A partogram is a tool that graphically represents cervicographic progress during labor. This tool is recommended for routine monitoring of labor to provide an early warning system. The partograph helps the care provider to identify abnormal progress in labor early, and to initiate appropriate interventions to prevent prolonged and obstructed labor.
A number of partograms have been described before, the earliest being that by Friedman. The progress was recorded in centimeters of cervical dilatation per hour. The resulting graph was a sigmoid or an S-shaped curve. However it could not be applied to a woman who did not present at the beginning of labor, since it always began at zero dilatation, and if applied to a woman with greater cervical dilatation, there would be a great delay in making a decision to intervene. Philpott modified this partogram later, starting at the active phase of labor (3 cm cervical dilatation) and added two lines, alert line and action line. The “alert line” was a straight line. It represented the mean rate of cervical dilatation of the slowest 10% of primigravid women in the active phase of labor. It had a progress rate of 1 cm per hour. The purpose of the alert line was to aid the midwife in a peripheral unit, or house surgeon in any hospital to detect at the earliest possible moment the abnormal labor. If a woman's cervical dilatation progressed more slowly than 1 cm per hour, it would cross this alert line and arrangements were made to transfer her from a peripheral unit to a central unit. The “action line” was 4 hours to the right of the alert line. If the patient’s partogram crossed this line, action needed to be taken.This allowed “time to transfer the patient without impairing the success of the essential active management. Later this line was shifted two hours to the left. This was better than Friedman’s partogram, but still could not be applied to women who predented in labor with greater than 3 cm cervical dilatation, as that would result in an error causing delay in getting alert or taking action. Studd modified this partogram and drew stencils for women presenting with 0-2, 2-4, 4-6, 6-8 cm cervical dilatation.
I have developed a composite of two stencils for parimgravidas and multiparas presenting in different staged oa labor. The partogram presented here is drawn by studying the mean cervicographic progress of 700 normal primigravidas in labor, presenting at 3, 4, 5, 6, 7, 8, 9 cm cervical dilatation (100 in each group), and similarly for 700 multigravidas. Thus there are two lines, the one on left for primigravidas and the one the right for multigravidas. These are stencils. When a woman presents in labor, her cervical dilatation is checked. The stencil for her is drawn on a blank graph paper, the time zero hour beginning at the point the transverse line for her cervical dilatation crosses the cervicographic progress line for her. Thus only an appropriate segment of the stencil is used for her. This partogram does away with multiple stencils for different women as with Studd’s partogram. There is no error since the partogram meant for her begins at the same dilatation as she has. Whenever her cervicographic progresses two hours or more on the left of her ideal partogram, appropriate action is taken.
Wednesday, October 20, 2010
Partogram: Update
A partogram is a tool that graphically represents cervicographic progress during labor. This tool is recommended for routine monitoring of labor to provide an early warning system. The partograph helps the care provider to identify abnormal progress in labor early, and to initiate appropriate interventions to prevent prolonged and obstructed labor.
A number of partograms have been described before, the earliest being that by Friedman. The progress was recorded in centimeters of cervical dilatation per hour. The resulting graph was a sigmoid or an S-shaped curve. However it could not be applied to a woman who did not present at the beginning of labor, since it always began at zero dilatation, and if applied to a woman with greater cervical dilatation, there would be a great delay in making a decision to intervene. Philpott modified this partogram later, starting at the active phase of labor (3 cm cervical dilatation) and added two lines, alert line and action line. The “alert line” was a straight line. It represented the mean rate of cervical dilatation of the slowest 10% of primigravid women in the active phase of labor. It had a progress rate of 1 cm per hour. The purpose of the alert line was to aid the midwife in a peripheral unit, or house surgeon in any hospital to detect at the earliest possible moment the abnormal labor. If a woman's cervical dilatation progressed more slowly than 1 cm per hour, it would cross this alert line and arrangements were made to transfer her from a peripheral unit to a central unit. The “action line” was 4 hours to the right of the alert line. If the patient’s partogram crossed this line, action needed to be taken.This allowed “time to transfer the patient without impairing the success of the essential active management. Later this line was shifted two hours to the left. This was better than Friedman’s partogram, but still could not be applied to women who predented in labor with greater than 3 cm cervical dilatation, as that would result in an error causing delay in getting alert or taking action. Studd modified this partogram and drew stencils for women presenting with 0-2, 2-4, 4-6, 6-8 cm cervical dilatation.
I have developed a composite of two stencils for parimgravidas and multiparas presenting in different staged oa labor. The partogram presented here is drawn by studying the mean cervicographic progress of 700 normal primigravidas in labor, presenting at 3, 4, 5, 6, 7, 8, 9 cm cervical dilatation (100 in each group), and similarly for 700 multigravidas. Thus there are two lines, the one on left for primigravidas and the one the right for multigravidas. These are stencils. When a woman presents in labor, her cervical dilatation is checked. The stencil for her is drawn on a blank graph paper, the time zero hour beginning at the point the transverse line for her cervical dilatation crosses the cervicographic progress line for her. Thus only an appropriate segment of the stencil is used for her. This partogram does away with multiple stencils for different women as with Studd’s partogram. There is no error since the partogram meant for her begins at the same dilatation as she has. Whenever her cervicographic progresses two hours or more on the left of her ideal partogram, appropriate action is taken.
