STAGES OF LABOR & DELIVERY

ESSENTIAL INTRAPARTUM and NEWBORN CARE

(EINC)
Evidenced-based standards for safe and quality care of
birthing mothers and their newborns, within the 48 hours of
Intrapartum period (labor and delivery) and a week of life for the
newborn

Mother= Essential Intrapartum Care (EIC)

Newborn= Essential Newborn Care (ENC)

ESSENTIAL INTRAPARTUM and NEWBORN CARE
(EINC)
December 2009

DOH Secretary Francisco Doque signed

Administrative order 2009-0025
• mandates implementation of EINC protocol in public and private
hospitals

Unang Yakap campaign was launched

 STAGES OF LABOR

Stage 1 = Stage of Cervical Dilatation

Stage 2 = Stage of Fetal Expulsion

Stage 3 = Stage of Placental Expulsion

Stage 4 = Stage of Puerperium

STAGE PRIMIS MULTIS

1ST STAGE 10-12 hours 6-8 hours

2ND STAGE 2 hrs. average 50 20 to 90 minutes
minutes average 20 minutes
3RD STAGE 30 minutes 30 minutes
4TH STAGE 1 to 4 hours 1 to 4 hours
FIRST STAGE OF LABOR
 FIRST STAGE OF LABOR
“STAGE OF CERVICAL
DILATATION”
• From the onset of true
labor contractions &
ends with complete or
full cervical dilatation
(10 cm)
 DILATATION
Progressive, opening/widening of the cervical canal

Expressed in centimeters

(cms)

10 cm = fully dilated cervix

Primigravida= 1.2 cm/hr

Multigravida= 1.5 cm/hr

 EFFACEMENT
shortening and thinning of the cervical canal

Expressed in percentage(%)
EFFACEMENT
 100% • fully effaced cervix
effaced • cervical canal become paper-thin

75% • cervix become ¼ of its original

effaced length

50 % • cervix become ½ of its original

effaced length

25 %
• cervix is ¾ of its original length
effaced
CLOSED CERVIX
 PHASES OF THE FIRST STAGE OF LABOR
LATENT ACTIVE TRANSITION
DILATATION 0-3 cms 4-7 cms 8- 10 cms
DURATION 20-40 sec. 40-60 sec. 60-90 sec.
INTERVAL 5-10 min. 3-5 min. 2-3 min.
INTENSITY Mild, short & Moderate to Strong
irregular strong
FREQUENCY > 10 min 3-5 min 2-3 min
 LATENT ACTIVE TRANSITIONAL
MATERNAL • Minimal • Increasing • Increased
DISCOMFORT discomfort discomfort, perspiration
• backache trembling of • Nausea & vomiting
• abdominal thighs and legs • Strong uterine
cramps • Pressure on the contractions
• rupture of bladder and • Backache
membrane rectum • Pressure on
bladder and rectum
• Leg trembling,
Cramps
 LATENT ACTIVE TRANSITIONAL
MATERNAL • Excited & • Fear of losing • Restlessness
BEHAVIOR alert control, • Panic and anxious
• Talkative, • Irritable, Restless • Irritability
able to • Less talkative, • Has lost control
laugh More anxious of labor
• Pain is • Skin warm and • irresistible urge
controlled flushed to push
• able to walk • May • circumoral pallor
hyperventilate • resist being
touched and
push person
away
ANALGESIA COMMONLY USED DURING CHILDBIRTH

Narcotic Analgesics Example:

• may be given during • Meperidine

labor because of Hydrochloride (Demerol)
their potent • Nalbuphine (Nubain)
analgesic effect • Fentanyl (Sublimaze)
• Butorphanol tartrate
(Stadol)
 Meperidine Hydrochloride (Demerol)
most commonly used

Has sedative and antispasmodic effect (Relieves pain and helps relax
the cervix)

given either intramuscularly or intravenously

Dose : 25 –100 mg depending on woman’s weight & route of

administration.
Onset of action:
• 30 minutes after intramuscular (IM) injection
• 5 minutes after intravenous (IV) administration.
Duration of action : 2 - 3 hours
 SPECIAL CONSIDERATIONS IN GIVING DEMEROL:

