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Abigail Kazembe, RNM, PhD.
UCM 2011
15/02/11
USE AND INTERPRETATION OF THE
LABOUR CHART/PARTOGRAPH
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GOAL:
To equip midwives with necessary knowledge, skillsand attitudes for the utilization of the labour chart
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LEARNING OUTCOMES:
1. Define Labour chart2. Outline parts of the labour chart
3. Explain indicators and landmarks of the labour chart
4. Record data on the labour chart
5. Interpret data recorded on labour chart
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Definition
A tool used to record all the information andobservations made on a woman in labour.
The central feature of the chart is the graphicrecording of the dilatation of the cervix and
descent of the head. It is used to ident i fy pro blems that may ar ise
du r ing labour per iod .
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PARTS OF THE LABOUR CHART
1. Admission Details
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PARTS OF THE LABOUR CHART
2. Composite labour chart The actual graph has three main
sections:
a) Foetal condition
The condition of the foetus isassessed by:
pattern of heart rate;
colour of amniotic fluid;
overlapping of the bones on thefoetal skull (moulding)
and degree of swelling on thescalp on the presenting part(caput).
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PARTS OF THE LABOUR CHART
b) Information on progress of labour Contractions: along with cervical dilation and
descent of the head, tell the progress oflabour. Contractions are recorded under the
time line Cervical dilatation: most important
observation to monitor progress of labour.The dilatation is plotted with an X.Dilatation is plotted on the active phase onthe alert line from 4 cm to 10 cm
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PARTS OF THE LABOUR CHART
Progress of labour
Descent of the presenting part: descent is
plotted with an O in cephalic presentation; in
other presentations nothing is recorded ondescent, instead the type of presentation
should be recorded on top of the partograph
in red
Time is recorded using the time of admissionas zero time. The actual time of the day is
recorded below the hours line.
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PARTS OF THE LABOUR CHART
c) Maternal condition
Blood pressure, pulse rate and
temperature are recorded in the space
provided.Urine: the amount is recorded every time
the mother passes urine. Albumin and
acetone (ketone) are tested and
documented on the appropriate space.
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PARTS OF THE LABOUR CHART
3. Details of the first vaginal examinationand pelvic assessment, which
includes
Condition of the soft tissues, cervix;membranes; and presenting part
Details of the pelvis are also explored
and the conclusion is drawn.
4. Details of the 2nd, 3rd, and 4th stagesof labour
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PARTS OF THE LABOUR CHART
Details of the puerperium for both motherand baby
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IMPORTANT LANDMARKS AND
INDICATORS
1. Landmarksa.Alert Line
Its a line that indicates labour progressin terms of cervical dilatation during the
active phase of the first stage of labour.Cervical dilatation progresses at 1cm
per hour in the active phase of labour.
Cervical dilatation should remain on orto the left of the alert line.
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IMPORTANT LANDMARKS AND
INDICATORS
1. Landmarks
a.Alert Line
When dilatation crosses to the right it is awarning that labour may be prolonged (i.e.if labour is progressing at less than 1cmper hour).
Subsequent vaginal examinations aredone:
at 4 hourly or expected time of delivery
and or when membranes rupture.
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LANDMARKS & INDICATORS
b. Action Line
An oblique line which is 4 hours to the right
of the alert line in primipara and multipara.
If a womans labour reaches this line, adecision must be made about action to betaken.
Refer the patient to the next level of
management.
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LANDMARKS & INDICATORS
b. Descent of the presenting part Plotted as O on time charted for
cervical dilatation or appropriate time incephalic presentation.
Descent is indicated in fifths of thefoetal head remaining above the pelvicbrim as per abdominal palpation.
Continuous descent of the presenting
part is an indicator for normal progressof labour
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LANDMARKS & INDICATORS
2. Uterine Contractions
Uterine contractions are necessary forprogress of labour.
Contractions become more frequent andlast as labour progresses.
Contractions are recorded on thepartograph below the time line.
Squares are numbered form 1-5.
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LANDMARKS & INDICATORS
Each square represents one contraction so that if
2 contractions are felt in 10 minutes, two squares
will be shaded.
Levels of intensity of the uterine contractions are
recorded differently.
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UTERINE CONTRACTIONS
For example:
Dots represent mild contractions ofless than 20 seconds duration.
///// Diagonal lines indicate moderatecontractions of 2040 seconds duration.
Solid shade represents strong
contractions of 40-60 seconds duration.
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INDICATORS
3. Foetal Condition Foetal heart rate, colour of liquor (amniotic
fluid) and moulding of the foetal skull giveinformation about the foetal condition.
a) Foetal heart rate: is recorded half hourly. Each block represents 30 minutes. The lines for 120 and 160 beats per minutes are
darker to remind the midwife that these are thenormal limits of foetal heart rate.
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FOETAL CONDITION
b) Membranes and liquor (amniotic fluid).The state of liquor or amniotic fluid determine
foetal condition.
The following observations are made during
vaginal examination and recorded as follows: Record I if membranes are intact R Record C If membranes are ruptured and liquor is
Clear
Record M when liquor is meconium stained Record B when liquor is Blood stained, Record A when liquor is Absent,
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FOETAL CONDITION
c. Moulding of the foetal skull Moulding is an important indicator as it shows
how well the pelvis will accommodate the foetalhead. Record the degree of moulding as
follows: O - bones are separated and sutures can be felt easily.
+ - bones are just touching each other.
++ -bones are overlapping but can be separated easilywith pressure from your finger.
+++- bones are overlapping but cannot be separatedeasily with pressure from your finger.
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MATERNAL INDICATORS
4. Maternal ConditionAll observations for the mothers conditionare written at the bottom of the partograph.
Monitor and record Pulse and BPhourly. Check Temperature2 hourly Ask the mother to empty bladder 2 hourly.
Check urine for :
Colour
Concentration
amount.
Albumin and acetone.
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MATERNAL INDICATORS
Maternal Condition contRecord any drugs given Drugs
Record any fluids given for rehydration
Oxytocin: there is a separate column for Oxytocin.
Record all entries and observations on the time line.
INTERPRETING INDICATORS ON THE
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INTERPRETING INDICATORS ON THE
LABOUR CHART
If readings for cervical dilatation remain to theleft of the alert line, cephalo pelvicdisproportion is unlikely and patient is allowedto deliver unless otherwise.
If readings cross the alert line to the right,labour becomes high risk (CPD is likely),patient should be transferred to the nearestdistrict hospital as soon as possible and
should reach the hospital before action line isreached.
INTERPRETING THE INDICATORS ON THE
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INTERPRETING THE INDICATORS ON THE
LABOUR CHART CONT
If the foetal heart is below 120, above 160 or isirregular manage the mother as foetal distress
according to the cause.
If maternal vital signs, and urine output becomes
abnormal act according to Protocols.
If contractions are weak augment labour
accordingly
If contractions are hypertonic manage accordingto protocol.
If descent is static for 3 hours refer to the next
level.
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QUESTIONS!
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