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

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

Summary

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

Test your knowledge

What are the stages of labour?

Oops! This section is restricted to members. Click here to signup!

What are the three signs that the 1st stage of labour is commencing?

Oops! This section is restricted to members. Click here to signup!

What are the causes of slow progression of the 1st stage?

Oops! This section is restricted to members. Click here to signup!