Partograph • Use partograph to monitor progress of labour at all women admitted to labour ward • Women should not be admitted for labour ward until in active labour • Active labour is when women have regular contractions (3-5 in ten minutes) and cervix is 4 cm. dilated
Fetal Heart Rate: • Assess after contraction for 60 seconds: • Each 30 minutes in first stage (each 15 minutes if risk factors are identified • Each 5 minutes when pushing
Cervical Dilatation • Assessed each 4 hours (or before if a crossed action line is anticipated) Alert Line: • Start recording cervical dilatation in the alert line. • As long as dilatation is 1 cm or more/hr the alert line is not crossed. • If cervical dilatation is < 1 cm/hr the alert is crossed and causes of prolonged labour should be considered: always consider: artificial rupture of membranes and augmentation with oxytocin.
Cervical dilatation Action Line: • If the action line is crossed the actions should be as follows in mentioned order (if not already performed) • ARM and oxytocin augmentation • Correction of malposition • Cesarean Section or Vacuum (if in second stage and descend is 1/5 or below)
Amniotic fluid: I= Intact Membranes C= Clear M= Meconium stained B= Blood stained Remember: the diagnosis “cephalopelvic disproportion” cannot be made with intact membranes!
Contractions: Chart every 30 minutes Number/10 minutes and Duration • Weak: Lasting <20 seconds Medium: Lasting 20-40 seconds Strong: Lasting >40 seconds Oxytocin: • Record oxytocin (amount/volume) and drops / minute