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THE PARTOGRAPH. Session Objectives. After this mini lecture, the student should be able to: Understand the concept of the partograph Record the observations on the partograph Understand the difference between the latent and the active phase of labour
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Session Objectives After this smaller than expected address, the understudy ought to have the capacity to: Understand the idea of the partograph Record the perceptions on the partograph Understand the contrast between the idle and the dynamic period of work Interpret a recorded partograph and perceive any deviation from ordinary Monitor the advance of work, perceive the requirement for activity

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INTRODUCTION Prolonged work is a main source of death among moms and babies in the creating scene. Etiology: Cephalo Pelvic Disproportion Uterus does not contract adequately Complications : blocked work, drying out, weariness, crack of the uterus, maternal disease, vesico-vaginal fistula, drain and neonatal contamination.

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INTRODUCTION The partograph is an instrument uses to record the data from the history and physical examination of the lady in labor. It takes after and decipher the advance of ladies\' work through recording of cervical dilatation, plunge of fetal head and compressions. Additionally screen maternal and fetal prosperity. Usefull to deal with the work of ladies with or without complexities . THE PARTOGRAPH IS NOT A REPLACEMENT OF Labor CARE

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work mind includes more than a partograph. It includes singular tend to every lady in labor.

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Partograph Name : G: P: An: age: Label with patient recognizing data Note fetal heart rate, shade of amniotic liquid, nearness of trim, compression design, medicines given Plot cervical enlargement Alert line begins at 4 cm- - from here, hope to widen at rate of 1 cm/hour Action line: If tolerant does not advance as above, activity is required

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Use of Partograph: Best Practice WHO prescribes utilizing the partograph to screen all ladies amid work. The partograph is an apparatus, not an end in itself. At the point when utilized viably, the partograph: gives a realistic representation of work advance and the state of the mother and baby controls early identification of delayed or deterred work illuminates basic leadership in the administration of work

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STARTING THE PARTOGRAPH Who ought not have a partograph ? Antepartum hemorhage Eclampsia Fetal trouble Malpresentation CPD = cepalopelvix disproporsi All ladies in labor must be screened for such unique issue

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STARTING THE PARTOGRAPH The partograph should just be begun when a lady is in a work: In the dormant stage : Contractions must be at least 2 in 10 minutes, each enduring 20 seconds or more. In the dynamic stages: Contractions must be at least 3 in 10 minutes, each enduring 40 seconds or more.

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HOW TO USE THE PARTOGRAPH When a lady\'s conceded in labor, you should assess her condition and the state of her infant. Begin the partograph by composing a lady\'s name and other affirmation data. Compose the season of affirmation

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Follow the advance of work: Find out when the withdrawals started, on the off chance that she has had any draining and if and when the layers burst. Take the lady temperature, heartbeat and circulatory strain. Listen for the fetal heart rate Feel for the withdrawal Physical examination Vaginal examination (if there is no dying) HOW TO USE THE PARTOGRAPH (cont.)

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PARTS OF THE PARTOGRAPH Progress of work Fetal Condition Maternal Condition

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A. Advance of work Cervical dilatation Descent of the showing fetal head Uterine Contractions

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CERVICAL DILATATION The primary phase of work is separated into the inert and dynamic stages The inactive stage : Slow time of cervical dilatation from 0 – 2 cm with a progressive shortening of the cervix. Ought not over 8 hours The dynamic stage: Faster time of cervical dilatation) is from 3 cm to 10 cm (full cervical dilatation) Normally 1 cm/hour

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RECORDING CERVICAL DILATATION ON THE PARTOGRAPH Mark hours along the base (flat) pivot. The season of confirmation is composed before the primary square Find the zone along the left side named : Cervix Cervical dilatation stamp as "X", every square speak to 1 cm dilatation

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RECORDING CERVICAL DILATATION ON THE PARTOGRAPH On the chart, Three dim line are drawn: Latent Phase drawn along the line for 3 cm in dilatation, from time 0 to 8 hours Alert is drawn start at 3 cm in dilatation from time 8 hours stretching out to 10 at 15 hours. This line expands 1 cm for each hour Action is attracted 4 hours to one side of the ready line (from 12 to 19 hours for 3 to 10 cm of dilatation

