PROGRESS OF LABOUR/

PARTOGRAM

ADAN HASSAN ALI

1
 Labor duration
Variable Nulliparas (h) Multiparas(h)
Latent phase
mean 6.4 4.8
upper limit 20.1 13.6
Active phase
mean 4.6 2.4
dilatation rate(cm/h) 1.2 1.5
Second stage
mean 1 0.5
upper limit 2.9 1.1
2
Partogram
• Used in established labour to check progress
• Plots cervical dilatation.
• Alert and action lines
• Maternal T, P, BP, urine, contractions.
• Fetal heart rate, descent, moulding & caput.
• Liquor
• Fluids & drugs.

3
Component of partograph

1 Part 1;Patient identification

2 part 2 fetal well being
3 part 3 progress of labour
4 part 4 maternal well -being
5 outcome

4
5
 Filling information in a partogram
Patient information:
• Fill in name
• gravida,
• para,
• hospital number,
• date and time of admission and time of ruptured membranes.
• Risk factors

6
• Fetal heart rate: Record initially and then after every half hour in
active phase
• After 5 minute in second stage
• Scale of fetal heart rate covers range range from 80 to 200 beat per
minute
• Each vertical side of rectangle have 10 beat per minute
• Each horizontal side of the rectangle represent 30 minute
• FHR less than 180 bpm or more than 180 npm requires immediate
action

7
Amniotic fluid: Record the colour of amniotic fluid at every vaginal
examination:
• I: membranes intact;
• C: membranes ruptured, clear fluid;
• M: meconium-stained fluid;
• A :membrane ruptured and the fluid contained is absent
• Thick meconium at any time or absent of fluids at time of membrane
rupture listen to fetal heart rate more frequently as this may a sign
of fetal distress

8
9
`

10
Cervical dilatation:
• Assessed at every vaginal examination and marked with a cross (X).

• Alert line: A line starts at 4 cm of cervical dilatation to the point of

expected full dilatation at the rate of 1 cm per hour.

• Action line: Parallel and 4 hours to the right of the alert line.

11
12
13
Descent assessed by abdominal palpation:
• Refers to the part of the head (divided into 5 parts) palpable above the
symphysis pubis;

• recorded as a circle (O) at every vaginal examination. At 0/5, the

sinciput (S) is at the level of the symphysis pubis.

14
15
16
Uterine contractions

• Contractions: Chart every half hour; palpate the number of

contractions in 10 minutes and their duration in seconds.
• Less than 20 seconds:
• Between 20 and 40 seconds:
• More than 40 seconds:

17
Uterine contractions cont…

• Frequency of uterine
contractions in 10 minutes
• Each block represents an
episode of contraction in 10min
of examination.

18
Oxytocin: Record the amount of oxytocin per volume IV
fluids in drops per minute every 30 minutes when used.

Drugs given: Record any additional drugs given.

Pulse: Record every 30 minutes and mark with a dot (●).

Blood pressure: Record every 4 hours and mark with arrows.

Temperature: Record every 2 hours.

Protein, acetone and volume: Record every time urine is

passed.

19
 DETECTION OF LABOUR ABNORMALITIES
USING A PARTOGRAM

FETAL DISTRESS
• Fetal heart rate <120 or >160beats/min
3 observations 15 mins apart are required to take action
If <100b/min (severe distress)- action should be taken at once
• Meconium stained liquor or absence of liquor at the time of membrane
rupture.

20
CEPHALO-PELVIC DISPROPORTION

• Defn. Secondary arrest of cervical dilatation and descent of

presenting part in presence of good contractions.
• Increased moulding of skull bones with the head high in the pelvis
• Large caput succadenium

21
 PROLONGED LATENT PHASE
Pt in labor not reached active phase after 8 hours of admission

Two types of PLP.

1. False labour.
No palpable contractions or infrequent contractions
Nulliparous woman; long cervix, admit a finger tip or closed.
Multiparous woman; Cx may be 1 or 2 cm dilated and not effaced.

22
2. Truly PLP
• Cervix not dilated beyond 3cm after 8hrs of regular contractions
• Cervix effaced but stays stationery at about 2cm or
• It effaces and dilates very slowly

23
 SECONDARY ARREST
Definition.
After 6cm dilatation there is 0cm dilatation/2hrs due to high presenting
part.
Cause;
• CPD
• Malpresentation
• Poor contractions
• Intact membranes.

24
Prolonged second stage of labour
• The second stage: from fully dilated cervix and ruptured membranes
to the delivery of the baby.

• Prolonged 2nd stage of labour sets in if it lasts for more than 30

minutes in a multipara, or 60 minutes in a nullipara

25
PROLONGED ACTIVE PHASE OF LABOUR

Definition. Cervical dilatation to the right of the alert line on the

partograph after attaining 4cm dilatation.
Or active phase takes 8hrs

Cause
• Inadequate uterine contractions
• CPD
• Intact membranes
• Obstructed labour

26
 OBSTRUCTED LABOUR
Definition;
Inspite of good contractions the progressive descent of the
presenting part is arrested due to mechanical obstruction.

On a patrograph the following are the signs;

Secondary arrest of cervical dilatation and descent of presenting
part with large caput.
Third degree moulding
Maternal and fetal distress

On vaginal examination look if these signs are present.

Cervix poorly applied to the presenting part
Edematous cervix
Ballooning of lower uterine segment
Formation of retraction bands 27
 IMPORTANCE OF PARTOGRAM
• Provide details of necessary information at a glance.
• Reduces repition of the labour events
• Can predict deviation from normal labour duration
• Influences decision making
• Facilitates hand over procedure.
• Has reduced the incidence of;
• prolonged labour from 6.4% to 3.4 %
• augmentation of labour from 20.7 % to 9.1 %
• emergency caesarean section from from 9.9 % to 8.3 % after introduction of a partograph
(Urio, East Afr Med J 1991)
• Improves quality of maternity services
• Is a useful labour ward and training tool

28
 LIMITATION OF A PARTOGRAM

• Cervical dilatation assessment is imprecise

• Deviation from the 1cm/hr dilatation rate may be normal
• Plotting of curves is not usually done

29
edf

• ASANTE………………
• MAHADSANIDIIN

30