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PARTOGRAM

What is a partogram?

 

An important development in the management of labour was the introduction of the partogram. First developed by Hugh Philpott in 1972 to identify abnormally slow labour, the partogram is a graphical representation of the changes that occur in labour, including cervical dilatation, fetal heart rate, maternal pulse,blood pressure, and temperature; it also shows a numerical record of features such as urine output and the volume and type of intravenous infusions (including oxytocin drips). It is therefore possibleat a glance to identify deviations from normal in any of thesevariables.


Partogram: the broken lines show expected progress of cervical dilatation in multiparous (left) and primiparous (right) women. Labour progress is different in primiparous and multiparous women and is best displayed graphically on a partogram, which shows average dilatation rates by parity


Latent (a) and active (b) phase of labour in a multiparous and a primiparous woman, as shown on partogram

The rate of cervical dilatation in the active phase at which augmentation of labour is indicated is controversial. In the1960s through to the early 1980s O'Driscoll and colleagues suggestedthat any nulliparous woman with a rate of cervical dilatationbelow the average (1 cm/h) should be augmented. Thus active managementwould be used in half of women in their first pregnancies; fewmultiparous women progress this slowly. Most obstetricians inBritain are now more conservative, and 0.5 cm/h is commonly takenas the cut off. Usually the first step in augmentation is to rupturethe amniotic membranes; if this is not followed by a speedy labourintravenous oxytocin is given to stimulate contractions. Carefulclinical monitoring is needed to ensure that contractions do notexceed one every two minutes, or fetal hypoxia may result fromrestriction of the maternal afferent placental blood flow.

When the progress of labour is so slow (despite oxytocic stimulation) that the woman is becoming exhausted and the fetus atrisk of hypoxia, a caesarean section is the best solution. Anindividual decision is taken by each woman on the recommendationof her obstetrician. A caesarean section cannot be performed withoutthe mother's specific consent, except when she is mentally incompetentand then the decision must be made by acourt.

A study in Canada found tha the use of a partogram without a mandatory management of labour protocol had no effect on rates of CS or other intrapartum interventions in healthy primiparous women at term.0701

The 2-hour partogram increases the need for intervention without improving maternal or neonatal outcomes, compared with the 4-hour partogram, advocated by the World Health Organization.0601

Women's Health


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