S.Anuchithra, MSc N, (PhD)
Vice- Principal and HOD Maternity Nursing,
Parshwanath Doddanavar Bharatesh College of Nursing,
Halaga, Belgaum- 590 003. Karnataka.
PARTOGRAM or PARTOGRAPH
Partograph is a Greek word which means “Labour Curve”. Partograph or Partogram is a simple, Inexpensive tool which gives continuous pictorial overview of labour. It is the easy way to detect prolonged labour. The common obstetric Emergencies are obstructed labour and prolonged labour. Obstructed labour means no progress in descending parts inspite of good uterine contractions and the appropriate management would be the Caesarean section. In Prolonged labour the Cervix dilates slowly and incompletely and vaginal delivery may be considered under medical supervision. Obstructed and Prolonged labour complications are rupture of uterus, fetal distress and fetal Death. Slow progress in labour results in postpartum hemorrhage (PPH), Infections and Obstetric fistulae. To prevent life threatening situations in labour it is important that the signs of Obstructed & Prolonged labour identified early in Peripherals where the emergency management facilities are not available.
Friedman is the first Obstetrician to provide a tool for the assessment of individual labour (Cervicograph).In 1972, Philpott developed Partogram from Cervicograph in Zimbabwe and Later Philpott and Castle introduced an ‘Action Line’ & ‘Alert Line’ in the Partogram. John Studd promoted the use of Partograph in United Kingdom.
THE CONCEPT OF PARTOGRAPH:
◆ It is a record of all observations made on a woman in labour ◆ Decision making tool
◆ Implies a functioning referral system with essential Obstetric service ◆ It improves Efficiency and Effectiveness of Maternity Services
❖ A Partograph is a tool to help in the management of labour for the identification of women who are not likely to have a normal delivery and who need medical assistance. ❖ Partograph is a chart in which the salient features of labour are entered in a graphic form and it provides the opportunity for early identification of deviations from normal. ❖ A Partograph is a graphical record of progress during labour. Progress measured by cervical dilatation against time in hours & it provides a record of the important conditions of the mother & fetus that may arise during the process of labour.
The Partograph can be used by midwives and health workers with adequate training in midwifery who are able to: ◆ Observe and conduct normal labour and delivery.
◆ Perform vaginal examination during labour and assess cervical dilation accurately. ◆ Plot cervical dilation accurately on a graph against time.
PURPOSE OF THE PARTOGRAPH:
1) To detect abnormal progress of labour as early as possible 2) To prevent prolonged labour
3) To recognize CPD long before obstructed labour
4) To assist in early decision on transfer, augmentation or termination of labour 5) To increase the quality and regularity of all observations of mother and fetus 6) To recognize maternal or fetal problems as early as possible
OBJECTIVE OF INTRODUCTION OF PARTOGRAPH:
Partograph facilitates the providers in
a) Differentiating between latent and active phase of labour and its deviation from normal b) Monitoring the progress of labour and well being of mother and fetus c) Recognizing the need for action at the appropriate time
FUNCTIONS OF PARTOGRAPH:
◆ Give early warning in prolonged labour.
◆ Moving to the right of the alert line serves as a WARNING for extra vigilance and specific management decisions must be made. ◆ Other observations on the progress of labour also recorded.
COMPONENTS OF THE PARTOGRAPH:
Part I Assessment of fetal condition
Part II Progress of labour
Part III Assessment of maternal condition
Part IV Outcome of labour
PART I -...
References: 1. Integrated Management of Pregnancy and Child birth – Managing Complications in Pregnancy and Child birth: A Guide for Midwives and Doctors., WHO 2003.
2. Ministry of Health., Integrated Reproductive Health Curriculum – Safe motherhood Module., May 2001.
3. Safe Motherhood – Preventing Prolonged Labour: a practical guide., WHO 1994.
4. Community Health & Disease Surveillance News letter., “Optimal use of Partograph in obstetric practice., 13(12)., 6-7.
5. Tina Lavender., “NCT Evidence based briefing- Use of the Partogram in Labour”., 14-16.
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