
perfect practice makes man perfect, so
keep practising….
Page 43