• Not given early in labor due to possible effect on contractions (delays

progress)
• Given if cervical dilatation is 6 – 8 cms.(more than 3 hours away from
birth)
• Not given too late (1-2 hours before delivery) because it can cause
respiratory depression in the newborn
• Narcotic Antagonist:
❖Naloxone Hydrochloride (Narcan)- used to counteract newborn
respiratory depression when a mother has received a narcotic
analgesic during labor.
ESSENTIAL INTRAPARTUM CARE (EIC)
PRACTICES DURING FIRST STAGE OF LABOR
Mobility= allow the mother to walk to increase the
descent of fetus only if BOW is intact

Food and drinks= light carbohydrates food

Non pharmacologic pain relief (effleurage, positioning)

Companion in labor= shorter labor

Use of partograph (begins at 4cm (active labor), IE

done every 4 hours (not to exceed 5x because it might
lead to infection)
 NOT RECOMMENDED PRACTICES

• No perineal shaving
• No enema
• No IV fluids
• No NPO
• No lying down
• No artificial rupture of membrane or BOW/ Amniotomy
• No drug induce labor
SECOND STAGE OF LABOR
 SECOND STAGE OF LABOR
( STAGE OF FETAL EXPULSION / DELIVERY STAGE)
from complete cervical dilatation ( 10 cm)
& ends with the delivery of the fetus.

Primigravida: 30 minutes to 2 hrs.

Multigravida: 20 minutes to 1 hr.

Crowning is the • Newborn’s head or presenting part

hallmark appears at the vaginal opening
 Engagement
Descent

CARDINAL MOVEMENTS IN
THE SECOND STAGE OF LABOR Flexion

• ED FIRE ERE Internal rotation

Extension
Descent
External rotation

Expulsion
MECHANISMS (CARDINAL MOVEMENTS) OF LABOR

ENGAGEMENT

• synonymous to station 0
• Passage of the biparietal
diameter of fetal head
through the maternal
ischial spine/pelvic inlet
 DESCENT

• downward movement
of the biparietal
diameter of the fetal
head to the pelvic
inlet.
• Measured by “station”
 FLEXION

• Fetal head bends forward unto the

chest
• Presenting diameter changes from
Occipitofrontal (11cm) to the
smallest AP diameter
suboccipitobregmatic diameter (9.5
cm) to present in the pelvic outlet.
 INTERNAL ROTATION

• fetal skull rotates from transverse to

anteroposterior diameter at pelvic
outlet; associated with descent
• Occiput rotates 45 degrees; is just
under the symphysis pubis
• Sinciput near the sacrum
 CROWNING
Fetal head is visible at
vaginal outlet

Encirclement of the largest

diameter of the fetal head
in the vulvar ring
 EXTENSION

• fetal head reaches the

perineum
• occiput passes under the
lower border of the
symphysis pubis first
• head emerges by extension:
first occiput, next face, finally
the chin
 • sterile towel over the perineum
and press forward on the fetal chin
RITGEN’S while the other hand is pressed
downward on the occiput
MANEUVER
• helps fetal extension
• controls the rate at which the head
is born
 (EXTERNAL
ROTATION/RESTITUTION)
• After head is delivered, it
rotates briefly to the position it
occupied when it was engaged in
the inlet
• 45-degree turn realigns
fetal head with his back and
shoulders
• anterior shoulder descends
first followed by posterior
shoulder
 EXPULSION

• head and shoulders are lifted up

toward the mother’s pubic bone
and the trunk of the fetus is
born by flexing it laterally in the
direction of the symphysis pubis.
PERINEAL ASSESSMENT DURING 2ND STAGE OF LABOR

LACERATIONS

• Injury or tear in the vaginal

canal and perineum that
occurs during delivery of the
fetus
 First Degree Laceration
• A tear on the fourchette, perineal skin, vaginal
mucous membrane
 Second Degree Laceration
• tear on the fourchette, perineal skin, vaginal mucous
membrane, fascia and perineal muscles
 Third Degree Laceration
• A tear on the fourchette, perineal skin, vaginal mucous membrane,
fascia and perineal muscles, perineal body, anal sphincter
 Fourth Degree Laceration

