2a intra partum care
DESCRIPTION
TRANSCRIPT
1
Intrapartum Care & Partograph
Session 2a
Care during labor and delivery
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
BEMoC - Presentation 2 (a)
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
2
Session Objectives
To learn about: How to conduct a normal labour Identify and manage complications during
labour How to plot a partograph
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
3
TRUE & FALSE LABOUR PAINS
True labour pains False labour pains
Regular and predictable Irregular
Felt first in lower back & sweeps towards lower abdomen
Remains confined to lower abdomen
Not relieved by rest Often relieved by rest
Increase in duration , intensity and frequency with time
Does not increase in duration, intensity or frequency
“Show” present “Show” absent
Accompanied by cervical changes Not accompanied by cervical changes
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
4
Stages of labour
First stage: From onset of labor till full dilatationof cervix Latent Phase
• Cervix < 4 cms• Contractions are weak• Less than 2 contractions per ten minutes
Active phase• Cervix > or = 4 cms• Contractions >3 per 10 min lasting 45 - 50 sec • Rate of dilatation 1cm / hour or more• Descent present
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
5
Points to Remember
Examine abdomen before vagina Do not shave perineum Wash hands,clean gloves,explain to the female
about PV If bleeding PV - PV not to be done Supine position with her legs flexed and apart
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
6
Cervical effacement Cervical dilatation in cms Presenting part Station and position of presenting part Status of membranes Color of liquor
During PV examination
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
7
Supportive Care during Labour
Keep woman informed of her progress Maintain privacy Encourage her to keep herself clean, wash
perineum Enema NOT ROUTINE: only if needed Empty bladder frequently
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
8
Supportive Care during Labour
Presence of second person or birth companion
Woman to be ambulatoryWoman free to choose any position
during labor & deliveryHold her hand, massage backPlenty of fluids, light fat free food
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
9
Non Pharmacological pain relief
Calm and gentle voice Offering encouragement, reassurance and
praise Relaxation techniques deep breathing
exercises and massage Assisting the woman in voiding urine and in
changing her position
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
10
Stages of labour
Second stage: From full dilatation of cervix till
delivery of baby Full cervical dilatation Bulging thinned out perineum Gaping anus and vagina Head visible at the perineum
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
11
Stages of labour
Third stage: From delivery of baby to delivery of placenta
Fourth stage: For 2 hrs after delivery of the baby
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
12
Monitoring of first stage of labour –Latent phase
Monitor every 1/2 hour• Contractions:
Frequency: How many contractions in 10 min Duration: Each lasting for how many seconds
• Fetal Heart Rate (FHR) Monitor the following every 4 hours: Temperature, pulse,
blood pressure Record time of rupture of membranes and color of
amniotic fluid. Emergency signs: Difficulty in breathing, shock, vaginal
bleeding
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
13
Monitoring of First Stage of Labour
In Latent Phase After 8 hours
Contractions stronger, more frequent, no change in dilatation or effacement ROM +/-
REFER to FRU
Prolonged latent phase
No increase in intensity / frequency / duration of contractions, membranes not ruptured and no progress in cervical dilatation
Ask woman to relax
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
14
Monitoring of first stage of labour – Active phase
Monitor the following every 30 minutes: Maternal pulse, uterine contractions, FHR Look for presence of -
• Meconium or blood stained liquor or cord prolapse
Monitor the following every 4 hours:• Cervical dilatation (in cm) by P/V• Temperature• Blood pressure
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
15
Monitoring of First stage of Labour
In Active Phase Never leave the woman alone Monitor intensively using Partograph Refer immediately if no progress
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
16
Partograph
What is a partograph? Graphic recording of the progress of labor
& condition of mother and fetus Labor record , thus reduces paper work Tool to identify complications of labor and
make timely referrals
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
17
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
18
Filling a Partograph
Identification data Name Age, Parity, Date and time of
admission Registration
number; Time of rupture of
membranes.
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
19
Filling a Partograph
Fetal Condition Count fetal heart
rate every half hour Count for one full
minute, immediately following a uterine contraction
Fetal distress: FHR <120
beats/minute or >160 beats/minute
Arrange for referral
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
20
Filling a Partograph
Record status of membranes and
amniotic fluid in Partograph as follows: Membranes intact (mark ‘I’) Membranes ruptured (mark ‘R’) Clear liquor (mark ‘C’) Meconium stained liquor (mark ‘M’)
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
21
Plotting a partograph
Labor Begin plotting in active
labor Cervical dilatation > 4
cms and > 2 contractions / 10 minutes
Plot the initial finding. Note the time.
