Module 15 Partograph
Module 15 Partograph
Course Number & Title: NCM 107 RLE: Care of Mother, Child, Adolescent (Well Clients)
Placement: Second Year – First Semester
Duration of the Module: August 8 – 13, 2022
Clinical Instructor-In-Charge: Mrs. Florence H. Baluran, RN, MN
Contact Information: [email protected]
PRAYER
To begin our participation with this module, we stand before our Heavenly Father in
humble prayer. We realize that without His blessings we would not be able to succeed
with the plans we have for this module. We ask from our Heavenly Father to bestow us
His grace, guidance, and divine wisdom to all of us so that we could attend to our classes
very well, as well as absorb and understand our lessons easier and well.
TODAY’S PRAYER
AMEN.
1 | The Partograph
I. INTRODUCTION
Approximately half a million women lose their lives every year because of complications
of pregnancy and about 99% of these occur in developing countries. The risk of a woman
dying because of a complication related to pregnancy in developing countries can be as
much as a hundred times that of women in Western Europe or North America. An average
of 450 women dies for every 100 000 live births in the developing world (WHO, 1991).
Recognizing the unacceptably high maternal mortality ratio, the preventable nature in
most cases, and the social consequences of a mother’s death to her family and children,
the Safe Motherhood Conference organized jointly by The World Bank, WHO and the
United Nations Population Fund held in Nairobi in February 1987 concluded with a “Call
to Action.” This call demands that health workers involved in the care of mothers and
children take positive action now to reduce maternal mortality and morbidity. Among the
actions called for are to ensure that all pregnant women are screened by supervised and
appropriately trained non-physician health workers where appropriate, with relevant
technology (including partographs as needed), to identify those at risk; and to provide
prenatal care and care during labor, as expeditiously as possible (Mahler, 1987).
Postpartum hemorrhage and sepsis are the most common causes of maternal death in
developing countries, but obstructed labor and ruptured uterus may cause as many as
70% of all maternal deaths in some situations.
Early detection of abnormal progress of labor and the prevention of prolonged labor would
significantly reduce the risk of postpartum hemorrhage and sepsis, and eliminate
obstructed labor, uterine rupture, and its sequelae.
To avoid such complications, a chart called a partograph will help you to identify the
abnormal progress of a labor that is prolonged, and which may be obstructed. It will also
alert you to signs of fetal distress.
The partograph is a graphical presentation of the progress of labor, and of fetal and
maternal condition during labor. It is the best tool to help you detect whether labor is
progressing normally or abnormally, and to warn you as soon as possible if there are
signs of fetal distress or if the mother’s vital signs deviate from the normal range. It serves
as an “early warning system” and assists in early decision on transfer, augmentation, and
termination of labor. Research studies have shown that maternal and fetal complications
due to prolonged labor were less common when the progress of labor was monitored by
the birth attendant using a partograph.
In this module, you will learn about the principles of using the partograph, the
interpretation of what it tells you about the labor you are supervising, and what actions
you should take when the recordings you make on the partograph deviate from the normal
range. When the labor is progressing well, the record on the partograph reassures you
and the mother that she and her baby are in good health.
2 | The Partograph
II. LEARNING OUTCOMES
At the end of this module, you will be able to:
1. Explain the principles of the partograph as a tool for prevention of fetal and
maternal complications during labor.
2. Record clinical observations accurately on the partograph.
3. Interpret and recognize any deviations from normal.
4. Describe specific course of action at the appropriate time.
3 | The Partograph
Malpresentation. Malpresentation refers to when your baby is in an unusual
position as the birth approaches
Meconium. Meconium is a newborn's first stool. This sticky, thick, dark green stool
is made up of cells, protein, fats, and intestinal secretions, like bile. Babies typically pass
meconium in the first few hours and days after birth. But some babies pass meconium
while still in the womb during late pregnancy.
Multipara. A woman who has had two or more pregnancies resulting in potentially
viable offspring.
Obstructed labor. Obstructed labor, also known as labor dystocia, is when the
baby does not exit the pelvis during childbirth due to being physically blocked, despite the
uterus contracting normally. Complications for the baby include not getting enough
oxygen which may result in death.
Oxytocin (hormone). Oxytocin is a peptide hormone and neuropeptide normally
produced in the hypothalamus and released by the posterior pituitary. It plays a role in
social bonding, reproduction, childbirth, and the period after childbirth
Oxytocin (synthetic). Synthetic oxytocin, sold under the brand name Pitocin
among others, is a medication made from the peptide oxytocin. As a medication, it is used
to cause contraction of the uterus to start labor, increase the speed of labor, and to stop
bleeding following delivery.
Parity (Para). Parity is defined as the number of times that she has given birth to
a fetus with a gestational age of 24 weeks or more, regardless of whether the child was
born alive or was stillborn.
Postpartum hemorrhage (PPH). Postpartum hemorrhage is commonly defined
as blood loss exceeding 500 milliliters (mL) following vaginal birth and 1000 mL following
cesarean.
Primipara. A woman who is pregnant for the first time or who has borne just one
child.
Prolonged labor. Prolonged labor is the inability of a woman to proceed with
childbirth upon going into labor. Prolonged labor typically lasts over 20 hours for first time
mothers, and over 14 hours for women that have already had children.
Uterine contractions. The tightening and shortening of the uterine muscles.
During labor, contractions accomplish two things: (1) they cause the cervix to thin and
dilate (open); and (2) they help the baby to descend into the birth canal.
V. LEARNING TASKS
Learning ACTIVITY
Simplified WHO partograph is a graphical record of maternal and fetal data during
progress of labor entered against time on single paper sheet. Entire labor can be
interpreted in a glance on the partograph. It helps to detect abnormal progress of
labor. it guides obstetrician to decide about the need for augmentation of labor or
termination of pregnancy either by instrumental delivery or CS and avoids prolong
labor before obstruction.
4 | The Partograph
DISCUSSION FORUM
FORUM_Partograph_Surname
(Example: FORUM_Partograph_BALURAN)
5 | The Partograph
ONLINE QUIZ
The aim of the quiz is to check your understanding of the topics
discussed per week. Read instructions carefully, and then click “Take
the Quiz” button.
MODULE FEEDBACK
Congratulations for completing this module. We want you to tell us about
your experience and general level of satisfaction for this module by
answering the module feedback in the eLearn course site. This also helps
us to highlight issues of concern that we can aim to improve for future
students who will take this module. You feedback has an important role in
helping us maintain, and improve where necessary, the quality of this
module.
V. SUMMARY
In the study sessions in this module, you have learned that the major reasons why you
need to monitor a laboring mother so carefully. Remember that a labor that is progressing
well requires your help less than a labor that is progressing normally. Documenting your
findings on the partograph during labor enables you to know quickly if something is going
wrong, and whether you should refer the mother to the nearest hospital for further
evaluation and intervention.
VI. REFERENCES
Mahler H. The safe motherhood initiative: a call to action. Lancet, 1987, 1:668-670.
Philpott RH. Graphic records in labour. British Medical Journal, 1972, 4:163-165
World Health Organization. The application of the WHO partograph in the management
of labour. Report of a WHO multicentre study 1990-91. Maternal Health and Safe
Motherhood Programme, Geneva, 1994 (WHO document WHO/FHE/MSM/94.4).
6 | The Partograph
7 | The Partograph