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FREQUENCY OF VAGINAL EXAMINATION Every 4 hours More Frequent : - Discomfort for the mother - Introducing contamination Less regular : Delay in analysis moderate advance in labor

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OTHER SIGNS OF PROGRESS IN Labor Although cervical dilatation is the most essential indication of advance in labor, other critical signs are : Uterine withdrawals Descent of the fetal head

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RECORDING HEAD DESCENT ON THE PARTOGRAPH Assess the level of the fetal head abdominally before each vaginal examination Note the quantity of fifth that can be felt over the pelvis Record the level by an "O" on the partograph. This implies each "X" check for cervical dilatation there is must be an "O" stamp for level of fetal head On the dynamic stage, "X" and "O" ought to be exchanged to the ready line

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Recording fetal plunge

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UTERINE CONTRACTIONS Measured more frequently than cervical dilatattion and fetal head drop Every hour in the inert stage and each ½ hour in the dynamic stage Assess withdrawals in the most recent 10 minutes of every hour/half-hour Count every one of the compressions (recurrence and term) in that 10 minutes Fill in one box at the opportune time on the partograph

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Three conceivable ways the length of constrictions can be shaded.

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FETAL CONDITION Fetal Heart Rate Color and measure of liqour Molding of fetal skull

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Recording fetal condition Fetal Heart: Record each half-hour Liqour: record at regular intervals at the season of vaginal examination, however at whatever time if the alcohol changes Molding: Note and record at each vaginal examination

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Recording fetal condition

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MATERNAL CONDITION Pulse and circulatory strain Temperature Urine test and volume Medications given Fluid admission

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Recording maternal condition

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Example: Mother condition

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POINTS TO REMEMBER Time of confirmation is 0 time, when the lady in the inactive period of work When the dynamic period of work starts, all recordings are exchanged, plotting the cervical dilatation on the ready line. On the off chance that the ladies comes in the dynamic period of work, recording of cervical dilatation begins on the ready line. At the point when the advance of work is ordinary, plotting of the cervical dilatation stays on the ready line or to one side of it.

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ABNORMAL PROGRESS OF Labor Prolonged Latent Phase If a lady is conceded in labor in the idle stage (under 3 cm enlarged) and stays in the inert stage for the following 8 hours, advance - is irregular and she should be exchanged to a doctor\'s facility for a choice about further activity: This is the reason there is a substantial line drawn on the partograph toward the end of 8 hours of the idle stage:

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Plotting delayed inactive stage

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Observations on partograph above: On affirmation at 7:00, the head was 5/5 over the pelvic overflow and the cervix was 1 cm expanded. There were 2 withdrawals in 10 minutes, each enduring 20-40 seconds. Following 4 hours at 11:00, the head was 4/5 over the pelvic overflow and the cervix was 2 cm enlarged. In the most recent 10 minutes of that half-hour, there, were 2 constrictions, each enduring between 20 end 40 seconds. After four hours at 15:00, the head was still 4/5 over the pelvic overflow and the cervix was still 2 cm widened. There were 3 compressions in 10 minutes,each enduring somewhere around 20 and 40 seconds. The length of the inert stage was 8 hours in the unit.

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Support of Woman Give lady as much data and clarification as she goals Provide mind in labor and labor at a level where lady feels protected and sure Provide empathic support amid work and labor Facilitate great correspondence between parental figures, the lady and her friends Continuous compassionate and physical support is connected with shorter work, less medicine and epidural absense of pain and less agent conveyances WHO 1999.

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Support from female relative enhances work results Skilled administration of work utilizing a partograph, a basic diagram for recording data about the advance of work and the state of a lady and her infant amid work, is critical to the suitable counteractive action and treatment of delayed work and its complexities. Taking after the proposal of the World Health Organization (WHO), the Maternal and Neonatal Health (MNH) Program advances the utilization of the partograph to enhance the administration of work and to bolster basic leadership with respect to mediations. At the point when utilized suitably, the partograph helps suppliers distinguish delayed work and know when to take fitting activities. Madi et al 1999.

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Normal work and Childbirth: Conclusion Have a gifted orderly present Use partograph Use particular criteria to analyze dynamic work Restrict utilization of pointless intercessions Use dynamic administration of third phase of work Support lady\'s decision for position amid work and labor Provide con

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