PARTOGRAPH - NURSING ASSIGNMENT

INTRODUCTION

        Photograph is derived by Friedman (1954). It is a graphical record gives the information about fetal and maternal condition, which are all recorded on a single sheet of paper. In recent years the partogram or partograph has been widely accepted as an effective means of recording the progress of labour are entered in a graphic form and therefore provides the opportunity for early identification of deviations from normal. The charts are usually designed to allow for recording at 15 min intervals.

DEFINITION

        It is a composite graphical record of cervical dilation and descent of head against duration of labour in hours. It also give information about fetal and maternal conditions that are all recorded on a single sheet of paper.

COMPONENTS OF A PARTOGRAPH

• Patient identification
• Time recorded at hourly interval. Zero time for spontaneous labour is the time of admission in the labour ward and for induced labour is the time of induction.
• Fetal heart rate – recorded hourly
• State of membraneous and colour of liquour: to mark ‘I’ for intact membranes, ‘c’ for clear and ‘M’ for meconium stained liquor
• Cervical dilation and descent of head
• Uterine contractions
• Drugs and fluids
• Blood pressure (at every 2 hours and pulse at every 30 minutes)
• Oxytocin (contractions in the upper box and dose in lower box)
• Urine analysis
• Temperature record

 
CERVICAL DILATION

        Cervical dilation is a sigmoid curve and first stage of labour has good two phases.

1.   Latent phase (3cm dilation of cervix)

2.   Active phase (3cm to 10 cm full cervical dilation)

Active phase has got e components

1.   Acceleration phase with cervical dilation

2.   Phase of maximum slope 4-9 cm dilation

3.   Phase of declaration of 9-10 cm dilation

Cervical Dilation	Primi Gravidae	Multi Parae
Latent phase	8 hours	4 hours
Active phase	4 hours	2 hours

Bishop Score

        It is a pre-labour scoring system to assist in predicting whether the induction of labour will be required. The bishop score grades patients who would be most likely to achieve a successful induction. The duration of labour is inversely correlated with the bishop score.

        A score that exceeds 8 describes the patient most likely to achieve a successful vaginal birth. Bishop score less than 6  usually require that a cervical ripening method be used before other methods.

Parameters	Score
	0	1	2	3
Cervix
Dilation (cm)	Closed	1-2	3-4	5+
Effacement (%)	0-30	40-50	60-70	≥ 80
Consistency	Firm	Medium	Soft	-
Position	Posterior	Midline	Anterior	-
Head
Station	-3	-2	-1, 0	+1, +2
Cervical length (cm)	>4	2-4	1-2	<1

ROLES OF A MIDWIFE

        The midwife monitors;

·        Condition of the mother

·        Condition of the fetus

·        Progress of labour

Condition of the Mother

        The midwife should monitor the condition of the mother. General condition remains unaffected, although, a feeling of transient fatigue appears following a strong contraction. And also check the pulse, B.P and the temperature. The pulse rate is increased by 10-15 beats/min during contraction which settles down to its previous rate in between contractions. The systolic blood pressure is raised by about 10 mm Hg during contraction. Temperature remains unchanged.

Condition of the Fetus

        The midwife monitors the fetal heart rate and any adverse effect on the fetus. As long as the membranes are intact, there is hardly any adverse effect on the fetus. However during contraction there may be showing fetal heart rate by 10-20 minutes which soon returns to its normal rate of about 140/min as the intensity of contraction diminishes provide the fetus is not compromised.

Progress of Labour

        The midwife monitors the progressive anatomical changes in the cervix such as dilation and effacement are recorded following each vaginal examination. The cervical dilation usually measured with fingers but recorded in the centimeters.

ADVANTAGES OF A PARTOGRAPH

1.   A single sheet of paper provide details of necessary information at a glance.

2.   No need to record labour events repeatedly

3.   It can predict deviation from normal duration of labour early

4.   It facilitates hand over producer

5.   introduction of partograph in the management of labour has reduced the incident of prolonged labour and caesarean section rate.

SUMMARY

        Partograph is a unique method which has reduces the mortality and mortality and morbidity rate of both mother and child. The single sheet of paper provides details of necessary information at a glance. The repeated records of labour events are not needed and it also facilitates hand over procedures.

CONCLUSION

        It is a graphical record which gives the information about fetal and maternal condition, which all are recorded on a single sheet of paper. Partograph is a unique method which has reduces the mortality and morbidity rate of both mother and child.

BIBLIOGRAPHY

1.   A Myles Text Book of Midwives

14^th Edition

Page No.449-451, 463

2.   A Hendreson Jones Text Book for Essential Midwifery

6^th Edition

Page No.179

3.   A Text Book of Abstretics

D.C.Dutta, 5^th Edition

Page No. 567