Repeat P/V after 4 hours and plot the cervical dilatation
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
22
Plotting a Partograph
Chart the contractions every half an hour Number of contractions in 10 mins Duration in seconds.
• Less than 20 seconds • Between 20 and 40 seconds ////• More than 40 seconds
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
23
Plotting a partograph
Maternal Condition Record maternal pulse
every half hour and mark with a dot ( . )
Record maternal BP every 4 hours using a vertical arrow, with upper end signifying systolic BP and lower end diastolic BP
Record the temperature every 4 hours and note on temperature graph
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
24
Plotting a partograph
Interventions Mention dose, route
and time of administration of any drug
Mention the food items and liquids consumed
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
25
Plotting a Partograph
If Alert line is crossed (the plotting moves to the right of the alert line) it indicates abnormal labour : prolonged/ obstructed labour
Note the time Refer patient to FRU Send partograph with
patient
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
26
Plotting a Partograph
Crossing of the Action line (the plotting moves to the right of the Action line) : indicates the need for intervention
By the time the action line is crossed the woman should ideally have reached the FRU for the appropriate intervention to take place
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
27
What are the indications for referral to FRU – on the basis of partograph ?
FHR is <120 beats / min or > 160 beats / min Meconium and /or blood stained amniotic fluid When cervical dilatation plotting crosses the
alert line (moves towards the right side of the alert line)
Contractions not increasing in duration, intensity and frequency (e.g. < 2 contractions lasting for < 20 sec in 10 min)
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
28
Monitoring of second stage of labour
Monitor the following every 5 minutes Frequency,duration and intensity of
contractions FHR Perineal thinning and bulging Visible descent of foetal head during
contractions Presence of any signs indicating an
emergency
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
29
Abdominal palpation
Watch for signs of imminent deliveryGaping of vulva Thinning and bulging of perineumPouting of anusHead of the baby seen at vulva
Encourage the woman to push duringcontractions when she has an urge to do sowhile taking deep breaths
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
30
Supportive management during second stage
Any position woman is comfortable: dorsal lithotomy, tanding, sitting, squatting.
Encourage bearing down when has urge to push at full dilatation
Discourage bearing down before the cervix is fully dilated
Do not ask her to hold breath Avoid ironing (sweeping and stretching) the
perineum
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
31
2nd stage management (contd...)
OXYTOCICS: not routinely recommended insecond stage.
EPISIOTOMY: not routine complicated vag. Delivery (malpresent) h/o third/fourth degree perineal tears foetal distress Instrumental/assisted delivery.
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
32
2nd stage management (contd...)
Encourage rapid breathing with mouth open. Hydration- oral / IV fluids DO NOT apply fundal pressure 5 clean’s- surface, hands, cord tie, blade,
cord stump Prepare for active mgmt. 3rd stage
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
33
Delivery of Head
Ensure a controlled delivery of the head by keeping one hand gently on the head and other supporting the perineum
Feel gently around the baby’s neck for presence of umbilical cord
If it is loose around the neck, deliver the baby through the loop of the cord, or slip the cord over the baby’s head
If it is tight around the neck, doubly clamp and cut in between
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
34
Delivery of shoulders and rest of the body
Wait for the spontaneous rotation and delivery of the shoulders. This usually happens within 1-2 minutes
Apply gentle pressure downwards to deliver the top (anterior) shoulder
Then lift the baby up, towards the mother’s abdomen, to deliver the lower (posterior) shoulder
Deliver one shoulder at a time Rest of the baby’s body follows smoothly Note the time of birth
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
35
Immediate postpartum care
Fourth stage: first one hr after delivery. After placental delivery- check uterus well
contracted Examine perineum, lower vagina and vulva for
tears. Estimate the blood loss Clean the perineum Sanitary napkins
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
36
Immediate postpartum care
Dispose placenta in correct, safe and culturally appropriate manner.
Keep mother and baby together- encourage early breastfeeding.
Encourage woman to eat,drink and rest. Encourage woman to pass urine. Do not discharge the woman before 24 hours
after delivery.
