MCN NCM 07 RLE
LESSON 1: WEEK 1 (DEFINITION OF TERMS & PARTOGRAPH)
 DIFFICULTY OF LABOR
o Inefficient uterine contractions
o Abnormal fetal presentation or
position
o Inadequate bony pelvis
Note:
1/3 of first time mothers experience delay
in the first stage labor
 AUGMENTATION OF LABOR
o Frequency, duration and intensity of
contractions after onset of
spontaneous labor
o A labor that's progressing slowly
can be augmented, which means
certain techniques are used to
speed it along
o CAUSED BY:
 Uterine contractions
 Inappropriately coordinated
to dilate cervix
 Insufficiently strong
LABOR AND DELIVERY TERMS GLOSSARY
I.REVIEW OF TERMINOLOGIES  SHOW
o Also referred to as “bloody show” is
1. First stage
when the cervix begins to open,
 Starts from true labor pains to full dilation thus rupturing tiny blood vessels
of the cervix and leading to blood tinged mucus
o Latent phase
 GRAVIDA
 Begins from regular and
persistent contractions and a o Number of pregnancies
cervical dilation of 0 to 3 cm
 PARA
o Active phase
 4-7 cm dilation o Number of births/ deliveries that
o Transition phase reaches age of viability
 Contractions at peak
 FETAL HEART TONE
intensity that last for 60-90
o Heartbeat of the fetus
secs at 2-3 minutes interval
2. Second stage
 LIQOUR/ AMNIOTIC FLUID
o Serves as a cushion to the growing
 Full dilation to the delivery of the baby
fetus
3. Third stage
 STATION
 Delivery of the placenta
o How far into the birth canal your
4. Fourth stage
baby head is located.
o -5 (not engaged at all)
 Post partum
o +5 (very engaged; prep delivery)
 MECONIUM
o Fetal waste that accumulates in a
baby’s intestine during gestation
o Expelled during or shortly after birth
and is greenish in color
 BREECH
o Term given to the position of the
baby when the buttocks or feet are
positioned to exit the vagina before
the head
 EPISIOTOMY
o Cutting thin skin (perineum)
between the vagina and the anus
o Doctor perform this in the final
stage of labor in order to enlarge
the vaginal opening in preparation
for delivery
o Prevent excessive tearing
 MOULDING
o Extent of overlapping of fetal skull
bones
 CERVICAL DILATION
o Opening of the cervix
 EFFACEMENT
o Thinning of the cervix
 CONTRACTION
o Exhibits a wavelike pattern that
begins slowly climbing (increment)
to a peak (acme), and decreases
(decrement)
 INTERVAL
o Relaxation in between contractions
o End of contraction to beginning of
the next contraction
 FREQUENCY
o Beginning of one contraction to the
beginning of next contraction
 DURATION
o Time the contraction last
o Timed from beginning of PARTOGRAPH
contractions
 Composite graphical record of key data
 OXYTOCIN (maternal and fetal) during labor against
o Drug used to contract the uterus to time on a single sheet of paper
 Graphical analysis of labor for clinical
enhance labor and/ or prevent post-
evaluation of the progress of labor
partum bleeding or hemorrhage
 In its simplest form, it plots the dilation of
the cervix in cm against time in hours
 It is the process of identifying abnormal
progress of labor and fetal response
PROGRESS OF SPONTANEOUS LABOR AT  WHO (2000)
TERM
Principles:
th
Parameter Median 5 percentile
o Latent phase has been removed
Nullipara
Total duration 10.1 h o Latent phase should last no > 8 hrs
First stage 9.7 h 24.7 h o Active phase commences at 4 cm
Second stage 33 min 117.5 min cervical dilation during active
Third stage 5 min 30 min phase, the rate of cervical dilation
Latent phase 6.4 h 20.5 h should be slower than 1cm/hr.
Maximum 3 cm/h 1.2 cm/h
dilation rate
Descent rate 33 cm/h 1 cm/h OBJECTIVES OF USING PARTOGRAPH:
Multipara 1. Early detection of abnormal progress of
---- 6.2 h 19.3 h labor
---- 8h 18.8 h 2. Prevention of prolonged labor
---- ---- 46.5 min 3. Early recognition of maternal or fetal
problems such as cephalopelvic
MODIFICATION: disproportion
4. Assist in early decision on transfer,
 PHILPOLT & CASTLE(1972) augmentation, or termination of labor
a. alert and action lines 5. To facilitate research
o ALERT LINES 6. To defend one’s actions- no
 Represent the mean rate of documentation – no defense
slowest progress of labor 7. Highly effective in reducing complications
o ACTION LINES from prolonged labor for the mother
 Appropriate actions should 8. Reduce the incidence of CS rate
be taken
b. Descent of the head
c. Emphasized its clinical application
MOTHER INFORMATION:
 FETAL WELL-BEING PROGRESS OF LABOR TRANSFERRING DILATATION ONTO THE
o FHR ALERT LINE IN THE ACTIVE PHASE OF
 Provides early detection of abnormal
o Character of liquid LABOR
progress of labor
o Moulding o Cervical dilation  CERVICAL DILATATION
 LABOR PROGRESS o Descent of the fetal head o The central feature of the
o Dilatation partogram is a graph where cervical
o Uterine contractions
o Descend dilatation is plotted. Along the left
o Uterine contractions FETAL DESCENT/ STATION side, there are squares from 0 to
 MEDICATIONS  UTERINE CONTRACTIONS 10, each representing 1 cm
o Oxytocin o The lightening and shortening of the dilatation. Along the bottom of
o Pain relief uterine muscles graph are numbers 0-24 each
 MATERNAL WELL-BEING o Accomplish 2 things: representing 1h.
