PARTOGRAF

No. Register
NamaIbu/Bapak: / Umur: / G.... P....A....Hamil.............minggu

RS/Puskesmas/RB
Masuk Tanggal : Pukul: WIB

KetubanPecah sejakpukul WIB Mulessejakpukul WIB Alamat :............................................................

200
190
180
170
Denyut 160
Jantung 150
140
Janin
130
( x/menit)
120
110
100
90
80

airketuban
penyusupan

10
9
Pembukaan serviks (cm) beri tanda X

8
7
6
5
Turunnya kepala Beri tanda O

4
3
2
1
0
Waktu
(Pukul)

Kontraksi 5
<20
tiap 4
10menit 20-40
3
>40 2
(detik) 1

OksitosinU/It
etes/menit

Obatdan
cairanIV
Nadi 180
170
160
150
140
130
120
Tekanan 110
darah 100
90
80
70
60

Temperatur oC
Protein
Urine Aseton
Volume
Lembar partograf bagian belakang
CATATAN PERSALINAN

Tanggal : ............................................... Penolong Persalinan :............................................................................................................

Tempat persalinan : [ ] rumah ibu [ ] Puskesmas [ ] Klinik Swasta [ ] Lainnya...................................................................................
Alamat tempat persalinan......................................................................................................................................................................

KALA I
[ ] Partograf melewati garis waspada
[ ] Lain-lain, Sebutkan...........................................................................................................................................................................
Penatalaksanaan yang dilaksanakan untuk masalah tersebut :............................................................................................................
Bagaimana hasilnya? :..........................................................................................................................................................................

KALA II
Lama Kala II :............................................menit Episiotomi : [ ] tidak [ ] ya. Indikasi :...................................................
Pendamping pada saat persalinan : [ ] suami [ ] keluarga [ ] teman [ ] dukun [ ] tidak ada
Gawat Janin : [ ] miringkan Ibu ke sisi kiri [ ] minta Ibu menarik napas [ ] episiotomi
Distosia Bahu : [ ] ManuverMcRobert Ibumerangkang [ ] Lainnya.......................................................................................
Penatalaksanaan untuk masalah tersebut :.....................................................................................................................................
Bagaimana hasilnya? :....................................................................................................................................................................

KALA III
Lama Kala III : ............................................ menit JumlahPerdarahan...................................................ml
a. Pemberian Oksitosin 10 U IM <2menit? [ ] ya [ ] tidak, alasan........................................................................................
Pemberian Oksitosis ulang(2x)? [ ] ya [ ] tidak, alasan........................................................................................
b. Pemegangan tali pusatterkendali? [ ] ya [ ] tidak, alasan........................................................................................
c. Masasefundusuteri? [ ] ya [ ] tidak, alasan........................................................................................
Laserasi perineum derajat ..................Tindakan: [ ] mengeluarkansecaramanual [ ]merujuk
[ ] tindakan lain .................................................................................................
Atonia uteri : [ ] Kompresibimanualinterna [ ] Metil Ergometrin 0,2mgIM [ ] Oksitosindrip
Lain-lain, sebutkan :...............................................................................................................................................................................
Penatalaksanaan yang dilakukan untuk masalah tersebut :..................................................................................................................
Bagaimana hasilnya ? :.........................................................................................................................................................................

BAYI BARU LAHIR

Berat Badan :.................gram Panjang :.................cm Jenis Kelamin:L/P Nilai APGAR :......../......../........
Pemberian ASI < 1 jam [ ] ya [ ] tidak, alasan ..................................................................................................................................
Bayi baru lahirpucat/biru/lemas : [ ] mengeringkan [ ] menghangatkan [ ] bebaskan jalannapas
[ ] stimulasi rangsang aktif [ ] Lain-lain, sebutkan :...................................................................
[ ] Cacat bawaan, sebutkan :................................................................................................................................................................
[ ] Lain-lain, sebutkan :..........................................................................................................................................................................
Penatalaksanaan yang dilaksanakan untuk masalah tersebut :............................................................................................................
Bagaimana hasilnya ? :.........................................................................................................................................................................

PEMANTAUAN PERSALINAN KALA IV

Tinggi
Jam Tekanan Kontraksi Kandung
Pukul Nadi Suhu Fundus Perdarahan
ke Darah Uterus Kemih
Uteri

2
Masalah Kala IV :...................................................................................................................................................................................
Penatalaksanaan yang dilaksanakan untuk masalah tersebut :............................................................................................................
Bagaimana hasilnya? :..........................................................................................................................................................................

KIE
No Tanggal Materi Pelaksana Keterangan
 Semuanifas
 Breastcare
 ASI
 Perawatan TaliPusat
 KL
 Gizi
 Imunisasi