Partogram
A partogram or partograph is a composite graphical record of key data (maternal and fetal) during labour entered against time on a single sheet of paper. Relevant measurements might include statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs.[1]
It is intended to provide an accurate record of the progress in labour, so that any delay or deviation from normal may be detected quickly and treated accordingly. However, a Cochrane review came to the conclusion that there is insufficient evidence to recommend partograms in standard labour management and care.[2]
Many partograms showing cervical dilation versus time include an alert line. It starts at the position where there is 3[3] or 4[4] cm of cervical dilation. It is then continued diagonally at a rate of 1 cm per hour in primigravidae and 1.5 cm in multigravidae.[3] An action line is parallel to the alert line, and is located 4 hours to the right of the alert line.[3]
Components
- Patient identification
- Time: It is recorded at an interval of one hour. Zero time for spontaneous labour is time of admission in the labour ward and for induced labour is time of induction.
- Fetal heart rate: It is recorded at an interval of thirty minutes.
- State of membranes and colour of liquor: "I" designates intact membranes, "C" designates clear and "M" designates meconium stained liquor.
- Cervical dilatation and descent of head
- Uterine contractions: Squares in vertical columns are shaded according to duration and intensity.
- Drugs and Fluids
- Blood pressure: It is recorded in vertical lines at an interval of 2 hours.
- Pulse rate: It is also recorded in vertical lines at an interval of 30 minutes.
- Oxytocin: Concentration is noted down in upper box; while dose is noted in lower box.
- Urine analysis
- Temperature record
Advantages
- Provides information on single sheet of paper at a glance
- No need to record labour events repeatedly
- Prediction of deviation from normal progress of labour
- Improvement in maternal morbidity, perinatal morbidity and mortality
Usage
A partogram is contained in the Perinatal Institute's "Birth notes".[5]
Use of a partogram in established labour is recommended by the National Institute for Clinical Excellence (NICE) http://www.nice.org.uk/ in the "Intrapartum Care" guideline.[6]
References
- ↑ http://staff.um.edu.mt/csav1/lectures/partogram.pdf
- ↑ Lavender, T.; Hart, A.; Smyth, R. M. (2008). "Effect of partogram use on outcomes for women in spontaneous labour at term". The Cochrane Library. doi:10.1002/14651858.CD005461.pub2.
- 1 2 3 Preventing Prolonged Labor by Using Partograph by Ganesh Dangal. The Internet Journal of Gynecology and Obstetrics. Retrieved Feb 2014
- ↑ The Alert and Action lines from OpenLearn Labour and Delivery Care HEAT Module. Retrieved Feb 2014
- ↑ "Perinatal Institute". www.perinatal.org.uk.
- ↑ "Intrapartum care: care of healthy women and their babies during childbirth". NICE guidelines [CG190]. December 2014. Retrieved 6 December 2014.