• tear on the fourchette, perineal skin, vaginal mucous membrane, fascia

and perineal muscles, perineal body, anal sphincter and rectum
 Episiotomy

• surgical incision into the

perineum to enlarge the
vaginal opening
• to prevent tearing of the
perineum and release
pressure on the fetal head
with birth
• done during or prior crowning
 Midline/Median episiotomy
• incision is made straight in the
midline of the perineum
• Easily repaired, less discomfort
• allows faster and less painful
healing
• DISADVANTAGE: may extend up
to rectum
Mediolateral episiotomy
• incision directed laterally
away from the rectum
• rectal structures are
avoided
• cause more pain during
healing
 Episiorrhaphy

• Repair of perineal
laceration or of
episiotomy
• stitching together
the margins of a
tear in the tissues
lacerated during
vaginal delivery
EIC PRACTICES DURING SECOND STAGE OF LABOR

Spontaneous bearing down/pushing of the

mother

Place mother on semi upright

Restrictive episiotomy/indicated
episiotomy(do not do as a routine in Primi)
NOT RECOMMENDED PRACTICES:

•No perineal sweeping

•No fundal pushing
THIRD STAGE OF LABOR
 THIRD STAGE OF LABOR
(STAGE OF PLACENTAL EXPULSION)
begins with the delivery of the fetus
to the delivery of the placenta.

Occurs within 30 minutes

 SIGNS OF PLACENTAL SEPARATION
Calkin’s sign
• earliest sign ; uterus becoming firm, round, globular again
• Immediately after delivery fundus at midway between the
symphysis pubis and umbilicus, then rises to the level of the
umbilicus-midline.
sudden gush of blood
lengthening of the umbilical cord

Firm contraction of the uterus

Appearance of the placenta at the vaginal opening

TYPES OF PLACENTAL PRESENTATION
 SCHULTZE PRESENTATION

• Fetal side out first

• “ Shiny/Clean Side First”
• Common (80%)
• placenta separates first at its center & last at its edges
• Folds like an inverted umbrella
 DUNCAN PRESENTATION

• Maternal side out first

• Rough, “dirty”, reddish, irregular, with ridges or cotyledons
• Less common(20%)
• placenta separates first at its edges and last at its center
 TECHNIQUES FOR PLACENTAL EXPULSION
CREDE’S MANEUVER AND
BRANDT ANDREW MANEUVER
• gentle pressure is exerted with the hand on the
contracted uterine fundus and the placenta is
gently guided out of the vagina
• Gentle traction is made on the 4 fingers
pressed the midline of the contracted uterus
pushing it upward
• slowly pull cord and wind the cord around the
clamp until placenta is delivered
• Placenta is held and rotated gradually to ensure
that no membranes are retained
 EIC PRACTICES DURING THE THIRD STAGE OF LABOR
Wait for placental separation, deliver the placenta only if the
uterus is contracted

Expel placenta via BAM (Crede’s Maneuver and Brandt Andrew

maneuver); Use of controlled traction

Inject oxytocin (Check BP first )

Gentle Massage of the uterus

 AMTSL
(Active Management of Third Stage of Labor)
After delivery of baby check if there is a second baby
If none, oxytocic drugs are given IM or IV
Oxytocics-drugs that contracts the uterus thereby controls uterine bleeding
• Oxytocin, Pitocin, Syntocinon
• Ergotrate Maleate, Methergine
• Carboprost (given if uterus is still unable to contract after oxytocin
is given)
Note: Check first the Blood Pressure before giving these Oxytocic drugs
 FOURTH STAGE OF LABOR
(Immediate Postpartum Period)

First 1-4 hours after delivery

Period of recovery, stabilization or homeostasis

Follows placental expulsion and lasts until maternal vital

signs and conditions are stable
 Uterus

• Immediately
after delivery-
midway
between the
umbilicus and
symphysis
pubis.
 KEEP THE UTERUS FIRM IF UTERUS IS DISPLACED TO THE SIDE

