Partogram interpretation

A partogram is used to monitor the active phase of the first stage of labour.

Introduction

• Patient: name, DOB, age, parity, allergies, blood group, haemoglobin level
• Pregnancy: expected delivery date, preferences/action plans/risks, gestation
• Partogram: date and time

Observations during partogram

• Heart rates performed every 30 minutes; other maternal observations performed every 4 hours
• Look at:
  • Fetal heart rate (if between 100 and 180, may indicate fetal distress – CTG monitoring should be started, oxygen given and oxytocin stopped)
  • Maternal observations
    • Pulse
    • Blood pressure
    • Temperature (↑ = chorioamnionitis, UTI, group B streptococcal infection)
    • Urinalysis (protein = pre-eclampsia/liquor contamination; glucose = diabetes; ketones = starvation; blood = UTI/obstructed labour)
• Look at observations and trends
  • Note responses to fluids/drugs given

Contractions 

• Noted over every hour
• Assess:
  • Frequency per 10 minutes (aim by 2^nd stage is: 3-5 strong, 1 minute contractions in 10 minutes)
  • Strength
  • Regularity
• Determine the trend

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💡 Conditions

Cervical dilation 

• PV exam performed every 4 hours
• Cervical dilation (aim: 1cm/hour primiparous, 2cm/hour multiparous; alert line: 1cm/2 hours if primiparous, 1cm/hour if multiparous; if there is delay, oxytocin may be considered)
• Determine progress through labour
  • Note responses to oxytocin

Head descent

• PV exam performed every 4 hours
• Assess:
  • Fifths palpable per abdomen
  • Station of presenting part (measured relative to ischial spines, -1cm = 1cm above ischial spines)
  • Position, moulding and caput
    • Position: orientation of fetal head, assessed during PV exams, by feeling fontanelles/sutures
    • Moulding: extent of overlapping of fetal skull bones (excess moulding may suggest cephalopelvic disproportion and C-section may be indicated)
    • Caput: swelling of presenting part
• Assess progress through labour
  • Note responses to oxytocin

Liquor

• Noted every hour
• Assess if liquor is intact, clear (membrane rupture), bloody (placental abruption), or if meconium is present (fetal distress – CTG and fetal blood sampling should be performed)
• Note when changes occurred

Final birth details

• Note times of the following:
  • Onset of labour
  • Rupture of membranes
  • Active 2^nd stage
  • Delivery of fetus
  • Delivery of placenta
• Mechanism of delivery, e.g. normal vaginal delivery, instrumental vaginal delivery, C-section
• Position of occiput
• APGAR score at 1 and 5 minutes to evaluate the wellbeing of the baby after delivery (Apgar et al. 1953)
  • Score takes into account Appearance, Pulse, Grimacing, Activity and Respiration
  • If total score is <7, baby needs oxygen and specialist paediatric input 
• Estimated blood loss

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Summary

• Summarise 
• Note if/when and why oxytocin was given, and the response

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