Partogram

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Partogram

Partogram 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[3]

Components[edit]

  1. Patient identification
  2. 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.
  3. Fetal heart rate: It is recorded at an interval of thirty minutes.
  4. State of membranes and colour of liquor: "I" designates intact membranes, "C" designates clear and "M" designates meconium stained liquor.
  5. Cervical dilatation and descent of head
  6. Uterine contractions: Squares in vertical columns are shaded according to duration and intensity.
  7. Drugs and Fluids
  8. Blood pressure: It is recorded in vertical lines at an interval of 2 hours.
  9. Pulse rate: It is also recorded in vertical lines at an interval of 30 minutes.
  10. Oxytocin: Concentration is noted down in upper box; while dose is noted in lower box.
  11. Urine analysis
  12. Temperature record

Advantages[edit]

  • 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[edit]

A partogram is contained in the Perinatal Institute's "Birth notes" http://www.perinatal.nhs.uk/index.htm.
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.

References[edit]

  1. ^ http://staff.um.edu.mt/csav1/lectures/partogram.pdf
  2. ^ Lavender, T.; Hart, A.; Smyth, R. M. (2008). "Effect of partogram use on outcomes for women in spontaneous labour at term". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD005461.pub2.  edit
  3. ^ a b c Preventing Prolonged Labor by Using Partograph by Ganesh Dangal. The Internet Journal of Gynecology and Obstetrics. Retrieved Feb 2014
  4. ^ The Alert and Action lines from OpenLearn Labour and Delivery Care HEAT Module. Retrieved Feb 2014