Partogram Interpretation

A partogram is used to monitor the active phase of the first stage of labour.

Demographics

Patient: name, DOB, age, parity, allergies, blood group, haemoglobin level
Pregnancy: expected delivery date, preferences/ action plans/ risks, gestation
Partogram: date and time

Observations during partogram

Performed every 30 minutes (except temperature and urinalysis every hour)

Look at:
o Maternal observations


Temperature


Blood pressure


Urinalysis


Pulse
o Fetal heart rate
Look at current observations and trends
o Note responses to fluids/ drugs given

Contractions

Noted over each hour

Look at:
o Frequency
o Strength
o Regularity
Determine the trend

Cervical dilation

PV exam performed every 4 hours

Determine cervical dilation rate (alert line = 1cm/2h primip, 1cm/h multip)
Determine progress through labour
o Note responses to oxytocin

Head descent

PV exam performed every 4 hours

Look at:
o Station of presenting part (progression rate)
o Engagement
o Position moulding caput
o Fifths palpable per abdomen
Determine progress through labour
o Note responses to oxytocin

Liquor

Noted over each hour

Determine if liquor is intact, clear, bloody or meconium is present
Determine when changes occurred

Final birth details

Summary times
o Labour onset
o Rupture of membranes
nd
o Active 2 stage
o Birth
2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision

o Placenta delivery
Mechanism of delivery e.g. normal, instrumental, C-section
Position of occiput
APGAR score at 1 min and 5 mins
Estimated blood loss

Summary

Summarise
Identify causes for slow progression (e.g. cephalopelvic disproportion, maternal causes such as fibroids/ cervical stenosis, fetal
malpresentation, primary uterine inertia, drugs and fluids used)
Describe why oxytosin was given and the response

Scoring Systems to be Aware of

Bishop score
A PV exam scoring system to determine if labour is likely to commence spontaneously or induction will be required.

Cervical dilation (cm)

Cervical consistency
Length of cervix (cm)
Cervix position
Station of presenting
part (cm above ischial
spines)

Score 0
0
firm
>2
posterior
+3

Score 1
1-2
medium
2-1
central
+2

Score 2
3-4
soft
1-0.5
anterior
+1 to 0

Score 3
5
<0.5
<0

Total <5 = labour unlikely to start without ripening the cervix

Total 7 = labour should commence easily

Apgar score
Baby score at 1 minute and 5 minutes to determine the well being of the baby after the birthing process and outside the womb.

Appearance
Pulse
Grimacing
Activity
Respiration

Score 0
pale
absent
absent
no tone
none

Score 1
blue extremities
<100
weak
some/floppy
weak

Score 2
Pink all over
>100
good
normal muscle tone
strong

Total <7 = baby needs specialist paediactric support and oxygen

2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision

 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision