partogram of different stag of labour with Causes of abnormal partogarm

2. Content
•
•
•
•
•
Stage of labor
Content of partogram
Normal partogram in multi and nuli
Causes of abnormal partogram
Abnormal partogram
–
–
–
–
Prolong latent phase
Primary dysfunctional labor
Secondary arrest
Prolong second stage

3. First Stage of labour
•
•
•
•
Latent phase
Slow
Contractions irregular
Cervix:
–
–
–
–
shortens (effaces)
Softens
Moves
Dilates up to 3-4 cm
• 3-8h less in multi

4. First Stage of labour (2)
• Active phase
• Regular painful
contractions
• Progressive cervical
dilatation greater than 4
cm
• 2-6h shorter in multi

5. second stage
• Full dilatation until delivery
• Can allow a ‘passive’ second stage for the
head to descend
• Then active by assistance of mother bushing
• 30min up to 1h in multi
• 1h up to 2h in primi

6. Partograph and Criteria
for Active Labor
• Label with patient identifying
information
• Note fetal heart rate, color of
amniotic fluid, presence of
moulding, contraction pattern,
medications given
• Plot cervical dilation
• Alert line starts at 4 cm--from
here, expect to dilate at rate of
1 cm/hour
• Action line: 4h from alert linne
if patient does not progress as
above, action is required

7. Recording cevical dilataion
• At addmision
• Then after 4h

8. Multi & nuli

10. Recording uterine contraction

11. Recording fetal heart rate

12. Recording of liqour &molding
•
•
•
•
I: intact
C : clear
M : muconium
B : blood
stained
• +1 : suture fell
• +2: toutched
• +3:
overlapping

13. Recording of maternal condition

14. Cuases of abnormal partogarm
• ‘3Ps’ –
1. passenger (excessive fetal
size , malpositions ,congenital
anomalies , multiple gestation,
2. passages,(pelvic contraction , soft tissue
abnormalities of the birth canal , masses or
neoplasia , placental previa location
• CPD ?

15. 3- powers
• Less than three contractions in 10 minutes,
each lasting less than 40 seconds
• Inco-ordanated

16. Prolong Latent Phase
• Cevix not full effaced and not dialated beyond
4cm after 8h of regular contraction
• Most common in primi
delay in the
chemical process which soften the cervix and
allow effacement
• Management
–
–
–
–
Simple analgesia
Encourage mobilization
Reassurance
ARM and oxytocin will cuase poor progress later

18. Primary Dysfunctional
• Poor progress in the active phase <1cm/h
• Primi
dysfunctional uterin conti
• Multi
malpresintation, CPD
• Management
– ARM +oxcytocin
primi i(in multi ,CPD may
be but with cution 2.5 u in 500ml dexterose
– c/s
multi ,CPD,fetal comparamise, VBAC,
breach

21. Secondary Arrest
• Secondary arrest of cervical dilatation and
descent of presenting part tapiclly after7 cm
dilatation
• Most common causes is CPD
• Management
– ARM +oxcytocin
primi i(in multi ,CPD may
be but with cution 2.5 u in 500ml dexterose
– c/s
multi ,CPD,fetal comparamise, VBAC,
breach

24. Delay in the second stage
• Addational cuases:– OP position: long internal rotation , persistance OP
– Epidural anathesia
– Secondary uterine inerta : dehydration and ketosi
– Narrow med cavity (android pelvis) : deep transver
arrest

25. managment
• Oxytocin infusion if contraction is not stronge
• In DEEP transverse arrest rotational forceps
may use to brings the head to OA position
• C/S is best option
• Manual rotation also an option