• If relaxed, soft and not contracted,

gently massage until it contracts and • First action: Check
becomes firm. bladder distention
• Do not OVER MASSAGE as this can tire
the uterine muscles, causing relaxation • feel the lower
• A boggy uterus many indicate uterine abdomen for a
atony or retained placental fragments.
• Boggy - being inadequately contracted distended bladder
and having a spongy rather than firm
feeling. • When the bladder is
• Administer oxytocin medications if distended, stimulate
ordered.
• Check BP, uterine contraction and
voiding.
lochia after administration
 DOCUMENT LOCHIA FLOW
WHEN THE FUNDUS IS MONITOR VITAL SIGNS
MASSAGED
• Every fifteen (15) minutes • every 15 minutes for the
for the first hour. first one hour
• Every thirty (30) minutes • Every 30 minutes for the
for the next one hour. next two hours
• Every hour until ready for • Every hour until thereafter
transfer. until stable
 CHECK EPISIOTOMY MONITOR BLOOD
CHECK PERINEUM OR LACERATED LOSS DURING
WOUND DELIVERY
• appearance • Bleeding • Normal
• redness, swelling, • Hematoma Spontaneous
bruising • edema Vaginal Delivery
• vaginal & suture line (NSVD): 300-500 ml
bleeding average 250 ml
• Cesarean Birth :
<1000 ml
 ASSESS LOCHIA
• the maternal discharge of blood,
mucus, and tissue from the uterus
• Bright red and can saturate 1 to 2
perineal pads in one hour
• If Reddish persists more than 2
weeks, it indicates either retention
of small portions of the placenta or
imperfect involution of the
placental site
ASSESSMENT
• Keep a pad count. Record the
number of pads soaked with lochia
during recovery.
• Identify presence of bright red
bleeding or blood clots.
• Document thick, foul-smelling
lochia.
• Observe for constant trickle of
bright red lochia. This may indicate
lacerations.
• Identify lochia amounts as small,
moderate, or heavy (large)
 PROMOTE SLEEP PROVIDE PROMOTE
AND COMFORT NOURISHMENT BONDING
• Keep warm. Chills • the woman may be • Early feeding can
are common in thirsty and hungry contract the uterus
fourth stage of and promote
labor bonding (LATCH-
• Give partial bath, ON)
perineal care( front • Breastfeeding
to back) change started: 30
wet linens. minutes after a
• Assess afterpains normal delivery
 STABLE MATERNAL CONDITION
Firm fundus

Lochia moderate in amount

No bladder distention

Alert and responsive

Stable vital signs

No signs of bleeding
STAGES OF LABOR & DELIVERY
PARTOGRAPH
Graphical presentation of the progress of
labor, fetal and maternal condition during
labor.

Tool to help detect whether labor is

progressing normally or abnormally

recording starts when the labor is in

ACTIVE PHASE (4 cm or above).
 OBJECTIVES
1.Early detection of abnormal progress of
a labor and Prevention of prolonged labor

2.Early recognition of maternal or fetal

problems

3.Recognize cephalopelvic disproportion

long before obstructed labor

4.Assist in early decision on transfer or

augmentation of labor
 IDENTIFICATION SECTION
❑ Name
❑ Gravidity
❑ Parity
❑ Hospital Number
❑ Date of Admission
❑ Time of Admission
❑ Rupture Membranes
COMPONENTS OF THE PARTOGRAPH

Part 1 • Fetal Condition (Top)

Part 2 • Progress Of Labor (Middle)

Part 3 • Maternal Condition (Bottom)

PARTOGRAPH
 PART 1
FETAL CONDITION
Part 1 : FETAL CONDITION
Fetal heart rate

Membranes and Amniotic

Fluid

Molding of the fetal skull

bones

Fetal Descent
 FETAL HEART RATE

Recorded initially and then

every 30 minutes.

The scale for fetal heart rate

covers the range from 80 to
200 beats per minute.
 FETAL HEART RATE

Indicator of fetal distress

Normal term HR (37 weeks and more) = 120–160 beats/minute.

