Table of Contents IntroductionObservations during partogramContractions Cervical dilation Head descentLiquorFinal birth detailsSummaryTest your knowledge 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 levelPregnancy: expected delivery date, preferences/action plans/risks, gestationPartogram: date and time Observations during partogram Heart rates performed every 30 minutes; other maternal observations performed every 4 hoursLook at:Fetal heart rate (if between 100 and 180, may indicate fetal distress – CTG monitoring should be started, oxygen given and oxytocin stopped)Maternal observationsPulseBlood pressureTemperature (↑ = chorioamnionitis, UTI, group B streptococcal infection)Urinalysis (protein = pre-eclampsia/liquor contamination; glucose = diabetes; ketones = starvation; blood = UTI/obstructed labour)Look at observations and trendsNote responses to fluids/drugs given Contractions Noted over every hourAssess:Frequency per 10 minutes (aim by 2nd stage is: 3-5 strong, 1 minute contractions in 10 minutes)StrengthRegularityDetermine the trend Cervical dilation PV exam performed every 4 hoursCervical 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 labourNote responses to oxytocin Head descent PV exam performed every 4 hoursAssess:Fifths palpable per abdomenStation of presenting part (measured relative to ischial spines, -1cm = 1cm above ischial spines)Position, moulding and caputPosition: orientation of fetal head, assessed during PV exams, by feeling fontanelles/suturesMoulding: extent of overlapping of fetal skull bones (excess moulding may suggest cephalopelvic disproportion and C-section may be indicated)Caput: swelling of presenting partAssess progress through labourNote responses to oxytocin Liquor Noted every hourAssess 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 labourRupture of membranesActive 2nd stageDelivery of fetusDelivery of placentaMechanism of delivery, e.g. normal vaginal delivery, instrumental vaginal delivery, C-sectionPosition of occiputAPGAR 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 RespirationIf total score is <7, baby needs oxygen and specialist paediatric input Estimated blood loss Summary Summarise Note if/when and why oxytocin was given, and the response Example partogram Test your knowledge What are the stages of labour? Oops! This section is restricted to members. What are the three signs that the 1st stage of labour is commencing? Oops! This section is restricted to members. What are the causes of slow progression of the 1st stage? Oops! This section is restricted to members.