partogram
DESCRIPTION
partogram of different stag of labour with Causes of abnormal partogarmTRANSCRIPT
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PartogramBy Mohamed Al_mobarek
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Content
• Stage of labor • Content of partogram• Normal partogram in multi and nuli• Causes of abnormal partogram• Abnormal partogram – Prolong latent phase – Primary dysfunctional labor– Secondary arrest – Prolong second stage
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First Stage of labour
• Latent phase• Slow• Contractions
irregular• Cervix:– shortens (effaces)– Softens – Moves– Dilates up to 3-4 cm
• 3-8h less in multi
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First Stage of labour (2)
• Active phase• Regular painful
contractions• Progressive cervical
dilatation greater than 4 cm
• 2-6h shorter in multi
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second stage
• Full dilatation until delivery• Can allow a ‘passive’ second stage for the
head to descend• Then active by assistance of mother bushing• 30min up to 1h in multi• 1h up to 2h in primi
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Partograph and Criteria for Active Labor
• Label with patient identifying information
• Note fetal heart rate, color of amniotic fluid, presence of moulding, contraction pattern, medications given
• Plot cervical dilation• Alert line starts at 4 cm--from
here, expect to dilate at rate of 1 cm/hour
• Action line: 4h from alert linne if patient does not progress as above, action is required
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Recording cevical dilataion
• At addmision • Then after 4h
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Multi & nuli
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Recording uterine contraction
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Recording fetal heart rate
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Recording of liqour &molding
• I: intact• C : clear• M : muconium• B : blood
stained
• +1 : suture fell• +2: toutched • +3:
overlapping
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Recording of maternal condition
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Cuases of abnormal partogarm
• ‘3Ps’ –1. passenger (excessive fetal size ,
malpositions ,congenital anomalies , multiple gestation,
2. passages,(pelvic contraction , soft tissue abnormalities of the birth canal , masses or neoplasia , placental previa location
• CPD ?
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3- powers• Less than three contractions in 10 minutes,
each lasting less than 40 seconds • Inco-ordanated
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Prolong Latent Phase
• Cevix not full effaced and not dialated beyond 4cm after 8h of regular contraction
• Most common in primi delay in the chemical process which soften the cervix and allow effacement
• Management – Simple analgesia– Encourage mobilization – Reassurance– ARM and oxytocin will cuase poor progress later
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Primary Dysfunctional
• Poor progress in the active phase <1cm/h• Primi dysfunctional uterin conti• Multi malpresintation, CPD
• Management– ARM +oxcytocin primi i(in multi ,CPD may
be but with cution 2.5 u in 500ml dexterose– c/s multi ,CPD,fetal comparamise, VBAC,
breach
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Secondary Arrest
• Secondary arrest of cervical dilatation and descent of presenting part tapiclly after7 cm dilatation
• Most common causes is CPD• Management– ARM +oxcytocin primi i(in multi ,CPD may
be but with cution 2.5 u in 500ml dexterose– c/s multi ,CPD,fetal comparamise, VBAC,
breach
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Delay in the second stage
• Addational cuases:-– OP position: long internal rotation , persistance OP– Epidural anathesia– Secondary uterine inerta : dehydration and ketosi– Narrow med cavity (android pelvis) : deep transver
arrest
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managment
• Oxytocin infusion if contraction is not stronge • In DEEP transverse arrest rotational forceps
may use to brings the head to OA position• C/S is best option• Manual rotation also an option
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THANK YOU