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
37
Postpartum
Nutrition: advise to eat greater amount of foods Exclusive breastfeeding and rooming in Contraception: advise regarding birth spacing
or limitation. Registration of birth Postpartum visits- first at 7-10 days. Second at
6 weeks
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
38
Key Messages
Let the woman choose a comfortable position during labour and delivery
Maintain a partograph
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
39
Moulding
Sutures apposed +
Sutures overlapped but reducible 2+
Sutures overlapped but not reducible 3+
Symbols
Cervix x
Head O
Breech w
Fetal heart rate .
Amniotic fluid
Membranes intact I
Membranes ruptures, clear fluid C
Meconium stained fluid M
Blood stained fluid B
1 WHO Managing complications in pregnancy and childbirth
PARTOGRAPH
Usual frequency of examination
Vaginal examination 4 hourly
Fetal Heart Rate ½ - ¼ hourly
Descent: Abdominal palpation1Descent: Abdominal palpation1
Contractions: Palpate abdomen (uterine fundus) over 10 min
Mild <20 seconds
Sutures overlapped but reducible 20-40 seconds
Sutures overlapped but not reducible >40 seconds
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
40
Partograph Case 1
Name: Mrs KA
Hospital No.: 462432 XY
Age (Years): 20
Parity: Para 0 +0
Gestational age (Weeks): 38
TimeCervix (cm)
Membranes/Liquor
Lie PresentationFHR
(/Min.)Moulding Descent
Contractions(/10 Min.)
9am 2cm Intact longitudinal Cephalic 140 o 5/52 (<20
seconds)
History
• Lower abdominal pains• No drainage of liquor
Time 9am
Pulse rate (/Min.) 90
Blood pressure (mmHg) 120/80
Temperature (o C) 37.1o
Questions
• What actions will you take?
• How will you look after this woman?
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
41
Partograph Case 2
Name: Mrs AD
Hospital No.: 462432 XY
Age (Years): 18
Parity: Para 2+0
Gestational age (Weeks): 38
Time Cervix (cm)
Membranes/Liquor
Lie Presentation FHR (/Min.)
Moulding Descent Contractions(/10 Min.)
4pm 4cm Intact longitudinal Cephalic 144 0 3/5 3 (35sec. each)
8pm 8cm Clear longitudinal Cephalic 146 0 2/5 4 (45 sec. each)
History
• Lower abdominal pains for 2 hours• Drainage of liquor for 1 hour
Time 4pm 8pm
Pulse rate (/Min.) 88 90
Blood pressure (mmHg) 120/70 120/70
Temperature (o C) 37o 37o
Questions• What actions will you take
at 4pm?
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
42
Partograph Case 2
Name: Mrs AD
Hospital No.: 462432 XY
Age (Years): 18
Parity: Para 2+0
Gestational age (Weeks): 38
Time Cervix (cm)
Membranes/Liquor
Lie Presentation FHR (/Min.)
Moulding Descent Contractions(/10 Min.)
4pm 4cm Intact longitudinal Cephalic 144 0 3/5 3 (35sec. each)
8pm 8cm clear longitudinal Cephalic 146 0 2/5 4 (45 sec. each)
History
• Lower abdominal pains for 2 hours• Drainage of liquor for 1 hour
Time 4pm 8pm
Pulse rate (/Min.) 88 90
Blood pressure (mmHg) 120/70 120/70
Temperature (o C) 37o 37o
Questions• What actions will you take
at 4pm?• What actions will you take
at 8pm?
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
43
Partograph Case 3
Name: Mrs DG
Hospital No.: 462432 XY
Age (Years): 19
Parity: Para 0 +1
Gestational age (Weeks): 38
Time Cervix (cm)
Membranes/Liquor
Lie Presentation
FHR (/Min.)
Moulding
Descent
Contractions(/10 Min.)
6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each)
10am 5cm Artificial rupture of membranes: clear
longitudinal Cephalic 146 0 3/5 2 (20sec. each)
12pm (noon)
8cm clear Longitudinal
Cephalic 140 0 2/5 2 (10 sec. each)
2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each)
History
• Lower abdominal pains for 10 hours• No drainage of liqour
Time 6am 10am 12pm 2pm
Pulse rate (/Min.) 80 84 88 92
Blood pressure (mmHg) 130/70 130/70 140/70 140/70
Temperature (o C) 37.3o 37 37.5 37.5
Questions• What actions are
required?• When would the next
examination be?
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
44
Partograph Case 3
Name: Mrs DG
Hospital No.: 462432 XY
Age (Years): 19
Parity: Para 0 +1
Gestational age (Weeks): 38
Time Cervix (cm)
Membranes/Liquor
Lie Presentation
FHR (/Min.)