Signs of fetal distress during labor :

• fetal bradycardia : FHR < 120 beats/minute for 10 minutes or more

• fetal tachycardia : FHR > 160 beats/minute for 10 minutes or more
 RECORDING FETAL HEART RATE
FHR RECORDED :
• every half hour(30minutes) in
the first stage of labor (if
every count is within the
normal range)
• every 5 minutes in the second
stage.
COUNT THE FETAL HEART
RATE:
• every five(5) minutes if the
amniotic fluid contains thick
green or black meconium.
• Whenever the fetal
membranes rupture, for
possible cord prolapse, cord
compression, or abruptio
placenta as the amniotic fluid
gushes out.
 AMNIOTIC FLUID
Intact Membranes …………………………..............................I
Ruptured Membranes + Clear Amniotic Fluid …………………..C

Ruptured Membranes + Meconium- Stained Amniotic Fluid……..M

Ruptured Membranes + Blood – Stained Amniotic Fluid ………..B

Ruptured Membranes + Absent Amniotic Fluid …………………A

Note:
• if the fetal membranes have ruptured, you should record the color of the fluid
initially and every 4 hours.
 MOLDING
The extent to which the bones of the fetal
skull are overlapping each other as the
fetal head is forced down the birth canal

Important indicator of how adequate the

pelvis can accommodate the fetal head

Assess the degree of moulding

initially and every 4 hours
ASSESSING MOLDING AND CAPUT FORMATION
Normal variations in Molding of the newborn
skull, which usually disappears within 1–3 days
after the birth.
A caput (swelling) of the fetal skull is normal if it
develops centrally, but not if it is displaced to one side.
CAPUT SUCCEDANEUM CEPHALOHEMATOMA
 RECORDING MOLDING
Bones are separated; sutures can be felt easily 0
Sutures apposed or just touching each other +1
Sutures overlapping but reducible +2
Sutures severely overlapping, not reducible +3
 FETAL HEAD DESCENT
Record of how far down the
birth canal the fetal head has
progressed.

Descent is plotted with an “O”

as symbol

Done initially and every 4

hours
FETAL HEAD DESCENT

Assessed by ABDOMINAL
EXAMINATION immediately
before doing a vaginal
examination

Measured by abdominal palpation using

the width of the fingers to express in
fifths the part of the fetal head palpable
above the symphysis pubis using
landmarks sinciput (S) and occiput (O)
Scrcroiooc ioints
I ac bone

lnl I i lidplait uf1_I

 DESCENT OF THE FETAL HEAD

Uses the RULE OF FIFTH to assess

Descent
• The palpable fifth of the fetal head
are felt by abdominal examination to
be above the level of symphysis pubis
• When 2/5 or less of fetal head is
felt above the level of symphysis
pubis , this means that the head is
engaged, and by vaginal
examination , the lowest part of
vertex has passed or is at the level
of the ischial spines
5/5: head completely palpated above the symphysis pubis
4/5: sinciput high; occiput easily felt
3/5: sinciput easily felt; occiput felt
2/5: sinciput: felt; occiput just felt
1/5: sinciput felt; occiput not felt
0/5: None of the head palpable; sinciput at the level of the symphysis pubis
A A Head is mobile above the
symphysis pubis = 5/5
B B Head accommodates full width of
five fingers above the symphysis
pubis
C C Head is 2/5 above the symphysis

D D Head accommodates two fingers

above the symphysis pubis
Progress of fetal descent can be estimated by measuring
the station of the fetal head relative to the ischial spine of
the maternal pelvis. Station can only be determined by
Internal examination.
FLOATING (HIGH)
▪ Unengaged presenting part
STATION -3
▪ presenting part is 3cm above the ischial spines
STATION -2
▪ presenting part is 2cm above the ischial spines
STATION -1
▪ presenting part is 1cm above the ischial spines
STATION 0/ENGAGEMENT
▪ presenting part is at the level of the ischial spines
STATION +1
▪ presenting part is 1cm below the ischial spines
STATION +2
▪ presenting part is 2cm below the ischial spines
STATION +3 OR +4
▪ the presenting part is at the perineum & can be seen if
the vulva is separated
STATION +4
▪ “crowning”
Corresponding positions of the station of the fetal head (determined by
vaginal examination) and the record of fetal descent on the partograph.

