PARTOGRAF

No.Register : Nama Ibu : Alamat :

No.Puskesmas : Umur : G: P: A: Tgl : Jam :
Ketuban pecah : Sejak Jam : Mules sejak jam :

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

10
Pembukaan Serviks, beri tanda X

DA
8 K
A A
7 SP I ND
Turunnya Kepa

A T
6 W ER
beri tanda

B
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Waktu
( Jam )

5
Kontraksi ⁞⁞⁞⁞⁞ < 20 4
tiap ///// 20 - 40 3
10 mnt > 40 2
1

Oksitosin U/L
Tetes/menit

Obat dan
Cairan IV
180
• Nadi 170
160
150
140
130
Tekanan 120
Darah 110
100
90
80
70
60

Suhu ⁰C

Protein
Urine Aceton
Volume
 CATATAN PERSALINAN
1. Tanggal : ............................................................................ 27. Massase fundus uteri
2. Nama Bidan : ............................................................................ □ Ya
3. Tempat Persalinan : □ Tidak, alasan : ...............................................................
□ Rumah ibu □ Puskesmas 28. Placenta lahir lengkap (intact) : Ya / Tidak
□ Polindes □ Rumah Sakit Jika tidak lengkap, Tindakan yang dilakukan :
□ Klinik Swasta □ Lainnya : ............................... a. ......................................................................................
4. Alamat tempat persalinan : b. ......................................................................................
........................................................................................................ 29. Plasenta tidak lahir > 30 menit : Ya / Tidak
5. Persalinan : □ Normal, □ Tindakan, □ Sectio Caesaria Tindakan :
6. Usia Kehamilan : .........................................Minggu a. .....................................................................................
□ Prematur, □ Aterm, □ Post term b. .....................................................................................
7. Presentasi Janin : .......................................................................... c. .....................................................................................
8. Catatan : □ Rujuk Kala : I / II / III / IV 30. Laserasi :
9. Alasan merujuk : ............................................................................ □ Ya, dimana : ..................................................................
10. Tempat rujukan : ............................................................................ □ Tidak
11. Pendamping pada saat merujuk : Laserasi perinium derajat : 1 / 2 / 3 / 4
□ Bidan □ Keluarga □ Dukun Tindakan :
□ Suami □ Teman □ Tidak ada □ Penjahitan dengan / Tanpa anastesi
KALA I □ Tidak dijahit, alasan : ...............................................
12. Partogram melewati garis waspada : Y / T 31. Atonia Uteri :
13. Masalah lain, Sebutkan : ........................................................ □ Ya, Tindakan :
.................................................................................................... ...........................................................................................
14. Penatalaksanaan masalah tersebut : ...........................................................................................
.................................................................................................... ...........................................................................................
15. Hasilnya : ..................................................................................... □ Tidak
KALA II 32. Jumlah perdarahan : ................................ Ml
16. Episiotomi 33. Masalah lain, sebutkan : ........................................
□ Ya, Indikasi : ......................................................................... ...........................................................................................
□ Tidak 34. Penatalaksaan masalah tersebut :
17. Pendamping pada saat persalinan : ...........................................................................................
□ Suami □ Teman □ Tidak ada 35. Hasilnya : ................................................................
□ Keluarga □ Dukun CATATAN KELAHIRAN
18. Gawat janin 36. Tanggal Lahir : ...................................., Jam : ...............
□ Ya, Tindakan yang dilakukan : 37. Jenis Kelamin : L / P
.................................................................................................... 38. Penilaian bayi baru lahir :
.................................................................................................... Apgar Score :
.................................................................................................... □ Menit 1 : ................ □ Menit ke-5 : ..................
□ Tidak 39. Asuhan bayi baru lahir :
19. Distosia bahu : □ BBL Normal, Tindakan :
□ Ya, Tindakan yang dilakukan : □ Mengeringkan □ Rangsang Taktil
.................................................................................................... □ Menghangatkan □ Bungkus bayi dan IMD
.................................................................................................... Asfiksia : □ Ringan, □ Sedang, □ Berat
.................................................................................................... Tindakan yang dilakukan :
□ Tidak □ Mengeringkan □ Rangsang Taktil
20. Masalah lain, sebutkan : ....................................................... □ Menghangatkan □ Bungkus bayi dan IMD
................................................................................................... □ Bebaskan jalan napas
21. Penatalaksanaan masalah tersebut : □ Ventilasi Tekanan Positif : .................................. Menit.
................................................................................................... Hasilnya : ..................................................................
22. Hasilnya : .................................................................................... ......................................................................................
................................................................................................... 40. Antropometri :
KALA III Berat badan : ............... Gram,Lingkar Kepala : ........... Cm
23. Lama kala III : ..................................................... Menit. Panjang badan : ............... Cm, Lingkar Dada : ............ Cm
24. Pemberian Oksitosin 10 U im : 41. Cacat bawaan, sebutkan : .............................................
□ Ya, Waktu : ............................ Menit sesudah persalinan. 42. Hipotermi, Tindakan : .............................................
□ Tidak, alasan : ....................................................................... ...........................................................................................
25. Pemberian ulang Oksitosin (2x) ...........................................................................................
□ Ya, alasan : ........................................................................... 43. Pemberian ASI :
□ Tidak ...........................................................................................
26. Penegangan tali pusat terkendali ...........................................................................................
□ Ya 44. Masalah lain : ................................................................
□ Tidak, alasan : ...................................................................... Hasilnya : ................................................................

PEMANTAUAN PERSALINAN KALA IV

Jam Tekanan Darah Kontraksi Kandung
Waktu Nadi (x/mnt) Suhu ( °c ) Tinggi Fundus Uteri Perdarahan
Ke (mmHg) Uterus Kemih

II
Masalah Kala IV : .................................................................................................................................................................................
Penatalaksanaan masalah tersebut: ..............................................................................................................................................................
Hasilnya : .................................................................................................................................................................................
Cm