Moulding
Descent
Contractions(/10 Min.)
6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each)
10am 5cm Artificial rupture of membranes: clear
longitudinal Cephalic 146 0 3/5 2 (20sec. each)
12pm (noon) 8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each)
2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each)
History
• Lower abdominal pains for 10 hours• No drainage of liqour
Time 6am 10am 12pm 2pm
Pulse rate (/Min.) 80 84 88 92
Blood pressure (mmHg) 130/70 130/70 140/70 140/70
Temperature (o C) 37.3o 37 37.5 37.5
Questions• Comment on the
partograph. What actions are required?
• When would the next examination be?
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
45
Partograph Case 3
Name: Mrs DG
Hospital No.: 462432 XY
Age (Years): 19
Parity: Para 0 +1
Gestational age (Weeks): 38
Time Cervix (cm)
Membranes/Liquor
Lie Presentation
FHR (/Min.)
Moulding
Descent
Contractions(/10 Min.)
6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each)
10am 5cm Artificial rupture of membranes: clear
longitudinal Cephalic 146 0 3/5 2 (20sec. each)
12pm (noon) 8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each)
2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each)
History
• Lower abdominal pains for 10 hours• No drainage of liqour
Time 6am 10am 12pm 2pm
Pulse rate (/Min.) 80 84 88 92
Blood pressure (mmHg) 130/70 130/70 140/70 140/70
Temperature (o C) 37.3o 37 37.5 37.5
Questions• Comment on the
partograph. What actions are required?
• When would the next examination be?
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
46
Partograph Case 3
Name: Mrs DG
Hospital No.: 462432 XY
Age (Years): 19
Parity: Para 0 +1
Gestational age (Weeks): 38
Time Cervix
(cm)
Membranes/Liquor
Lie Presentation
FHR (/Min.)
Moulding
Descent
Contractions(/10 Min.)
6am 5cm Intact membranes longitudinal Cephalic 140 0 4/5 3 (40sec. each)
10am 5cm Artificial rupture of membranes: clear
longitudinal Cephalic 146 0 3/5 2 (20sec. each)
12pm (noon)
8cm clear longitudinal Cephalic 140 0 2/5 2 (10 sec. each)
2pm 9cm clear longitudinal Cephalic 144 0 2/5 2 (20 sec. each)
History
• Lower abdominal pains for 10 hours• No drainage of liqour
Time 6am 10am 12pm 2pm
Pulse rate (/Min.) 80 84 88 92
Blood pressure (mmHg) 130/70 130/70 140/70 140/70
Temperature (o C) 37.3o 37 37.5 37.5
Questions• Comment on the
partograph. What actions are required?
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
47
Partograph Case 4
Name: Mrs HA
Hospital No.: 462432 XY
Age (Years): 16
Parity: Para 0 + 0
Gestational age (Weeks): 39
Time Cervix (cm)
Membranes/Liquor
Lie Presentation
FHR (/Min.)
Moulding Descent Contractions(/10 Min.)
10am 4cm Spontaneous rupture, clear
L Cephalic 150 1 + 3/5 3 (30 sec. each)
2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec. each)
4pm 6cm Meconium stained L Cephalic 164 3 + 3/5 4 (45 sec. each)
History
• Labour at home for 6 hours• Membrane ruptured 4 hours before admission
Time 10am 2pm 4pm
Pulse rate (/Min.) 80 86 92
Blood pressure (mmHg) 120/70 130/70 130/70
Temperature (o C) 37 37.2 37.2
Questions• Plot the information on a partograph.• What action will you take?• When would you perform the next
vaginal examination?
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
48
Partograph Case 4
Name: Mrs HA
Hospital No.: 462432 XY
Age (Years): 16
Parity: Para 0 + 0
Gestational age (Weeks): 39
Time Cervix (cm)
Membranes/Liquor
Lie Presentation FHR (/Min.)
Moulding Descent Contractions(/10 Min.)
10am 4cm Spontaneous rupture, clear
L Cephalic 150 1 + 3/5 3 (30 sec. each)
2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec. each)
4pm 6cm Meconium stained
L Cephalic 164 3 + 3/5 4 (45 sec. each)
History
• Labour at home for 6 hours• Membrane ruptured 4 hours before admission
Time1 10am 2pm 4pm
Pulse rate (/Min.) 80 86 92
Blood pressure (mmHg) 120/70 130/70 130/70
Temperature (o C) 37 37.2 37.2
Questions• Comment on the partograph.• When would you perform the next
vaginal examination?
