How often should you record the liquor findings? The recordings should be made: At each vaginal examination. Whenever a change in the liquor is noted, e. Recording the progress of labour F. Recording the length of the cervix effacement The length of the cervix is recorded by drawing a thick, vertical line on the same part of the chart that is used for the cervical dilatation.
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The partograph is a graphic record of the progress of labour and relevant details of the mother and fetus. It was initially introduced as an early warning system to detect labour that was not progressing normally.
This would allow for timely transfer to occur to a referral centre, for augmentation or Caesarean section as required. The partograph indicates when augmentation is needed, and can point to possible cephalopelvic disproportion before labour becomes obstructed.
It increases the quality and regularity of observations made on the mother and fetus, and it also serves as a one-page visual summary of the relevant details of labour. It is important to ensure that adequate supplies of the form are always available.
The WHO partograph begins only in the active phase of labour, when the cervix is 4 cm or more dilated see below. However, it is a tool which is only as good as the health-care professional who is using it.
If the findings become abnormal, increased frequency of observation and testing will be required, and intervention may be implemented. O Fetal well-being: record fetal heart rate for 1 minute every 15—30 minutes after a contraction in the first stage, and every 5 minutes in the second stage. If abnormalities are noted, urgent delivery can be considered.
O Liquor: clear, meconium stained thick or thin , bloody or absent. Thick meconium suggests fetal distress, and closer monitoring of the fetus is indicated.
Check every 30 minutes. O Frequency, duration and strength of uterine contractions assessed by palpation : record every 30 minutes. The number of squares filled in records the number of contractions in 10 minutes. The shading shows the length of contractions. O Vaginal examination: this should be done no less than every 4 hours to assess cervical dilatation, descent of the fetal head, and moulding of skull bones.
More frequent examination is only undertaken if indicated. There must be a team approach, and senior staff must oversee the care of high-risk patients. Ideally there should be one-to one care. Begin at 4 cm. O Alert line: starting at 4 cm of cervical dilatation, up to the point of expected full dilatation at the rate of 1 cm per hour.
O Descent assessed by abdominal palpation: this refers to the part of the head which is divided into five parts palpable above the symphysis pubis; recorded as a circle O at every vaginal examination.
O Time: record the actual time at minute intervals. O Drugs given: record any additional drugs given. O Blood pressure: record every 4 hours and mark with arrows, unless the patient has a hypertensive disorder or pre-eclampsia, in which case record every 30 minutes.
O Temperature: record every 4 hours. O Urine, ketones and volume: ideally record every time urine is passed.
Labour and Delivery Care Module: 4. Using the Partograph
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Provides information on single sheet of paper at a glance Early prediction of deviation from normal progress of labour Improvement in maternal morbidity , perinatal morbidity and mortality Limitations[ edit ] It requires a skilled healthcare worker who can fill and interpret the partograph. Recent studies  have shown there is no evidence that partograph use is detrimental to outcomes. Often paper-partograph and the equipment required to complete it are unavailable in low resource settings. Despite decades of training and investment, implementation rates and capacity to correctly use the partograph are very low. According to some recent literature,  cervical dilatation over time is a poor predictor of severe adverse birth outcomes. This raises questions around the validity of a partograph alert line.