PARTOGRAM
Definition A partograph is a composite graphical record of cervical dilatation and descent of head against duration of labour in hours
Principles Active phase of labour commences at 3cm cervical dilatation. Latent phase of labour should not last longer than 8 hours During active labour, the rate of cervical dilatation should not be slower than 1 cm/hour Vaginal examination should be performed as frequenlty as once in 2-4 hours Uterine activity and fetal heart tones are assessed every 15-30 minutes It should be used for all women in established labour.
History Friedman (1954) Hendricks (1969) Philpott (1972) WHO (1987)
Components of a partograph
Identification data
Vitals signs of the mother
Fetal Heart Rate
Membrane and Liquor
Cervical Dilatation Latent to active phase Latent phase upto 3cm Active phase from 3cm to 10cm
Descent of the head
Uterine Contractions
Oxytocin Regime Drugs and IV Fluids Urine volume, output and Proteins
Advantages Useful tool in the labour room Information in a single sheet Easy to maintain Record are straight forward and objective Facilitates easy handing over Has a predictive value Possible to estimate time of delivery Early warning in case of impending problems
Limitations Frequency of examination varies Difficult for a incompetent personnel to maintain and record Chances of copying the previous recordings Deviation from 1cm/hour dilatation rate may be normal