o BP, pulse, temp.  Cervix to thin and dilate o The first stage of labor is divided
o Urine  Help the baby descend into into latent and active phase, the
the birth canal latent phase is from 0 to 3 cm, and
it lasts up to 8 h. The active phase
Note: is from 3 to 10 cm(full cervical
 Begin plotting at zero in partograph dilation). The dilation of cervix is
 All entried made in relation to time when plotted with “X”.
the observations are made o When a woman is admitted in the
 Notes should be legible, dated and timed active phase, the cervical dilatation
 Enter the outcome of delivery is plotted on the alert line, if
Premature rupture of membranes progress of labor is satisfactory, the
plotting of cervical dilatation will
remain on the left of alert line.
PLOTTING THE UTERINE CONTRACTIONS:
SYMBOLS FOR THE DURATION OF
CONTRACTIONS
 Dots
o Contractions less than 20 sec
 Diagonal lines
o Contractions lasting between 20-40
secs
 Solid shading
o Contractions more than 40 secs
 Below the cervical dilatation, there is a
space for recording uterine contractions
per 10 min and the scale is numbered
from 1 to 5. Each square represent one
contraction. So if two contractions are felt
in 10 min, two squares are shaded.
Duration of contractions is indicated by the
following symbols:
 LIQOUR
o Below the FHR, there are two rows,
and the first is for liquor. Once the
membranes rupture, the color of
amniotic fluid is noted
o Intact membrane (I)
o Liquor is clear (C)
o Meconium stained (M)  c/s  multi ,CPD, fetal
o Liquor is bloody (B) comparamise, VBAC, breach
IMPORTANCE OF ALERT AND ACTION LINES MANAGEMENT OF LABOR USING THE
PARTOGRAPH
In the normal labor during the active phase,
plotting of cervical dilation will remain on the left  Moving to the right of alert line- a warning
of or on the alert line. If it moves to the right of sign
the alert, labor may be prolonged. In this What to do:
situation, transfer the patient if facility for
emergency intervention is not available. Transfer 1. Transfer the woman from health center to
allows adequate time for assessment or hospital
intervention till she reaches the action line. 2. Decision needed on further management
Action line is 4h to the right of the alert line. (usually by obstetrician or resident)
Assess the cause of the slow progress, and take
necessary action. Action should be taken in a
place where facility for dealing with obstetric DELAY IN THE SECOND STAGE
emergencies is available.
Additional causes:
o OP position, long internal rotation,
SECONDARY ARREST persistence OP
o Epidural anesthesia
o Of cervical dilatation and descent of
o Secondary uttering inertia:
presenting part typically after 7 cm
dehydration and ketosis
dilatation
o Narrow med cavity (android pelvis):
o Most common cause is CPD
deep transver arrest
o Management
 ARM + oxytocin  primi (in
Management:
multi, CPD may be but cution
o Oxytocin infusion if contraction not
2.5 u in 500 ml dextrose)
strong
 o In DEEP transverse arrest o If second stage without severe fetal
rotational forceps may use to bring distress and/ or obstruction
the head OA position o Oxytocin—if no contraindications--
o c/s is the best option support only—if satisfactory
o manual rotation also an option progress is established and
dilatation could be anticipated at
1cm/hr. faster
WHEN PROGRESS IN ACTIVE PHASE o The latent phase should last no >8
REMAINS ON OR LEDT OF THE ALERT LINE/ hours
LATENT PHASE IS LESS THAN 8 HOURS o Active phase commences at 4cm
cervical dilatation
What to do:
o During active phase; the rate of
1. Do not augment oxytocin if
cervical dilatation should be slower
latent and active phases go
than 1cm/hr.
normally
2. Do not intervene unless
Management:
complications develop
o Full medical and obstetric
3. Artificial rupture of membrane
assessment
(ARM)
o Medications as indicated
Note: No ARM in latent phase
o Surgical procedure—c/s

MANAGEMENT OF LABOR AT OR BEYOND

THE ACTION LINE
1. Full medical and obstetric assessment
2. IV infusions / catheterization / analgesics
3. Options:
o PERFORN CS- if feta distress or
obstructed labor or operative
vaginal delivery