PARTOGRAF

Dr. Zaimursyaf Aziz, SpOG(K)

DEPARTEMEN OBSTETRI DAN GINEKOLOGI

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
RSUP dr. MOHAMMAD HOESIN PALEMBANG
Partograf
• Clinical information about progress of
labour
• asuhan
• To know what the complication
• To make clinical decision
Partograf
• Instrumen to monitoring progress of
the labour
• Contain data to make clinical
decision
• Contain documentation about
“asuhan persalinan”that have given
by the labour helper
Partograf
Allert line
and action
Note and Observation
• Inpartu
• Inisiation and the time of labour
• The process of labour
• Mother and fetus condition
• Asuhan and asupan
• Estimate about the complication
• Diagnosis and theraphy
For Whom ?
• For all mother that she is in the 1st
phase of labour, which is the mother
with the good or worse process of
labour
• For labour in institution health service
or in home
• Labour that help by health personel (
student, midwife, nurse that has been
train, doctor)
Principal of the Observation
3 component
I. Progress of labour
1. cervix opening
2. descend of the head
3. His ( uterus contraction )
- the frequency in 10 minutes
- duration ( in second )
Principal of the Observation
II. Condition of fetus
1. heart rate of the fetus
2. amnion membrane and amnion
water
3. molase
Principal of the Observation
III. Mother condition
1. pulse, heart rate and temperature
2. urine
volume, protein, aseton
3. drug and IV Fluid
4. oksitosin
Progress of labour
A. Cervix Opening
2 phase
- laten phase
- active phase
LATEN PHASE ( partograf not make )
- beginning of the labour until the
opening <4
- the progress of this phase not more
than 8 hours
- this phase just can evaluate by VT
Progress of labour
ACTIVE PHASE
- beginning from opening 4 cm until
10 cm
- usually opening is 1 cm/hour
- this phase is 7 hours long
- the opening is marked by cross ( X )
Active phase
There are 2 line
1. Alert line
- Beginning 4 cm opening until 10 cm
- Similar with the speed of opening 1
cm/hour that long is 7 hours
- If the opening is move to the right of
this line ( the progress of the labour is
slow ) and posibility will get action
2. Action line
– Beginning of 4 cm from allert line and
similar with allert line
– If the labour is well, the opening is in
this line or in the left of action line
– If passing tis line, so this labour need to
evalute more carefully
• B. Descent of the Head
• Can evaluate from outer evaluation
• Outer evaluation is did before VT
• Measure with 5 finger in the top of
simphysis
• It marked by circle ( O )
Descent of the Head
 Descent of the Head
Outer evaluation and VT
C. HIS
there are 2 kind must
evaluate
1. Frequency
how many times in 10
minutes
2. How long
how many second
B. Fetus Condition
1. Heart rate
- Count as soon after HIS
- Count in 1 minutes
- Mother in left oblique position
Abnormal Heart Rate
1. > 180 x/minute or
< 120 x/minute
 critical fetus
2. < 100 x/minute
 severe critical fetus
Theraphy of critical fetus
• Evaluation of fetus heart rate in 15
minutes
• If in 3 times observation still abnormal 
termination
– If we use oksitocyn  stop
– Mother lying left oblique
– Give O2 to mother
– VT  maybe umbilical cord prolaps
– Enough hidration
2. Amniotic membrane and amniotic fluid
1. Amniotic membrane is intact marked by
(I)
1. Amniotic membrane is break
- “J” membrane break water is clear
- “M” membrane break water is meconial
- “D” membrane break water with blood
- “K” membrane break no water
III. Molase
4 grade of molase
0 = bone are still separate (feel suture)
+ = bone are sticky
++ = bone over lapping
+++ = bone severe over lapping
C. Mother Condition
• Blood pressure, pulse and temperature
• Urine
– Catheter just if mother can not urinal by her
self
• Volume
• Protein
• aseton
• Drugs
• Give oksitosin
Note of the Mother
Condition
• Frequency and kontraction in every 10
minutes ( observe the fetus heart rate in
every 30 minutes)
• Pulse in every 30 minutes
• Cervix dilatation in every 4 hours
• Decent of the lowest part in every 4 hours
• Blood pressure and body temperature in
every 4 hours
• Urine production, aseton or protein in urine
in every 2-4 hours
Partograf for
normal labour
Prolonged Labour
• Problem
– Prolonged laten phase ( > 8 hours )
– Prolonged active phase
• Opening < 1 cm / hour
• Cervix dilatation in the right of the
allert line
Prolonged
labour
Theraphy
• Evaluate the general condition of the
mother and fetus
• Evaluate the partograf, does mother
have been laboured
• Repair the mother general condition
– Suportive theraphy, change the position
– Cek the aseton urine, give fluid by parenteral
or oral
– Try to get the urine (catheter if nesscessary)
– Give analgetik
Partograf that shown
inadequate uterine
contraction
and corrected
by giving oxitocin