USE AND INTERPRETATION OF THE LABOUR CHART/PARTOGRAPH

Abigail Kazembe, RNM, PhD. UCM 2011 15/02/11

GOAL:
To equip midwives with necessary knowledge, skills

and attitudes for the utilization of the labour chart

LEARNING OUTCOMES:
1. Define Labour chart 2. Outline parts of the labour chart 3. Explain indicators and landmarks of the labour chart 4. Record data on the labour chart 5. Interpret data recorded on labour chart

Definition
A tool used to record all the information and

observations made on a woman in labour. The central feature of the chart is the graphic recording of the dilatation of the cervix and descent of the head. It is used to identify problems that may arise during labour period.

PARTS OF THE LABOUR CHART

1.

Admission Details

PARTS OF THE LABOUR CHART

2.

Composite labour chart The actual graph has three main

sections: a) Foetal condition The condition of the foetus is assessed by: pattern of heart rate; colour of amniotic fluid; overlapping of the bones on the foetal skull (moulding) and degree of swelling on the scalp on the presenting part (caput).

PARTS OF THE LABOUR CHART

b) Information on progress of labour

Contractions: along with cervical dilation and

descent of the head, tell the progress of labour. Contractions are recorded under the time line Cervical dilatation: most important observation to monitor progress of labour. The dilatation is plotted with an X. Dilatation is plotted on the active phase on the alert line from 4 cm to 10 cm

PARTS OF THE LABOUR CHART

Progress of labour Descent of the presenting part: descent is plotted with an O in cephalic presentation; in other presentations nothing is recorded on descent, instead the type of presentation should be recorded on top of the partograph in red Time is recorded using the time of admission as zero time. The actual time of the day is recorded below the hours line.

PARTS OF THE LABOUR CHART

c)

Maternal condition Blood pressure, pulse rate and temperature are recorded in the space provided. Urine: the amount is recorded every time the mother passes urine. Albumin and acetone (ketone) are tested and documented on the appropriate space.

PARTS OF THE LABOUR CHART

3. Details of the first vaginal examination

and pelvic assessment, which includes Condition of the soft tissues, cervix; membranes; and presenting part Details of the pelvis are also explored and the conclusion is drawn. 4. Details of the 2nd, 3rd, and 4th stages of labour

PARTS OF THE LABOUR CHART

Details of the puerperium for both mother and baby

IMPORTANT LANDMARKS AND INDICATORS

1. Landmarks a. Alert Line Its a line that indicates labour progress in terms of cervical dilatation during the active phase of the first stage of labour. Cervical dilatation progresses at 1cm per hour in the active phase of labour. Cervical dilatation should remain on or to the left of the alert line.

IMPORTANT LANDMARKS AND INDICATORS

1. Landmarks a. Alert Line When dilatation crosses to the right it is a warning that labour may be prolonged (i.e. if labour is progressing at less than 1cm per hour). Subsequent vaginal examinations are done:
at 4 hourly or expected time of delivery and or when membranes rupture.

LANDMARKS & INDICATORS

b.

Action Line An oblique line which is 4 hours to the right of the alert line in primipara and multipara. If a womans labour reaches this line, a decision must be made about action to be taken. Refer the patient to the next level of management.

LANDMARKS & INDICATORS

b.

Descent of the presenting part Plotted as O on time charted for cervical dilatation or appropriate time in cephalic presentation. Descent is indicated in fifths of the foetal head remaining above the pelvic brim as per abdominal palpation. Continuous descent of the presenting part is an indicator for normal progress of labour

LANDMARKS & INDICATORS

2. Uterine Contractions Uterine contractions are necessary for progress of labour. Contractions become more frequent and last as labour progresses. Contractions are recorded on the partograph below the time line. Squares are numbered form 1-5.

LANDMARKS & INDICATORS

Each square represents one contraction so that if

2 contractions are felt in 10 minutes, two squares will be shaded. Levels of intensity of the uterine contractions are recorded differently.

UTERINE CONTRACTIONS
For example: Dots represent mild contractions of less than 20 seconds duration. ///// Diagonal lines indicate moderate contractions of 20 40 seconds duration. Solid shade represents strong contractions of 40-60 seconds duration.

INDICATORS
3. Foetal Condition

Foetal heart rate, colour of liquor (amniotic fluid) and moulding of the foetal skull give information about the foetal condition. a) Foetal heart rate: is recorded half hourly.

Each block represents 30 minutes. The lines for 120 and 160 beats per minutes are darker to remind the midwife that these are the normal limits of foetal heart rate.

FOETAL CONDITION
b) Membranes and liquor (amniotic fluid). The state of liquor or amniotic fluid determine foetal condition. The following observations are made during vaginal examination and recorded as follows:
Record I if membranes are intact R Record C If membranes are ruptured and liquor is

Clear Record M when liquor is meconium stained Record B when liquor is Blood stained, Record A when liquor is Absent,

FOETAL CONDITION
c. Moulding of the foetal skull
Moulding is an important indicator as it shows

how well the pelvis will accommodate the foetal head. Record the degree of moulding as follows:
O - bones are separated and sutures can be felt easily. + - bones are just touching each other. ++ -bones are overlapping but can be separated easily

with pressure from your finger. +++- bones are overlapping but cannot be separated easily with pressure from your finger.

MATERNAL INDICATORS
4. Maternal Condition

All observations for the mothers condition are written at the bottom of the partograph.
Monitor and record Pulse and BP hourly. Check Temperature 2 hourly Ask the mother to empty bladder 2 hourly. Check urine for : Colour Concentration amount. Albumin and acetone.

MATERNAL INDICATORS
Maternal Condition cont
Record any drugs given Drugs Record any fluids given for rehydration Oxytocin: there is a separate column for Oxytocin.

Record all entries and observations on the time line.

INTERPRETING INDICATORS ON THE LABOUR CHART

If readings for cervical dilatation remain to the

left of the alert line, cephalo pelvic disproportion is unlikely and patient is allowed to deliver unless otherwise. If readings cross the alert line to the right, labour becomes high risk (CPD is likely), patient should be transferred to the nearest district hospital as soon as possible and should reach the hospital before action line is reached.

INTERPRETING THE INDICATORS ON THE LABOUR CHART CONT

If the foetal heart is below 120, above 160 or is

irregular manage the mother as foetal distress according to the cause. If maternal vital signs, and urine output becomes abnormal act according to Protocols. If contractions are weak augment labour accordingly If contractions are hypertonic manage according to protocol.
If descent is static for 3 hours refer to the next

level.

Required competencies
Fill in the labour chart with
Client data Indicators for maternal condition

QUESTIONS!