Station of fetal Corresponding

head mark on the
partograph
–4 or –3 5
–2 or –1 4
0 3
+1 2
+2 1
+3 0
 To plot the fetaI hea:d descent use the
space from 5 to Oin the same area
where you record cervica,Idilatatiion.

,
Each vertical siide of the rectangle,
.
one fifth of the head above the pelvic
·· .a. brim. For conveniience, the width of
'
the finger is used as a practiical guide.
::f; • Each hor.i:zontal si1de of the rectangle
· shows 3,0 m nute
I ' • "
❖ So plot the values of the fetal head descent (0) sign
❖ Plot at the same vertical lines as the values of the cervical
dilatation reflected with (x) sign
❖ The descent should be taken at the same time of vaginal
examination or cervical dilatation
EXAMPLE
 PART 2
PROGRESS OF LABOR
GRAPH SECTION
Divided evenly into small boxes by
gridlines vertically and horizontally

Vertical gridline = cervical dilatation in

centimeter from 4 to 10

Horizontal gridlines= Time the patient is

in active labor. Each small box is 30
minutes so each square represent 1 hour
 CERVICAL DILATATION
Assessed during every vaginal examination
made every 4 hours, unless contraindicated.

Plot cervical dilatation with (X).

Begin plotting on the partograph at 4 cm.

Represents the rates of cervical dilatation

1cm per hour.

Most important information and the surest

way to assess progress of labor
 GRAPH SECTION
TWO
ALERT LINE ACTION LINE
DIAGONAL LINES
• labelled as • starts at 4 cm of • parallel to the
Alert and Action cervical dilatation Alert line
lines. • travels diagonally • 4 hours to the
upwards to the right of the Alert
point of expected line.
full dilatation (10
cm) at the rate of
1 cm per hour.
GRAPH SECTION
• h · · Iu · o di I.· io · a j • d miss iio ·
•

should ·...· d i a t e ly plott d on t ·

al rt Un imis plot d by (X).
un · g" chm · x v· g1 · " I
.· x - -i --: --...lotion - v·-.Iu_,- o - t · ·_
h gr • · d con U h i di g
a ·i . · a s o ild Iin
 If PROGRESS IS
SATISFACTORY
• plotting of cervical
dilatation REMAINS
ON OR TO THE LEFT
OF THE ALERT LINE
and should not move
to the right of the
alert line.
 _y_J
T - -
-
I I
Th cerVIcal In , doe-s L
not cross the Aler t

-
II ' I
,, _,,, :::,,.._ .,; ® 11fl ,"'
.,,-
/ --::.. .,,- .
,,,.v-
,.,6 :..----
I

I
,,,,. v-
-- I I I

- Good progre s
--- .... of descent

(a) _, _L 0
1"1-n, I
1 2 3 4 5 6 7 I
6 9 10 1 12

._,,,,.,,,,,-
110
8
I _.,,,;,
....,,. I I

c , ( rn )
B

7
0-i:;;:;.-- - IG.,;;,- . 9S?"'
,
. _..,,;;,

-- ----
P
[ l ot X) 6 .,.... ' .,,-
V
._.....,,.
ofh
T
'D es oe ll'l
d
5

1
[ lot OJ
2
1

0
Hours 1 2 ----=! s 8 ----L.. !!.
(b) TiITT I 10 1 1L 12 13 j,4 15 16 7
 If the rate of progress IS
LOWER THAN NORMAL:
• plotting of cervical dilatation
will CROSS THE “ALERT” LINE
AND THEN THE “ACTION
LINE”.
• The “action” line denotes the
critical point at which specific
management decisions
should be made to expedite
delivery.
 MOVING TO THE RIGHT OF THE ALERT LINE OR REACHES
THE ACTION LINE MEANS :

