This study aimed at evaluating the alert line of the partogram in recognizing the need for neonatal resuscitation 20—30 s after delivery. In order to decide on the onset of resuscitation, the three indicators of fetal respiration, heart rate, and skin color were used 20—30 s after delivery. The findings from the evaluation of fetal conditions were compared to the position of the ultimate cervical dilatation graph to the alert line of the partogram, and through using appropriate statistical procedures, sensitivity, specificity, and positive and negative prediction values of the alert line to recognize the need for neonatal resuscitation were computed. The indices of the alert line for predicting the need for resuscitation 20—30 s after birth had a sensitivity of In mothers who had normal vaginal delivery, with normal fetal heart rate, and with no oxytocin administration or omniotomy, the alert line showed appropriate sensitivity, specificity, and negative prediction value. So, it can assist in predicting the necessity of action for neonatal resuscitation 20—30 s after delivery.
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The condition of the mother, the condition of the fetus, and the progress of labour are recorded on the partogram. The length of the cervix is recorded by drawing a thick, vertical line on the same part of the chart that is used for the cervical dilatation. The length of the line drawn indicates the length of the endocervical canal in cm.
It is drawn on the chart whenever the cervical dilatation is recorded. Figure 8C Recording the cervical dilatation, cervical length, the amount of fetal head above the brim, position of the head, and moulding on the partogram. This is recorded at every vaginal examination. The duration of contractions is also recorded on the partogram. The block is stippled if the contractions last less than 20 seconds i.
The number of contractions occurring within 10 minutes is recorded by marking off 1 block for each contraction, e. After each examination an assessment must be made and recorded in the Maternity Case Record. All management in labour must also be recorded on the partogram. The time, to the nearest half hour, should also be entered on the partogram whenever an observation is recorded, medication is given, an assessment is made or management is altered.
Only the information given in the cases will be shown on the partogram. In practice, all the appropriate spaces on the partogram must be filled in. A primigravida at term is admitted to a primary-care perinatal clinic at with a history of painful contractions for several hours.
She received antenatal care and is known to be HIV negative. The maternal and fetal conditions are satisfactory. On abdominal examination a single fetus with a longitudinal lie is found.
On vaginal examination the cervix is 1 cm long and 2 cm dilated. The fetal head is in the right occipito-posterior position. The cervix is less than 5 cm dilated. The patient is, therefore, still in the latent phase of labour. As the patient is still in the latent phase of labour, the descent and amount of fetal head palpable above the brim, the presenting part and the position of the head, and the length and dilatation of the cervix, must be recorded on the vertical line forming the left-hand margin of the latent phase part of the partogram.
The correct way of entering the above data on the partogram is shown in figure 8C The patient must have the routine observations such as pulse rate, blood pressure and fetal heart performed at the usual intervals. She must be offered analgesia and sedation. Adequate analgesia, e. A second complete examination should be done at , i. The patient must be encouraged to walk about as this will help the progress towards the active phase of the first stage of labour. At the second complete examination the maternal and fetal conditions are satisfactory.
On vaginal examination the cervix is 2 mm long and 6 cm dilated. The head is in the right occipito-anterior position. The cervix is more than 5 cm dilated. The patient is, therefore, in the active phase of labour.
The findings must be entered on the latent phase part of the partogram, 6 hours to the right of the findings at However, as the patient is now in active labour, the data must then be transferred to the active phase part of the partogram.
This must be indicated with an arrow. The X cervical dilatation must be moved horizontally to the right until it lies on the alert line. This will again be at 6 cm dilatation. The O number of fifths of the head above the pelvic brim is similarly transferred to lie on the same vertical line on the vertical axis. The new position of the head ROA must be indicated on the O.
The length of the cervix is recorded by a 5 mm thick black column on the base line vertically below the X and O. The correct method of transferring the above findings from the latent to the active part of the partogram is shown in figure 8C A multigravida is admitted to the labour ward at in labour at term. On vaginal examination the cervix is 1 cm long and thus not fully effaced and 5 cm dilated. The presenting part is in the left occipito-posterior position.
The patient complains that her contractions are painful. As the patient is in the active phase of labour, the findings must be entered on the active phase part of the partogram. The X cervical dilatation is recorded on the alert line, opposite the 5 on the vertical axis indicating 5 cm dilatation. The O number of fifths palpable above the pelvic brim is recorded below the X opposite the 4 on the vertical line.
The length of the cervix is recorded by a 1 cm column on the base line, vertically below the X and O. The correct way of recording the above findings is in figure 8C The routine observations e.
The patient must be offered analgesia. Pethidine mg and promethazine 25 mg or hydroxyzine mg should be given by intramuscular injection as soon as the patient requests pain relief. On vaginal examination the cervix is 5 mm long and 6 cm dilated with bulging membranes.
