Normal Labour Partogram Pain Relief Epidurals Epidurals Active Management Episiotomy
PARTOGRAM
What is a partogram?
An important development in the management of labour was the
introduction of the
partogram. First developed by Hugh Philpott
in 1972 to identify abnormally slow labour, the
partogram is a graphical representation of
the changes that occur in labour, including cervical
dilatation, fetal heart rate, maternal pulse,blood pressure,
and temperature; it also shows a numerical record of features
such as urine output and the volume and type of intravenous
infusions (including oxytocin drips). It is therefore possibleat a glance to identify deviations from normal in any of thesevariables.
Partogram: the broken lines show
expected progress of cervical dilatation in multiparous (left) and
primiparous (right) women. Labour progress is different in
primiparous and multiparous women and is best displayed graphically on a
partogram, which shows average dilatation rates by parity
Latent (a) and active (b) phase of labour in a multiparous and a
primiparous woman, as shown on partogram
The rate of cervical dilatation in the active phase at which augmentation of labour is indicated is controversial. In the1960s through to the early 1980s O'Driscoll and colleagues suggestedthat any nulliparous woman with a rate of cervical dilatationbelow the average (1 cm/h) should be augmented. Thus active managementwould be used in half of women in their first pregnancies; fewmultiparous women progress this slowly. Most obstetricians inBritain are now more conservative, and 0.5 cm/h is commonly takenas the cut off. Usually the first step in augmentation is to rupturethe amniotic membranes; if this is not followed by a speedy labourintravenous oxytocin is given to stimulate contractions. Carefulclinical monitoring is needed to ensure that contractions do notexceed one every two minutes, or fetal hypoxia may result fromrestriction of the maternal afferent placental blood flow.
When the progress of labour is so slow (despite oxytocic stimulation) that the woman is becoming exhausted and the fetus atrisk of hypoxia, a caesarean section is the best solution. Anindividual decision is taken by each woman on the recommendationof her obstetrician. A caesarean section cannot be performed withoutthe mother's specific consent, except when she is mentally incompetentand then the decision must be made by acourt.
A study in Canada found tha the use of a partogram without a mandatory management of labour protocol had no effect on rates of CS or other intrapartum interventions in healthy primiparous women at term.0701
The 2-hour partogram increases the need for intervention without improving maternal or neonatal outcomes, compared with the 4-hour partogram, advocated by the World Health Organization.0601
- A randomized controlled trial of a bedside partogram in the active management of primiparous labour.(2007-01)
- Effect of different partogram action lines on birth outcomes: a randomized controlled trial.(2006-01)
- Partogram action line study: a randomised trial.(1998-01)
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
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