icon Mneme

Partography

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References:

  1. Lecturer (V)

A partograph includes three components: progress of labor, fetal parameters, and maternal parameters. Its use is indicated once the woman enters the active phase of labor (4 cm cervical dilatation, 2-3 uterine contractions/10 min)

Composite Partograph

  1. Fetal Parameters (top section): fetal heart rate
  2. Progress of Labor (middle section): plot with the alert and action line. This is a visual representation of the dilation of the cervix and the station of the head.

Regardless of Gravidity, the cervix should dilate at least one centimeter per hour in a normal pregnancy.

  1. Maternal Parameters (lower section)

Guidelines for Use

  1. In the plot, one time column is subdivided into two columns: the left border of the left column is used for plotting dilatation (intersecting the line with an X). For any other parameter on the column, they are written centered.
  2. The cervical dilation found during the first internal examination is placed along the alert line. This means that the starting column with tracking is the column that contains the point at which the alert line represents the actual cervical dilatation; for example, start three columns from the left if the initial cervical dilatation was found to be 6.
  3. Fetal descent us determined by the head’s distance from the pelvic inlet (symphysis pubis) in fingerbreadths or centimeters. 5 indicates the head of the fetus is 5 fingerbreadths above the symphysis pubis.
  4. The time plotted after the first Time designation is at an interval of one hour each (actual hour on clock). The row above Time, Hours, is a sequence of hours passed since she entered active labor; starts with 1 upon admission, and so on. If this exceeds eight hours while the mother remains in the active phase, the patient becomes a candidate for emergency cesarean section.
  5. Amniotic Fluid contains notation of the following: C - clear, I - intact, M - meconium-stained, B - bloody, A - absent (ruptured)
  6. Moulding: graded with 0: open suture, +: closed suture, ++: one plate rises, +++: two plates overlap
  7. Contractions: a measurement of frequency every 10 minutes. This contains a maximum of five contractions per minute. If contracts are more frequent, report to the obstetrician. The number of cells is filled from the bottom of the column, chronologically, according to the occurrence of contractions. This uses a visual representation of contraction quality:
    • Dotted: <20 seconds
    • Line-shaded: 20-40 seconds
    • Fully shaded: >40 seconds
  8. The IV section (outdated), simply writes medications and fluids given.
  9. Pulse and BP: a margin drawn for the systolic and diastolic pressure, with the pulse marked with a dot along the same column.

Simplified Partograph

  1. Vaginal Bleeding: 0- no bleeding, +- mild bleeding, ++- moderate bleeding, and +++- strong bleeding
  2. Amniotic Fluid: same as the notation for the composite partograph.
  3. The beginning of the plotted column must coincide with the alert line, same as before.

Nursing Responsibilities in the Alert Area

  1. Notify the doctor. The doctor writes a referral letter for the facility the patient will be transferred to. The nurse aids in the preparation of the letter.
  2. Contact CEmONC (Comprehensive Emergency Obstetric Newborn Care) Facility, a blood-banking facility with an operating room that may handle a possible cesarean section.
  3. Prepare Emergency Transport Service: ambulance, barangay patrol, etc.
  4. NPO for food, but not fluid; drinking is still allowed. This is to prepare for a cesarean section.
  5. Bladder emptying
  6. Continue monitoring both the mother and child.

One CEmONC facility caters to 500,000 population, while a BEmONC (basic) facility caters to 125,000 population.

Graph View