LAB 6

• Assessment of mother & fetus / newborn

during labor

PREPARED BY : MS.Binitha
MODIFIED BY : MS Preetha

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OBJECTIVES
1. Describe the partograph used in labor
2. Assist/assess in conduction of spontaneous vaginal delivery
and placenta examination-
• Attached checklist - Lab syllabus
3. Discuss the placenta examination-
Attached checklist- Lab syllabus
• 4. Demonstrate the immediate care of newborn
• Required text book (472-474, 478-479)
Attached checklist- Page 41 Lab syllabus
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 Partograph
• A partograph is a graphical record
of the observations made of a
women in labor
• For progress of labor and
conditions of the mother and the
fetus
• It was developed and extensively
tested by the world health
organization WHO

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 Components of partograph could include
1. The fetal heart rate.
2. Maternal temperature, pulse and blood pressure.
3. Cervical dilatation.
4. Descent of fetal head& molding.
5. State of membranes and color of liquor.
6. Strength frequency and duration of uterine contractions.
7. Drugs and Fluids.
8. Urine analysis.

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 Partogram -
Assessment done for mothers? Assessment done for Fetus ?
• Vital signs – BP, Pulse, TºC • Descent of fetal head&
• Cervical dilatation & molding
Effacement • The fetal heart rate.
• Strength frequency and
duration of uterine
contractions

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 Advantages
• Provides an easy access to information on single sheet of paper at a
glance.
• Indicates the progress of labor.
• Predicts deviation from normal progress of labour.
• Prevent intrapartum and postnatal complications such as
obstructed labour, uterine rupture, postpartum hemorrhages and
sepsis.
• Assist in early decisions on transfer, augmentation and termination
of labour.
• Encourage timely referral from the periphery.
• Reduces maternal morbidity and mortality
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 How to use the partograph for monitoring

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 PARTOGRAM
Mother personal
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
04-Dec-22 • Urine
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 PARTOGRAM RECORDING

Mother personal
information
❑ Name
❑ Age
❑ Parity
❑ Gestational period
❑ Date/time of
admission
❑ Time of rupture
membrane
❑ Short antenatal history

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 Components of the partograph
• Part 1 : fetal condition ( at top )
• Part 2 : progress of labour (at middle )
• Part 3 : maternal condition ( at bottom )

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Assessment of Fetal
condition
• 1 - Fetal heart rate
• 2 - membranes and
liquor
• 3 - molding the fetal
skull bones. Caput
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Assessment of
maternal condition
❑Vital signs – BP, Pulse, TºC
❑ Urine analysis – acetone,
albumin, glucose ,
❑ Urine volume
❑ Medications or drug given
11
 Assessment of Progress of labor

oCervical dilatation
oDescent of the fetal
head
oUterine contractions

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 Part 1 : Fetal condition
This part of the graph is used to monitor and assess fetal condition
• 1 - Fetal heart rate
• 2 - membranes and liquor
• 3 - molding the fetal skull bones. Caput

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 How to plot the condition of
membranes and liquor ?
• Intact membranes ……………………………………….I
• Ruptured membranes + clear liquor …………………….C
• Ruptured membranes + meconium- stained liquor ……..M
• Ruptured membranes + blood – stained liquor …………B
• Ruptured membranes + absent liquor…………………....A

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How to plot moulding of fetal skull in
partogram sheet
It Provide information about the adequacy of pelvis to
accommodate fetal head

1.Record the degree of moulding

0 → bones separated
+ → bones touching but can
be separated.
++ → bone over lapping
+++ → bones over lapping
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 MOULDING OF THE HEAD
oThe extent of overlapping of fetal skull bones
is called molding.
oDue to molding shape of the fetal skull
changes, which helps to reduce the fetal
head circumference during labor .
oIt is produced by the force of uterine
contractions pressing the vertex of the
head against the undilated cervix .
How the skull bones overlap for molding?
oFrontal bones slip under parietal bones
oParietal bones override each other
oParietal bones slip under the occipital
bone
 Part 2 – progress of labour

oCervical dilatation
oDescent of the fetal head
oUterine contractions

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ALERT LINE
• •As soon as cervix is 3cm or more dilated on vaginal examination, an
alert line is drawn in red obliquely upward ,along the expected rate of
dilatation 1cm per hour .
• •Alert line indicates the expected rate of dilatation during active phase
of labor
• •If on subsequent vaginal examination the cervical dilatation is on the
right of the Alert line the doctor should be informed as it gives in
indication that labour is not progressing as it should be.
THE ACTION LINE
• is drawn parallel and 4 hours to the right of the Alert line.Is drawn
parallel to action line .This shows when some action is to be taken.
• These two lines are designed to warn you to take
action quickly if the labour is not progressing
normally.
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 Cervical condition and related part