• WARNING: possible danger

• carefully reassess to determine why there is lack of
progress , and a decision must be made on further
management
• If labor occurs in birthing clinic or Rural health centers,
possible referral to hospital with facilities for cesarean
section , unless the cervix is almost fully dilated
• Continue observing labor progress for short period
• Artificial rupture of membrane(Amniotomy) may be
performed if membranes are still intact:
• Catheterization may be done
• Oxytocin augmentation
 MOVING BEYOND ACTION LINE

• the critical line at which specific

management decisions must be made at
the hospital with complete facilities
• Conduct full medical assessment
• Consider intravenous infusion / bladder
catheterization / analgesia
• Options
• - Deliver by cesarean section if there is
fetal distress or obstructed labor
• - Augment with oxytocin by intravenous
infusion if there are no contraindications
• the c _
-: _ ci a t dita jo -- e
r :__c - es or
rv cross ·· ctEo · i e i . · e ·.· s v e r y
the s lo w r e s s o la · our
.· rog
 UTERINE CONTRACTIONS
Assessed by number of contractions in a 10- minute period

Measured in seconds from the time the contraction starts

until it ends (duration)

Each square represents one contraction

Contractions are recorded every 30 minutes

On each shaded square, you
will also indicate
the duration of each
contraction by using the
symbols shown

Different shading on the

squares on the partograph
indicates the strength and
duration of contractions.
Palpate number of contraction in ten minutes and duration of
each contraction in seconds
LESS THAN 20 SECONDS:
• mild contraction (represented with dots)

BETWEEN 20 AND 40 SECONDS:

• moderate contractions (represented with diagonal lines)

MORE THAN 40 SECONDS:

• strong contractions (represented solid color)
2.
3.
..

0
 PART 3 MATERNAL
CONDITION
(BOTTOM)
 PART 3 : MATERNAL CONDITION(BOTTOM)
Rows for recording
administration of :
• Oxytocin during labor and
the amount given.
• Drugs given and IV
fluids given to the
mother.
 e. C

U-.r n e ana y.sl c o e

Ur
n
Near the bottom of
the partograph:
• Record the mother’s vital
signs
• Pulse and BP with a
possible range from 60
to 180
• Temperature °C
MATERNAL PULSE RATE
BLOOD PRESSURE
TEMPERATURE
RECORD URINE OUTPUT
 PROTEIN IN THE URINE

Only a small amount or trace of protein in the

urine during pregnancy can be normal.

Larger amounts of excess protein in urine can

indicate a more serious complication such as
Pregnancy Induced Hypertension or preeclampsia
 ACETONES OR KETONES IN THE URINE
When the body burns fat instead of glucose to produce energy, it produces a by-
product called ketones.

Although ketones appear in trace amounts throughout the pregnancy, excess

ketones in urine for a considerable time could be an indication of gestational
diabetes.

During pregnancy, hormonal changes affect woman’s body’s resistance to insulin,

which plays a key role in glucose metabolism .

This prevents the body cells from utilizing the glucose in blood sugar to produce
energy. This, in turn, causes the cells to burn fats, thus producing ketones
References

Printed Textbooks:

618.20231 Si327 2018 v.1. Silbert-Flagg, J. (2018). Maternal & child health nursing: care of
the childbearing & childrearing family. Philadelphia, PA Wolters Kluwer Health.
618.20231 Si327 2018 v.2. Silbert-Flagg, J. (2018). Maternal & child health nursing: care of
the childbearing & childrearing family. Philadelphia, PA Wolters Kluwer Health.
Electronic Books :
eBooks (Ebschohost). Clair, B. (2022). Carrying on: another school of thought on
pregnancy and health. New Brunswick Rutgers University Press.
eBooks (Wiley). Yearwood, E. (2021).Child and adolescent behavioral health: a resource for
advanced practice psychiatric and primary care practitioners in Nursing. Hoboken, New
Jersey Wiley Blackwell.
eBooks (Ebschohost). Simpson K. (2021). AWHONN's Perinatal Nursing. Philadelphia, PA
Wolters Kluwer Health.
HAVE FUN IN LEARNING!
KEEP SAFE & GODBLESS