DEPARTMENT OF

OBSTETRICS & GYNAECOLOGY

NORMAL PARTOGRAM

YEAR 3/2020

GROUP 1 COHORT 5

LECTURER’S NAME : PROF DATO’ DR. MOHAMED ROUSE B. ABD MAJID

PREPARED BY : FARAH NUR AISYA BT FADZIL

MATRIC NUMBER : M183000334

DATE : 4th APRIL 2021

Patient’s Name: Hafizah binti Abdul Rahman

Age: 30-year-old

CASE SUMMARY:

Puan Hafizah binti Abdul Rahman, 30-year-old Malay lady, Gravida 3, Para 2, at 39 weeks
period of amenorrhea (POA). Her last menstrual period (LMP) was on 3 rd May 2020 and her
estimated date of delivery (EDD) was on 27th January 2021.

She was admitted to the ward on 16 th December 2020 at 06:00 pm with a complaint of
contraction pain once every ten minutes. She said that she first felt the pain at 05:00 am on
the same day. The contraction pain last for 10 to 20 seconds and keep increasing in intensity
and frequency. The pain was associated with show. Otherwise, the was no leaking liquor and
fetal movements were good. She also denied any fever, per vaginal bleeding and foul-
smelling vaginal discharge. There was also no urinary frequency, dysuria, hesitancy, or
urgency.

This was a planned and wanted pregnancy. She had early urine pregnancy test (UPT) done at
8 weeks of POA in the health clinic. She had her first booking at 12 weeks of POA. During
this visit, she was told that her blood pressure was normotensive. Her booking weight was 62
kg with a height of 155 cm making her BMI was 25.4 kg/m2 which was normal. On her
booking urine test, there was no proteinuria and glycosuria. Early scan dating was done at 12
weeks of POA, and the date was confirmed. Her latest scan was done at 20 weeks POA and
she was told that her fetus was growing well. Otherwise, the pregnancy has progressed well
and uneventful.

COMMENTS ON THE PARTOGRAM:

The patient was sent to the labour room at 10:00 pm on 16 th December 2020 at active phase
of labour. There was moderate contraction felt, twice in every ten minutes which lasted for 30
seconds. Abdominal palpation showed uterine was 38 weeks size. There was singleton fetus
in longitudinal lie with cephalic presentation. Fetal head was engaged and 3/5 palpable.
Estimated fetal weight was 3.2 to 3.4 kg. Vaginal examination showed cervical os was 4 cm
dilated, fully effaced cervix and membrane intact. Fetal heart was present and regular at 130
bpm. CTG was reactive.

She was given 1 pint Dextrose Saline maintenance, IM Pethidine and IM Phenergan 25 mg.
She had artificial rupture membrane (ARM) done at 11:00 pm. No moulding and the liquor
were clear. Maternal blood pressure was 120/80 mmHg. Her pulse was 100bpm and her
temperature was 37°C. Her urine test was negative for ketone.

At 01:00 am on 17th December 2020, there was strong contraction felt that lasted for 50
seconds which was 4 in 10 minutes. She was given Entonox. Maternal blood pressure (BP)
was 130/80 mmHg. Her pulse was 80 bpm, and she was afebrile with temperature of 37 °C.
Then, second stage of labour began. Abdominal examination showed fetal head was engaged
and 2/5 palpable. Vaginal examination revealed os 8 cm dilated and fully effaced cervix.
Caput was felt and no moulding. The liquor was clear. CTG findings shows a baseline fetal
heart rate approximately 130 bpm, frequent accelerations, baseline variability of 10-15 bpm
and no decelerations. Progress of labour was recorded on partogram.

Strongest contraction felt at 03:00 am which increases to 5 in 10 minutes and lasted for 50
seconds. Abdominal examination showed uterus was 36 weeks. Fetal head was engaged and
1/5 palpable. Vaginal examination revealed fully effaced cervix with os fully dilated (10 cm).
Caput was felt and no moulding. The liquor was clear. Then, she was brought to labour.

She was bearing down to push the baby out. Episiotomy was done by the staff nurse to
prevent extensive vaginal tears. The CTG was reactive.

There were no complications during the labour and no significant amount of excessive blood
loss. The baby was delivered within 15 minutes and followed by delivery of placenta 10
minutes later. Mother did not complain of any pain and was stabilised throughout the labour.
Both mother and baby were well throughout the labour.

LABOUR OUTCOME AND COMMENTS:

Mother was put in lithotomy position. Episiotomy was done at 03:15 am to deliver the baby.
A baby boy was delivered at 03:15 am on 17 th December 2020 weighing 3.14 kg with Apgar
score 9. Vitamin K and Hepatitis B vaccination were given to the baby shortly 30 minutes
after birth. Cord blood was collected and G6PD test was negative.

Placenta and membrane were completely delivered with weighing 500 g. Estimated blood
loss was 200 ml. IM Syntometrine 1 amp was given. Episiotomy was sutured with Vicryl 2.0.
Postpartum, she was comfortable with BP 118/80 mmHg, pulse 86 bpm and afebrile with
temperature 37°C. Her uterus was well contracted to 18 weeks size. She was prescribed with
Haematinics once daily. Both mother and baby were discharged well.

CRITICAL APPRAISAL:

Hafizah binti Abdul Rahman, 30-year-old Malay Lady, Gravida 3 Para 2, at 39 weeks period
of amenorrhea (POA). She was admitted to the ward on 16 th December 2020 at 06:00 pm due
to contraction pain. Artificial rupture of membrane (ARM) was done to augment her labour.
After ARM was done, cervical os was found to be 4 cm dilated and 1 hour 15 minutes later,
the os was fully dilated. She was going to fast active phase of labour since this is her third
pregnancy. Usually, multigravida women are easier to pass an active phase of labour and
more rapid dilatation of cervix which is normally at 0.5-1.0 cm compared to primigravid
women. Hence, positioning the patient in lithotomic position also plays important role in
helping the labour progress to become easier and well and the baby also was delivered with
good Apgar score.
NORMAL PARTOGRAM