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Partogram

Composite graphical record of key data (maternal and fetal) during labor entered against time on a single sheet of paper. It provides an accurate record of the progress of labor and any delay or deviation from normal may be detected quickly and treated accordingly. It was first devised by Freidman in 1954.
 

Description: 1111


Components

  1. Patient identification.
  2. Time: It is recorded at an interval of one hour. For spontaneous labor zero time is the time of admission in the labor ward while for induced labor, it is the time of induction.
  3. Fetal heart rate: Recorded every thirty minutes.
  4. Liquor color and membrane status: 'I' = intact membranes, 'C' = clear and 'M' = meconium stained liquor.
  5. Cervical dilatation and descent of head.
  6. Uterine contractions: Intensity and duration.
  7. IV fluids and any drugs given.
  8. Temperature record.
  9. Blood pressure: At an interval of 2 hours.
  10. Pulse rate: Every 30 minutes.
  11. Oxytocin: Dose and concentration if used.
  12. Urine analysis.

Advantages

  1. Provides all important information on single sheet of paper.
  2. Predicts any deviation from normal progress of labor.
  3. Improvement in maternal and perinatal morbidity and mortality.

The concept of 'alert line' and 'action line' was introduced by Philpott and Castle in 1972. The action line can be placed at 2-4 hours interval, to the right and parallel to alert line. In partograms recommended by 'WHO' the distance between the alert and action lines is 4 hours.
 

Guidelines for intrapartum fetal heart rate surveillance

 

Surveillance

Low-Risk Pregnancies

High-Risk Pregnancies

Acceptable methods

 

 

Intermittent auscultation

Yes

 Yes

Continuous electronic monitoring (internal or external)

Yes

 Yes

Evaluation intervals

 

 

First-stage labor (active)

30 min

 15 min

Second-stage labor

15 min

 5min

 

Frequency of various presentations

 

Presentation

Frequency (%)

Cephalic

96.5

Breech

2.7

Transverse

0.3

Compound

0.1

Face

0.05

Brow

0.01

  • C malpresentation = Breech
  • C malposition = Occipitoposterior

Ritgen Maneuver

When the head distends the vulva and perineum enough to open the vaginal introitus to a diameter of 5 c or more, a towel-draped, gloved hand may be used to exert forward pressure on the chin of the fetus through the perineum just in front of coccyx. Concurrently, the other hand exerts pressure superiorly against the occiput. This maneuver allows controlled delivery of the head.

Management of Normal Labour

  1. Asepsis
  2. Thorough physical examination: The vital signs are obtained, a systematic examination is rendered, the pelvic examination being reserved for last.
  3. Abdominal examination: Fetal lie, presentation, and position and the fetal heart tones,
  4. Vaginal examination: Dilatation, effacement, membrane status, position and station of the presenting part, caput, moulding and pelvic assessment.
  5. Bowel preparation.
  6. Relief of pain.





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