Dr Ban Hadi Objectives by the end of this lecture we should be able to 1 Read a partograph 2 Record the findings on partograph 3 Diagnose partograph abnormalities 4 Manage the patients with abnormal ID: 931879
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Slide1
Partograph clinical cases
Dr Ban
Hadi
Slide2Objectives: by the end of this lecture, we should be able to:
1. Read a
partograph
2. Record the findings on
partograph
.
3. Diagnose
partograph
abnormalities.
4. Manage the patients with abnormal
partograph
.
Slide3Case 1:
Mrs
Layla
ahmed
a 25 years old G2P1 woman admitted on the 1
st
of October at 10:00 am with
labour
pain.
OE
:
Temp.37C0, PR 88bpm, BP 120/70mmHg.
FHR 140bpm
Uterine cont. 3/10 min each lasts for 35 sec.
Fetal head 5/5 palpable
PV: 5 cm dilatation, intact
memb
.
PLOT these findings on
partograph
.
Slide4Slide5Slide6After 4 hours:
Temp.37C0, PR 90bpm, BP 130/70mmHg.
FHR 130bpm
Uterine cont. 4/10 min each lasts for 45 sec.
Fetal head 3/5 palpable
PV: 7 cm dilatation, ruptured
memb
. With a clear
liquore
.
PLOT these findings on
partograph
.
Slide7Slide8Slide9After 4 hours:
Temp.37.5 C0, PR 100bpm, BP 140/80mmHg.
FHR 100bpm
Uterine cont. 5/10 min each lasts for 55 sec.
Fetal head 1/5 palpable
PV: 7 cm dilatation, ruptured
memb
. With a
meconium
stained
liquore
,
moulding
++.
Urine 200 ml, protein +/HPF.
PLOT these findings on
partograph
.
Slide10Slide11Slide12Case 2:
Mrs
Yasmin
admitted to the
labour
room with
labour
pain, she is a 40 weeks pregnant
primigravida
,
O\E: The head was 3/5 palpable, the cervix was 5cm dilated The membranes were ruptured spontaneously and it was a clear
liquore
.
Observation after 4 hrs revealed the following
partograph
:
Slide13Slide14What further action would you consider?
Slide15This is a normally progressing labour
, no action is required. Just continue the observation
Slide16Case 3:
Mrs
Heyam
is a 34-year-old woman,
para
2 vaginal deliveries , pregnant 38 weeks presented with
labour
pain.
O/E: No fetal head was palpable abdominally, the cervix was 4 cm dilated with intact membranes.
4 hrs observation revealed the following
partograph
:
Slide17
Slide18What will be your further action?
Slide19Poor progress of labour
as the uterine contractions are infrequent so ARM then after that
oxytocin
is the optimal action
Slide20Case 4:
Mrs
Merium
a 34-year-old patient, pregnant 39 weeks presented with
labour
pain.
O/E: The head was 5/5 palpable, the cervix was 4cm dilated with intact membranes.
Slide21Admission partograph
Slide22After 4 hrs of active labour
, ARM revealed clear liquor with the following
partograph
:
Slide23Slide24After 2hrs of active
labour
, the following
partograph
:
Slide25Concerning fetal observations, the following findings are seen:
Slide26What will be your further action?
Slide27Consider referral for hospital with facilities for caesarean delivery
Slide28What is the abnormality in this
partograph
?
Slide29Slide30A primary dysfunctional labour
or prolonged active phase of
labour
Slide31What is the abnormality in this
partograph
?
Slide32Secondary arrest of cervical dilatation
Slide33Slide34Slide35What is the abnormality in this
partograph
?
Slide36Secondary arrest of descent of presenting part
Slide37Slide38The American College of Obstetrics and Gynecology (ACOG) proposed extending the minimum period before diagnosing active-phase arrest. It defines 6 hours as the 95th percentile of time to go from 4 cm to 5 cm dilatation, with the active phase defined as beginning at 6 cm (instead of 4 cm).
The ACOG has also stated that extending the time from 2 to 4 hours with
oxytocin
augmentation appears effective. Irrespective of the duration, maternal and fetal well-being status must be confirmed.
Slide39Slide40Slide41Evidence for Adequate and Arrested Labor
Arrest
of labor:
“. . . the diagnosis of arrest of labor should not be made until adequate time has elapsed.”
Adequate labor:
“. . . includes greater than 6 cm dilation with membrane rupture and 4 or more hours of adequate
contractions (e.g., greater than 200 Montevideo units) or 6 hours or more if contractions inadequate with no
cervical change. . . .”
Second-stage labor:
“. . . no progress for more than 4 hours in
nulliparous
women with an epidural, more than 3 hours in
nulliparous
women without an epidural. . . .”
“No cesarean before these time limits . . . in the presence of reassuring maternal and fetal status.”
Slide42Specific Recommendations to Safely Reduce Primary Cesarean Deliveries
Permit prolonged latent (early)-phase labor.
Consider the start of active-phase labor to be defined as cervical dilation of 6 cm (instead of 4 cm).
Permit more time for labor to progress in the active phase.
Permit
multiparous
women to push for 2 or more hours and
primiparous
women to push for 3 or more hours. In some situations, for example, when epidural anesthesia is used, pushing may be allowed to continue even longer.
Use techniques, such as use of
ventous
, to facilitate vaginal delivery, which is the preferred method when possible.
Encourage patients to avoid excessive weight gain during pregnancy.
Increase access to nonmedical interventions during labor, such as continuous labor and delivery support, which has been shown to decrease cesarean birth rates.
Perform external cephalic version for breech presentation.
Permit a trial of labor for women with twin gestations when the first twin is in cephalic presentation
Permit a trial of labor for women with previous caesarean birth
Slide43Thank you
QUIZ
Slide44Q1: What is the abnormality?
Q2: What is the cause?
Q3: Mention the treatment.