The presenting part is in the left occipito-transverse position. Poor progress is diagnosed and a systemic assessment of the patient is made in order to determine the cause. Intact membranes and inadequate uterine contractions are diagnosed as the causes of the poor progress. The X must be recorded on the horizontal line corresponding to 6 cm cervical dilatation, 4 hours to the right of the record at The position of the fetal head and length of the cervix are recorded on the same vertical line as the X.
The correct way of recording these observations is shown in figure 8C This is immediately apparent by observing that the second X has crossed the alert line. For labour to have progressed satisfactorily, the cervix should have been at least 9 cm dilated 5 cm initially plus 1 cm per hour over the past 4 hours. The membranes must be ruptured. Rupture of the membranes will result in stronger uterine contractions. Because there has been inadequate progress of labour, a third complete examination should be performed at , i.
At the third complete examination the maternal and fetal conditions are satisfactory. On vaginal examination the cervix is 1 mm long and 9 cm dilated. The presenting part is in the left occipito-anterior position.
The findings are recorded as shown in figure 8C Labour is progressing satisfactorily. This is shown by the third X having moved closer to the alert line. The head, which has rotated from the left occipito-posterior to the left occipito-anterior position, is also engaged. A spontaneous vertex delivery may be expected within an hour. A gravida 2 para 1 is admitted to the labour ward at in labour at term. She has already had painful contractions for the past 2 hours. Two years before she had a vacuum extraction for a prolonged second stage of labour.
The cervix is 2 mm long and 6 cm dilated. The patient is HIV negative and an artificial rupture of the membranes is performed and a small amount of meconium-stained liquor is drained. The patient is given pethidine mg and promethazine 25 mg or hydroxyzine mg. A second complete examination is scheduled for The X cervical dilatation is recorded on the alert line opposite the 5 on the vertical line. The other findings are entered in their appropriate places as shown in figure 8C Meconium in the liquor indicates that the fetus is at an increased risk for fetal distress.
Therefore, the fetal heart rate pattern must be observed carefully for signs of fetal distress e. The most likely outcome is the development of cephalopelvic disproportion. An urgent Caesarean section should then be performed. Bettercare Learning Programmes Maternal Care 8c. Skills: Recording observations on the partogram. Record and assess the condition of the fetus. Record and assess the progress of labour. The partogram The condition of the mother, the condition of the fetus, and the progress of labour are recorded on the partogram.
Figure 8C An example of a partogram Recording the condition of the mother A. Recording the blood pressure, pulse and temperature The maternal blood pressure, pulse and temperature should be recorded on the partogram.
Recording the urinary data Volume is recorded in ml. Figure 8C Recording blood pressure, pulse, temperature and urine results on the partogram Recording the condition of the fetus C. Recording the fetal heart rate pattern The following two observations must be recorded on the partogram: The baseline heart rate.
The presence or absence of decelerations.
The Partograph in Childbirth: An Absolute Essentiality or a Mere Exercise?
The condition of the mother, the condition of the fetus, and the progress of labour are recorded on the partogram. The length of the cervix is recorded by drawing a thick, vertical line on the same part of the chart that is used for the cervical dilatation. The length of the line drawn indicates the length of the endocervical canal in cm. It is drawn on the chart whenever the cervical dilatation is recorded. Figure 8C Recording the cervical dilatation, cervical length, the amount of fetal head above the brim, position of the head, and moulding on the partogram.
Evaluation of the alert line of partogram in recognizing the need for neonatal resuscitation
WHO has recommended use of the partograph, a low-tech paper form that has been hailed as an effective tool for the early detection of maternal and fetal complications during childbirth. Yet despite decades of training and investment, implementation rates and capacity to correctly use the partograph remain low in resource-limited settings. Nevertheless, competent use of the partograph, especially using newer technologies, can save maternal and fetal lives by ensuring that labor is closely monitored and that life-threatening complications such as obstructed labor are identified and treated. To address the challenges for using partograph among health workers, health-care systems must establish an environment that supports its correct use. Health-care staff should be updated by providing training and asking them about the difficulties faced at their health center. Then only the real potential of this wonderful tool will be maximally utilized. The function of the partograph is to monitor the progress of labor and identify and intervene in cases of abnormal labor.
A realist review of the partograph: when and how does it work for labour monitoring?
Skip to content. Skip to navigation. The percent of deliveries correctly monitored with a partogram sometimes known as a partograph. A partogram is a simple chart that clinical staff can use to monitor labor and identify when it is not progressing satisfactorily. Correct use is defined as: 1 starting the monitoring process only after the woman begins labor and 2 measuring the essential parameters, such as cervical dilation, descent of fetal head, and uterine contractions. In a pictorial overview, the partogram graphically displays the dynamics of labor during the first stage of delivery.