Презентация на тему: BY – RITIK GUPTA GROUP 173 B

BY – RITIK GUPTA GROUP 173 B
P ARTOGRAPH
BY – RITIK GUPTA GROUP 173 B
Objectives of using partograph
BY – RITIK GUPTA GROUP 173 B
WHO REQUIRE S PARTOGRAM RECORDING ???
BY – RITIK GUPTA GROUP 173 B
BY – RITIK GUPTA GROUP 173 B
BY – RITIK GUPTA GROUP 173 B
BY – RITIK GUPTA GROUP 173 B
e. Cervicogram
f. Uterine Contractions
BY – RITIK GUPTA GROUP 173 B
Benefits of a partograph
BY – RITIK GUPTA GROUP 173 B
BY – RITIK GUPTA GROUP 173 B
The active phase is further into 3 parts :
During Normal Progress of Labor
Abnormal progress of labour
BY – RITIK GUPTA GROUP 173 B
BY – RITIK GUPTA GROUP 173 B
BY – RITIK GUPTA GROUP 173 B
Moving to the right of alert line
When progress in active phase remains on or left of the alert line / latent phase is less than 8 hours
MANAGEMENT OF LABOUR BETWEEN ALERT AND ACTION LINES (Alert or Referral zone)
MANAGEMENT OF LABOUR AT OR BEYOND THE ACTION LINE
BY – RITIK GUPTA GROUP 173 B
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Первый слайд презентации: BY – RITIK GUPTA GROUP 173 B

PARTOGRAPH MONITORING OF LABOR

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Слайд 2: P ARTOGRAPH

It is composite graphical record of key data (maternal and fetal) during labour entered against time on a single sheet of paper. PARTOGRAM It is the process by which normal and abnormal progress of labour and also fetal response in labour can be identified.

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Слайд 3

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Слайд 4: Objectives of using partograph

O Early detection of abnormal progress of labour. O Prevention of prolonged labour. O Increase the quality and regularity of all observations of mother and fetus. O Early recognition of maternal or fetal problems. O To provide a basis of decision making. O To facilitate research. O To defend one’s actions – no documentation – no defense.

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Слайд 5

IMPORTANCE OF USING PARTOGRAPH : It allows an instant visual assessment of the rate of Cervical dilatation and comparision with an expected normal, so that abnormal progress can be recognized Early and appropriate actions taken to correct it where possible.

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Слайд 6: WHO REQUIRE S PARTOGRAM RECORDING ???

A ll women who are in labour.

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Слайд 7

Mother information Fetal well-being Fetal heart rate Character of liquor Moulding Labour progress Dilatation Descent Uterine contraction Medications Oxytocin Pain relief (e.g. pethidine) Maternal well-being BP, Pulse, Temperature Urine – albumin, glucose, acetone Urine output

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Begin “ze r o” p l ot t ing hour a t the on t he Enter the outcome of delivery 1 partogram 2 All entries made in relation to time when the observations are made 3 Notes should be legible, dated and timed. 4

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Components In Detail a. Patient identification Name / Date and time of admission /Gestation/ Medical / Obstetrical issues

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Fetal heart rate recorded every 30minutes. The condition of the membranes and liquor amnii. Mark ‘I’ for intact membrane. ‘C’ for clear liquor amnii. ‘M’ for meconium stained liquor. Moulding.

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Слайд 11: e. Cervicogram

It is a graphic representation of cervical dilatation and descent of the presenting part. It is an essential part of the partogram. It offer the chance of early detection of abnormal progess of labour. First, alert line starts at 3cm cervical dilatation and ends at 10cm at the rate of 1cm/hour.

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Слайд 12: f. Uterine Contractions

5 strong contractions in 10 minutes 2 weak contractions in 10 minutes 3 moderate contractions in 10 minutes

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g.Assess maternal condition regularly by monitoring : O Drugs, IV fluids, and oxytocin, if labour is augmented O Pulse, Blood pressure O Temperature O Urine volume analysis for protein, acetone, glucose and volume.

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Слайд 14: Benefits of a partograph

O A single sheet of paper can provide details of necessary information at a glance. O No need to record labour events repeatedly. O Can predict deviation from normal progress early. O It facilitates handover procedure. O Introduction of partograph in management of labour {WHO 1994} has reduced the incidence of prolonged labour and caesarean section rates. There is improvement in maternal morbidity, perinatal morbidity and mortality.

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Слайд 15

Friedman's partogram - 1954 2 phases of labour (base on dilatation of the cervix ) Latent phase (dilatation < 3 cm) Active phase (>3 cm dilated) Latent phase Active phase Philpott and Castle - 1972 Introduced the concept of “ALERT” and “ACTION” lines. ALERT LINE – represent the mean rate of slowest progress of labour ACTION LINE – appropriate action should be taken. Normal labour is plotted to the left alert line

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The WHO model of the partograph was developed as an international standard in 1988 following the launch of the worldwide Safe Motherhood Initiative. Following a multicenter trial in 1990-1991, WHO recommended that the partograph should be used in monitoring all labors.

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Слайд 17: The active phase is further into 3 parts :

Friedman′s Division of Labor : The active phase is further into 3 parts : Acceleration phase. Phase of maximum slope and Decceleration phase.

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Слайд 18: During Normal Progress of Labor

latent phase : 8 hours or less. active phase : progress of the cervical dilatation remains on the alert line or between the alert and the action lines ( 1cm/hour ). * second stage : represents reasonable rotation and descent of the presenting part within 1 hour or less.

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Слайд 19: Abnormal progress of labour

o Disorders of 1 st stage Protracted active phase -the rate of cervical dilatation <1.2cm/hr in primipara and <1.5cm/hr in multipara. Arrest disorder -no cervical dilatation in 2 hrs after active phase of labour. o Secondary arrest is defined when the active phase of labour commences normally but stops or slows significantly for 2 hrs or more prior to full dilatation of cervix.

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o Disorders of 2 nd stage Protraction of descent -descent of presenting part is <1cm/hr in nullipara and <2 cm/hr in multipara. Arrest of descent -no progress of descent is observed.

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Слайд 23: Moving to the right of alert line

This is a warning sign. We should Transfer the woman from healt h center to hospital. Decision is needed on further management.(usually by obstetrician or resident )

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Слайд 24: When progress in active phase remains on or left of the alert line / latent phase is less than 8 hours

O Do not augment with oxytocin if latent and active phases go normally O Do not intervene unless complications develop O Artificial rupture of membranes ( ARM ) O No ARM in latent phase O ARM at any time in active phase

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Слайд 25: MANAGEMENT OF LABOUR BETWEEN ALERT AND ACTION LINES (Alert or Referral zone)

Transfer the woman to hospital unless th e cervix is almost fully dilated ARM may be performed if membranes are still intact and first stage of labour is advanced and delivery is expected soon. Perform ARM at vaginal examination Continue routine monitoring Repeat vaginal examination 4 hrs or earlier if delivery is expected sooner Do not intervene or augment – unless complications develop

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Слайд 26: MANAGEMENT OF LABOUR AT OR BEYOND THE ACTION LINE

Full medical and obstetric assessment Consider IV infusions / catheterization / analgesics (tramadol, pethidine, etc) Options O Perform CS - if fetal distress or obstructed labour or operative vaginal delivery if in 2 nd stage without severe fetal distress and/or obstructed. O Oxytocin – if no contraindications O Supportive only – if satisfactory progress is established and dilatation could be anticipated at 1cm/hr or faster.

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Последний слайд презентации: BY – RITIK GUPTA GROUP 173 B

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