Maternal and Newborn Health Unit Liverpool School of Tropical MedicineLSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and
Newborn Care
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
49
Partograph Case 4
Name: Mrs HA
Hospital No.: 462432 XY
Age (Years): 16
Parity: Para 0 + 0
Gestational age (Weeks): 39
Time Cervix (cm)
Membranes/Liquor
Lie Presentation
FHR (/Min.)
Moulding Descent Contractions(/10 Min.)
10am 4cm Spontaneous rupture, clear
L Cephalic 150 1 + 3/5 3 (30 sec. each)
2pm 6cm Blood stained L Cephalic 156 2 + 3/5 4 (40 sec. each)
4pm 6cm Meconium stained L Cephalic 164 3 + 3/5 4 (45 sec. each)
History
• Labour at home for 6 hours• Membrane ruptured 4 hours before admission
Time 10am 2pm 4pm
Pulse rate (/Min.) 80 86 92
Blood pressure (mmHg) 120/70 130/70 130/70
Temperature (o C) 37 37.2 37.2
Questions• Comment on the partograph.• What action will you take in a
BEOC and CEOC health facility
Maternal and Newborn Health Unit Liverpool School of Tropical MedicineLSTM/RCOG Life Saving Skills –Essential (Emergency ) Obstetric Care and
Newborn Care
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
50
Partograph Case 5
Questions• You are called. What would you
do? • When will you do another vaginal
examination?
Name: Mrs SA
Hospital No.: 462432 XY
Age (Years): 24
Parity: Para 3+1
Gestational age (Weeks): 39
Time Cervix (cm)
Membranes/Liquor
Lie Presentation
FHR (/Min.)
Moulding Descent Contractions(/10 Min.)
10am 4cm Spontaneous rupture 2 hours ago, clear
L Cephalic 140 0 3/5 3 (30 seconds)
2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds)
4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds)
History
• Lower abdominal pains 3 hours• Drainage of liquor 2 hours
Time 10am 2pm 4pm
Pulse rate (/Min.) 86 90 92
Blood pressure (mmHg) 130/70 130/70 130/70
Temperature (o C) 37o 37o 37
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
51
Partograph Case 5
Questions• Comment on the partograph.• What action would you take?
Name: Mrs SA
Hospital No.: 462432 XY
Age (Years): 24
Parity: Para 3+1
Gestational age (Weeks): 39
Time Cervix (cm)
Membranes/Liquor
Lie Presentation FHR (/Min.)
Moulding Descent Contractions(/10 Min.)
10am 4cm Spontaneous rupture 2 hours ago, clear
L Cephalic 140 0 3/5 3 (30 seconds)
2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds)
4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds)
History
• Lower abdominal pains 3 hours• Drainage of liquor 2 hours
Time 10am 2pm 4pm
Pulse rate (/Min.) 86 90 92
Blood pressure (mmHg) 130/70 130/70 130/70
Temperature (o C) 37o 37o 37
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
52
Partograph Case 5
Questions• Comment on the partograph.• What action will you take?• What are the options for delivery?
Name: Mrs SA
Hospital No.: 462432 XY
Age (Years): 24
Parity: Para 3+1
Gestational age (Weeks): 39
Time Cervix (cm)
Membranes/Liquor
Lie Presentation FHR (/Min.)
Moulding Descent Contractions(/10 Min.)
10am 4cm Spontaneous rupture 2 hours ago, clear
L Cephalic 140 0 3/5 3 (30 seconds)
2pm 8cm Clear L Cephalic 156 1+ 3/5 3 (40 seconds)
4pm 9cm Clear L Cephalic 120 2+ 1/5 4 (45 seconds)
History
• Lower abdominal pains 3 hours• Drainage of liquor 2 hours
Time 10am 2pm 4pm
Pulse rate (/Min.) 86 90 92
Blood pressure (mmHg) 130/70 130/70 130/70
Temperature (o C) 37o 37o 37
INTRAPARTUM CARE & PARTOGRAPH
Maternal Health DivisionMinistry of Health & Family
WelfareGovernment of India
53
Session 2a
Case Study No. …………….. 1-3
Page no……………………… 15-19
Answer to Case Study……… 125-127
54
Thank you