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Management of Labour
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Monitoring during the first stage includes monitoring the well-being of the woman, the progress of labour, and the well-being of the fetus. Graphic representation of all three of the above in a single sheet – a “partogram” – has been used for many years. It makes the documentation and comprehension of the temporal change in findings during labour extremely easy to refer to at one glance. A partogram is a good objective tool to monitor a woman in labour.
First Stage Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
A partogram is a preprinted form, the aim of which is to provide a pictorial overview of labor to plot progress and to alert health professionals of any problems with the mother or baby. The general intervention with the partogram is early use of oxytocin as soon as the cervical dilatation falls to the right of the partogram, usually on the 2-hour cervical exams.
Labour and birth care
Published in Helen Baston, Midwifery, 2020
The routine use of a partogram, a single pre-printed sheet to document progress in labour in graphic form, is contentious. Based on the documentation of cervical dilatation in 100 primigravida at term, the Friedman curve was developed to identify ‘normal’ progress in labour (Friedman 1954). Deviation from the curve is used to highlight when action should take place to expedite the birth because of lack of progress. An alert line represents labour progress in the slowest 10 per cent of women, and the action line is set at two or four hours after that (Lavender et al. 2012). NICE (2014) guidance recommends the use of a partogram with a four-hour action line. The partogram is also used to record other maternal and fetal observations, such as blood pressure and the fetal heart rate, and therefore provides an overview of the history of a woman’s labour, which is particularly valuable when care is handed over to another midwife.
Pattern of implementation of Emergency Obstetric Life-Saving Skills in public health facilities in Nsukka Local Government Area of Enugu State, Nigeria
Published in Journal of Obstetrics and Gynaecology, 2022
Scholastica N. Ugwu, Oluwafemi J. Adewusi
The use of partograph in monitoring the first and second stage of labour in this study is low compared to other past studies (Fawole et al. 2008; Mathibe-Neke et al. 2013). This is probably because our study was conducted at the lowest level of healthcare delivery in Nigeria compared to other studies carried out in secondary and tertiary health facilities. The reported use of oxytocin for active management of labour using by a large proportion of the health workers is similar to the findings of an earlier study carried out in Anambra state although the study also reported that few health workers actually carried out the activity when observed (Oyetunde and Nkwonta 2015). Immediate newborn care such as delay in cord clamping was always being carried out by one-third of the respondents. This is higher than the findings of Oyetunde and Nkwonta (2015).
Effect of vaginal pH on efficacy of dinoprostone gel for labour induction: a cross-sectional study
Published in Journal of Obstetrics and Gynaecology, 2022
G. K. Poomalar, N. Fathima Shantini, Rini Ezhil
Once the patient who required induction was admitted in labour room, vaginal pH was measured prior to per vaginal examination. It was done by using a pH strip (NICE universal indicator papers, pH 1–14). To avoid the observer bias, researcher did not perform pH or Bishop’s score assessment. After introducing speculum, pH strip was placed by an assistant into the lateral fornix of vagina who compared with the manufacturer’s calorimetric scale. Meanwhile, the person who introduced the speculum carried out Bishop’s score assessment. Per-vaginal examination was carried out using a sterile glove without any obstetric cream or lignocaine gel in an aseptic manner and Bishop’s score assessed. Dinoprostone gel 0.5 mg was then administered in the endocervical canal. Bishop score was reassessed six hours after 1st gel. When the Bishop score is unfavourable, two further doses of dinoprostone gel were administered every six hours after Bishop’s score reassessment. One hour after each PGE2 gel, CTG monitoring was done and recorded. Six hours after 3rd dose of dinoprostone gel, oxytocin administration (5 units in 500 ml RL) was started and dose titrated accordingly. Progress of labour is monitored and charted in partogram. Foetal heart monitoring was done every 15 minutes. Mode of delivery was noted. All the women were categorised into two groups as pH > 4.5 and pH ≤ 4.5. Those women in whom cervix remained unfavourable even after 12 hours of oxytocin administration, were labelled as failed induction.
Progression of the first stage of labour, in low risk nulliparas in a South Asian population: a prospective observational study
Published in Journal of Obstetrics and Gynaecology, 2021
Roli Purwar, Sunita Malik, Zeba Khanam, Archana Mishra
A graphical record of cervical dilatation and descent was made on the WHO modified partograph. In group A, 250 women were marked on the alert line at 4 cm and then progress was documented. In group B, 250 women were also marked on the alert line at 4 cm and again shifted back to alert line at 6 cm (assuming commencement of active phase from 6 cm) if they crossed the alert line. Between 4 and 6 cm, group B women were considered in latent phase. They were only monitored with supportive care, without any intervention provided maternal and foetal status were reassuring. Labour pattern in both groups was evaluated. Time taken for dilatation of the cervix from 4 to 6 cm was noted in all women. The rate of dilatation was calculated retrospectively in all women who underwent VD. Primary outcome was to study, the average labour pattern curve of all parturients, and to see the labour duration using the modified WHO partogram. Secondary outcome was to study the maternal and perinatal outcome in active phase of labour in both groups defined at 4 cm versus 6 cm. The results were considered to be statistically significant when p < .05. Data analysis was performed using SPSS version (SPSS Inc., Chicago, IL).