Partograph clinical cases

Dr Ban Hadi
Objectives: by the end of this lecture, we
:should be able to
Read a partograph .1
.Record the findings on partograph .2
.Diagnose partograph abnormalities .3
.Manage the patients with abnormal partograph .4
:Case 1
Mrs Layla ahmed a 25 years old G2P1 woman admitted on
.the 1st of October at 10:00 am with labour pain
:OE
.Temp.37C0, PR 88bpm, BP 120/70mmHg
FHR 140bpm
.Uterine cont. 3/10 min each lasts for 35 sec
Fetal head 5/5 palpable
.PV: 5 cm dilatation, intact memb

.PLOT these findings on partograph

:After 4 hours
.Temp.37C0, PR 90bpm, BP 130/70mmHg
FHR 130bpm
.Uterine cont. 4/10 min each lasts for 45 sec
Fetal head 3/5 palpable
PV: 7 cm dilatation, ruptured memb. With a clear
.liquore

.PLOT these findings on partograph

:After 4 hours
.Temp.37.5 C0, PR 100bpm, BP 140/80mmHg
FHR 100bpm
.Uterine cont. 5/10 min each lasts for 55 sec
Fetal head 1/5 palpable
PV: 7 cm dilatation, ruptured memb. With a meconium
.++ stained liquore, moulding
.Urine 200 ml, protein +/HPF
.PLOT these findings on partograph
:Case 2
Mrs Yasmin admitted to the labour room with labour
,pain, she is a 40 weeks pregnant primigravida

O\E: The head was 3/5 palpable, the cervix was 5cm
dilated The membranes were ruptured spontaneously
.and it was a clear liquore
Observation after 4 hrs revealed the following
:partograph
?What further action would you consider
This is a normally progressing labour, no action is
required. Just continue the observation
:Case 3
Mrs Heyam is a 34-year-old woman, para 2 vaginal
deliveries , pregnant 38 weeks presented with labour
.pain
O/E: No fetal head was palpable abdominally, the cervix
.was 4 cm dilated with intact membranes

:hrs observation revealed the following partograph 4

?What will be your further action
Poor progress of labour as the uterine contractions are
infrequent so ARM then after that oxytocin is the
optimal action
:Case 4
Mrs Merium a 34-year-old patient, pregnant 39 weeks
.presented with labour pain

O/E: The head was 5/5 palpable, the cervix was 4cm
.dilated with intact membranes
Admission partograph
After 4 hrs of active labour, ARM revealed clear liquor
:with the following partograph
After 2hrs of active labour, the following
:partograph
Concerning fetal observations, the following
:findings are seen
?What will be your further action
Consider referral for hospital with facilities for caesarean
delivery
?What is the abnormality in this partograph
A primary dysfunctional labour or prolonged active
phase of labour
?What is the abnormality in this partograph
Secondary arrest of cervical dilatation
?What is the abnormality in this partograph
Secondary arrest of descent of presenting part
The American College of Obstetrics and Gynecology
(ACOG) proposed extending the minimum period
before diagnosing active-phase arrest. It defines 6
hours as the 95th percentile of time to go from 4 cm to
5 cm dilatation, with the active phase defined as
beginning at 6 cm (instead of 4 cm). The ACOG has
also stated that extending the time from 2 to 4 hours
with oxytocin augmentation appears effective.
Irrespective of the duration, maternal and fetal well-
.being status must be confirmed
Evidence for Adequate and Arrested Labor
Arrest of labor: “. . . the diagnosis of arrest of labor should not be
”.made until adequate time has elapsed
Adequate labor: “. . . includes greater than 6 cm dilation with
membrane rupture and 4 or more hours of adequate
contractions (e.g., greater than 200 Montevideo units) or 6 hours or
more if contractions inadequate with no
”. . . .cervical change
Second-stage labor: “. . . no progress for more than 4 hours in
nulliparous women with an epidural, more than 3 hours in
”. . . .nulliparous women without an epidural
No cesarean before these time limits . . . in the presence of “
”.reassuring maternal and fetal status
Specific Recommendations to Safely Reduce Primary Cesarean
Deliveries
Permit prolonged latent (early)-phase labor.
Consider the start of active-phase labor to be defined as cervical dilation
of 6 cm (instead of 4 cm).
Permit more time for labor to progress in the active phase.
Permit multiparous women to push for 2 or more hours and primiparous
women to push for 3 or more hours. In some situations, for example,
when epidural anesthesia is used, pushing may be allowed to continue
even longer.
Use techniques, such as use of ventous, to facilitate vaginal delivery,
which is the preferred method when possible.
Encourage patients to avoid excessive weight gain during pregnancy.
Increase access to nonmedical interventions during labor, such as
continuous labor and delivery support, which has been shown to
decrease cesarean birth rates.
Perform external cephalic version for breech presentation.
Permit a trial of labor for women with twin gestations when the first twin
is in cephalic presentation
Permit a trial of labor for women with previous caesarean birth
Thank you
QUIZ
Q1: What is the
abnormality?
Q2: What is the
cause?
Q3: Mention the
.treatment