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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 2nd stage is: 3-5 strong, 1 minute contractions in 10 minutes)
    • Strength
    • Regularity
  • Determine the trend

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 2nd 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

Summary

  • Summarise 
  • Identify causes for slow progression 
    • Passenger: cephalopelvic disproportion, fetal malpresentation (e.g. persistent occipito-posterior position)
    • Passage: fibroids, cervical stenosis, narrow mid-pelvis
    • Power: primary uterine inertia
  • Note if/when and why oxytocin was given, and the response
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Example partogram
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