Ucm 2011 Labor Chart

8/13/2019 Ucm 2011 Labor Chart

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Abigail Kazembe, RNM, PhD.

UCM 2011

15/02/11

USE AND INTERPRETATION OF THE

LABOUR CHART/PARTOGRAPH


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GOAL:

To equip midwives with necessary knowledge, skillsand attitudes for the utilization of the labour chart


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LEARNING OUTCOMES:

1. Define Labour chart2. 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


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Definition

A tool used to record all the information andobservations made on a woman in labour.

The central feature of the chart is the graphicrecording of the dilatation of the cervix and

descent of the head. It is used to ident i fy pro blems that may ar ise

du r ing labour per iod .


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PARTS OF THE LABOUR CHART

1. Admission Details


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2. Composite labour chart The actual graph has three main

sections:

a) Foetal condition

The condition of the foetus isassessed by:

pattern of heart rate;

colour of amniotic fluid;

overlapping of the bones on thefoetal skull (moulding)

and degree of swelling on thescalp on the presenting part(caput).


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b) Information on progress of labour Contractions: along with cervical dilation and

descent of the head, tell the progress oflabour. 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 onthe alert line from 4 cm to 10 cm


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Progress of labour

Descent of the presenting part: descent is

plotted with an O in cephalic presentation; in

other presentations nothing is recorded ondescent, instead the type of presentation

should be recorded on top of the partograph

in red

Time is recorded using the time of admissionas zero time. The actual time of the day is

recorded below the hours line.


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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.


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3. Details of the first vaginal examinationand 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 stagesof labour


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Details of the puerperium for both motherand baby


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IMPORTANT LANDMARKS AND

INDICATORS

1. Landmarksa.Alert Line

Its a line that indicates labour progressin 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 orto the left of the alert line.


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IMPORTANT LANDMARKS AND

INDICATORS

1. Landmarks

a.Alert Line

When dilatation crosses to the right it is awarning that labour may be prolonged (i.e.if labour is progressing at less than 1cmper hour).

Subsequent vaginal examinations aredone:

at 4 hourly or expected time of delivery

and or when membranes rupture.


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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, adecision must be made about action to betaken.

Refer the patient to the next level of

management.


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b. Descent of the presenting part Plotted as O on time charted for

cervical dilatation or appropriate time incephalic presentation.

Descent is indicated in fifths of thefoetal head remaining above the pelvicbrim as per abdominal palpation.

Continuous descent of the presenting

part is an indicator for normal progressof labour


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2. Uterine Contractions

Uterine contractions are necessary forprogress of labour.

Contractions become more frequent andlast as labour progresses.

Contractions are recorded on thepartograph below the time line.

Squares are numbered form 1-5.


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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.


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UTERINE CONTRACTIONS

For example:

Dots represent mild contractions ofless than 20 seconds duration.

///// Diagonal lines indicate moderatecontractions of 2040 seconds duration.

Solid shade represents strong

contractions of 40-60 seconds duration.


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INDICATORS

3. Foetal Condition Foetal heart rate, colour of liquor (amniotic

fluid) and moulding of the foetal skull giveinformation 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 thenormal limits of foetal heart rate.


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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,


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FOETAL CONDITION

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

how well the pelvis will accommodate the foetalhead. 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 easilywith pressure from your finger.

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


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MATERNAL INDICATORS

4. Maternal ConditionAll observations for the mothers conditionare written at the bottom of the partograph.

Monitor and record Pulse and BPhourly. Check Temperature2 hourly Ask the mother to empty bladder 2 hourly.

Check urine for :

Colour

Concentration

amount.

Albumin and acetone.


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MATERNAL INDICATORS

Maternal Condition contRecord 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


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INTERPRETING INDICATORS ON THE

LABOUR CHART

If readings for cervical dilatation remain to theleft of the alert line, cephalo pelvicdisproportion is unlikely and patient is allowedto 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 nearestdistrict hospital as soon as possible and

should reach the hospital before action line isreached.

INTERPRETING THE INDICATORS ON THE


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INTERPRETING THE INDICATORS ON THE

LABOUR CHART CONT

If the foetal heart is below 120, above 160 or isirregular 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 accordingto protocol.

If descent is static for 3 hours refer to the next

level.


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QUESTIONS!


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Documents

Ucm 2011 Labor Chart