MANAGEMENT
OF NORMAL LABOUR /THE PARTOGRAM
PARTOGRAM: It is the key record of all the events in labour on a single sheet of paper. Its most important feature is a graphical plot of progress in labour.
BRIEF
HX OF PARTOGRAPH : the concept of platting cenical dilatation (in cm) aginst
time (in hrs)was antroduced by friedman in new york city
Plupoh
and castle: the partogram was madifed in later years and probably e most
remarkable was det done by these apple. In 1972, is added alert and actor
lines, and also a record of e presenting part descent. Following these
medificalons, scneral medification of e partogram have made. This rangs from e
sungle to the sophisticated. Bk of this, WHO has come up their own partogram,
in an attempt to have an internatrial standard partogram.
THE
COMPONENTS OF THE WHO PARTOGRAM.
It
consist of e following
1. patient’s biodata(a) name
b.grauidity
(ie e no of pregnancy urespective of e fermineted ones)
c.
para
d.
hospital no
e.
date of admission
f.
time of admission
g.
ruptured membranes.
2.
foetal heart rate (normal is b/w 120-160 beats /mins)
3.
liquor (is liquor clear © or meconium (m) staned
4.
moulding (one part of foetal skull overlopping another : may be muld
moderate,or sener ). Mild moulding : when the bones apose (come in condact
moderate moulding :when one bone overlaps another, but can be separated
atrogenically.
5.
cenucogram : ceruical dilatation from 1-10cm. when o, it means e corux a
closed. The descend of e head of e boby is measured by e criclton rule of 5.
5/5 =headfully felt, 4/5, 3/5, 2/5, or 1/5=head is felt partially respectively.
When e head is no longer felt it is 0/5 at this point labour is imminent. If
there is no dsscond for head, there’s likely a cophalolivic disproportion
(cpd). Most deliveries occurs before e graph reaches e alert lines. If e graph crosses e alert line and e woman hasn’t delivered, she should be
referred to a place e appropriate facilities, if the facilities are
unavailable. Otherwise evaluate e woman to find aid e case of e delay of
labour. When disconvered, augument e labour e oxytoan to TS e contraction. The uterine
contraction is also maintoned
LABOUR :
it is defined as e act of expulsion of e fetus and placenta to e outside world
per vegirenour e murinal risk to e mother fetus . togeda e convical dilatation.
Utenue contraction are recorded in 10mins (ie no of contraction /10nem) utenne
contraction is adequate if a woman is having at least 3 contraction. 10mins
each lasting abt 40 secs. Adat (.) indicates e contraction is lasting <20
seconds
Astripe
(/)undicatess e contraction is lasting
for 20-40seconds.
A
shade ()indicates that e contraction losting > 40seconds. The no of squares
marked indication e no of contraction in 10minites.
Any
dug gives or intervention undertaken should be recorded. Materinal uital sign’s
column.. any urine passed should be measured and recorded
STAGES OF LABOUR
Labour
is divided in to 3 stages.
a.
the Ist stage of labour is fruition e
onset of labour to full cervical dilatation. It is further divided into( i)
latent these
ii)
Active phase
i)
latent phase: comprised of cervical
ephasement and dilatation up to 3cm (in a grawda ) and 4cm (in a woman who has
delinees before )
ii)
Active phase: from that 3cm (in a P.G) and 4cm (in M) to a full
cervical dilation.
b. The
2nd stage of labour is from full cervical dilatationime e baby is
delivered. Further divided into 2: phase I , phase ii
Phase
I : from full cervical dilatation (with head still up ) to e descent of e
prescuting part to the perineum.
Phase
ii : from the time of presentation e perineum to e time baby is delivered.
c.
the 3rd stage is from the
delinery of e baby to the time e placenta is delivered.
MANAGEMENT OF NORMAL
LABOUR.
1. history
2. examination
:the most input place is e eye (for palar) B.P
under
systemic examination : abdomen and vagina (abdomen is size of uternus
compatible e age ve : in prima grauide ability of one figer when the ceruxs
indicates labour for a multiperous woman , 2 figers should be abled )
plotting
of parfogram should start only when labour has started. The key principles of
mgt of the ist stage of labour : they are
1. prevision
of coutinuity of care and emotrial support to e mother
2. observation
of progress of labans e timely intervention, if it be/comes obnormal
3. manitoning
of e foetal well-being.
4. adequate
and appropriate pain relieve consistant e woman’s wishes.
3. Adequate
hydration to prevent ketosis
HOW
DO YOU CONDUCT DELIVERY
Positions:
Dorsal position ( most common)
Left lateral position
Squatting position.
When may be placed in water ( esp. warm water, it
pain relieving effect) Use hands to support the fetus and the perineum, to
prevent the baby’s head from popping out.
Episiotomy
should be done only when necessary once
delivered, hand over to midwives.
Deliverer
placenta ( by active mgt of 3rd stage: i.e. oxytocic use ( it oxytocin argumentation) or sintometru)
After
baby is delivered, do a controlled cord Traction (cct): Uterus must be
contracted before this is done, to prevent uterine inversion.
Examine
cord and placenta to ensure it is complete
Examine
the perineum to ensure there is no tear (suture if any)
COMPONENTS OF NORMAL
LABOUR.
a.
Spontaneous in onset
b. Women
should be carrying a single baby
c.
Presentation should be cephalic
d. Age
of pregnancy should be below 37-42-weeks
e.
No artificial intervention.
f.
During delivery, there should no
instruments delivery
g.
For a prima grauida the labour should
be less than 12hours but for a multifarious women, should be < 8hrs.
h. You
must have a healthy mother and a healthy baby. After delivery.
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July 08, 2015
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