1. Cervical condition
* dilatation 0-10 cm
* effacement 0-100%

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 Descent of fetal head
Fetal descent assessed by abdominal exam
• measured by abdominal palpation and It is expressed in
number of finger width ( fifths of the head)

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Descent of fetal head -
Assessing descent of the fetal head by vaginal
examination;fetal
•
station
• 0 station is at the level of the ischial spine
• If the presenting fetal part lies above the ischial spines, the
station is reported as a minus station(negative station) which
range from -1 to -4 cms (each number is a centimeter).
• If the presenting part lies below the ischial spines, the station is
reported as a plus station ranging from +1 to +4 cms
• At – 4 stations, head is said to be floating.
• At + 4 stations, head is at outlet and it can be seen if the vulva
is separated
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 Fetal station
4. Station

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 Fetal station

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How to Plot cervical dilatation & descent of
fetal head
cervical dilatation:
• Dilatation of cervix plotted as “X” axis and Descent
plotted as “O” axis.
• Cervical dilatation measured by the diameter in cm

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 Uterine contractions
• Observations of the contractions are made every hour in the
latent phase and every half-hour in the active phase
• Frequency - how often are they felt ?
assessed by number of contractions in a 10 minutes period
• Duration - how long do they last ?
• Each square represents one contraction

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 How contractions are plotted ?
Palpate number of contraction in ten minutes and duration
of each contraction in seconds
• Mild- Contractions Less than 40 seconds
marked as:

• Moderate- Contractions Between 40 and 60 seconds:

• Strong - Contractions More than 60 seconds:

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 Part 3 of partogram : maternal
condition
❑ Vital signs – BP, Pulse, TºC
❑ Urine analysis – acetone,
albumin, glucose ,
❑ Urine volume
❑ Medications or drug given

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 PARTOGRAM RECORDING- Mother condition
❑ Vital signs recording

BP – 4 hourly or more
frequent if indicated

Pulse - ½ hourly
TºC – 4 hourly

❑ Urine analysis – dipstick

acetone → Nil or +
albumin → Nil or +
glucose → Nil or +

04-Dec-22 ❑ Urine volume

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 IMMEDIATE CARE OF
NEWBORN

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Goals of initial care

•Establish & maintain respiratory effort/function

•Provide warmth

•Provide safety

•Identify actual or potential problems

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 Care of new born at birth

▪New born identification band ties on the leg

& hand
▪Foot print
▪Birth registration
▪Birth record documentation (all
information related with initial new born
care)

PREETHA/BINITHA/MCH 2022/LAB 6
Birth Record Documentation
The infant’s chart is also a vital piece of documentation.It serves as a baseline indicating
whether the infant was well at birth. Be certain a newborn chart contains the following
information:
• Time of birth
• Time the infant breathed
• Whether respirations were spontaneous or aided
• Apgar score at 1 minute and at 5 minutes of life
• Whether eye prophylaxis was given
• Whether vitamin K was administered
• General condition of the infant
• Number of vessels in the umbilical cord
• Whether cultures were taken (they are taken if at some point sterile birth technique
was broken or the mother has a history of vaginal or uterine infection)
• Whether the infant voided and whether he or she passed a stool (this information is
helpful if, later on, the diagnosis of bowel obstruction or absence of a kidney
is considered)
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 Vitamin k administration for newborn

• Newborn at risk for bleeding disorders during the first

week of life as their gastrointestinal tract is sterile at
birth and unable to produce vitamin K
• Single dose Injection vitamin K 5 to 10 mg
administered intramuscularly within 1st hour of life to
prevent bleeding disorders.

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 APGAR SCORE

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 WHAT IS APGAR??

A – Activity

P – Pulse rate

G – Grimace

A – Appearance

R - Respiration

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 Assessment of the baby’s condition done :-

• While cleaning the airway & cutting the cord.

• At 1 minute & 5 minutes after birth
APGAR scoring system used

5 signs are considered & the degree to which

they are present or absent

• Airway can be cleared with gentle suctioning

with clear airways breathing is established &
baby’s color quickly improves
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 Apgar scoring chart
SIGN 0 1 2
Heart rate Absent Slow (<100) >100

Respiratory effort Absent Slow, irregular Good,regular

respiration ; weak cry respiration ; strong cry

Muscle tone Flaccid/limp Some flexion of Well flexed

extremities
Reflex irritability: Cough or sneeze
• Response to catheter No response Grimace
in nostril, or Cry and withdrawal of
• Slap to sole of foot No Grimace foot
response
Blue, pale Body normal & Normal skin color
Color extremities (pink)
04-Dec-22 blue(acrocyanosis)
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INTERPRETATION OF SCORES
The test is generally done at one and five
minutes after birth
Scores 7 and above are generally normal
Score below 3 – child may suffer
neurological damage

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