Among the five major causes of maternal mortality in developing countries like ethiopia hypertension, haemorrhage, infection, obstructed labour and unsafe abortion, the middle three haemorrhage, infection, obstructed labour are highly correlated with prolonged labour. There is some evidence that appropriate use of partograph in monitoring the progress of labour could decrease delivery related complications. Labour is obstructed when there is absence of progress in cervical dilatation, or, failure of presenting part to descent in the pelvis despite good, efficient and regular uterine contractions. The partograph indicates when augmentation is needed, and can point to possible cephalopelvic disproportion before labour becomes obstructed.
The documentation of parameters of partographs is however, poorly understood. Labour dystocia or obstructed labour is associated with significant maternal morbidity. Obstructed labour, causes, complications ask a gynecologist. Prolonged and obstructed labor is a significant cause of maternal morbidity and mortality in nigeria, one of the six countries contributing significantly to the global maternal mortality crisis. Module 5 prevention of prolongued and obstructed labor. A hospitalbased study in uganda reported that obstructed labour and its complications resulted in 26% of all maternal deaths and a maternal death audit conducted in rwanda showed that 12. Know when to start a partograph understand and complete all parts of the partograph describe all abnormalities in labour know how to recognize prolonged labour on the partograph know when to transfer a woman in labour have some knowledge of possible management options. Obstructed labour oxford academic journals oxford university. Eighty five percent 245,000 of these deaths occurred in subsaharan africa and southern asia. The prevention of obstructed labour can be promoted by. The purpose of the partograph is to enable health professionals to monitor wellbeing and progress in labour and provide timely intervention when required see fig. Knowledge and utilization of partograph among obstetric. The criteria used for diagnosis of obstructed labour included having three adequate uterine contractions in ten minutes lasting 4560 s with no cervical progression in two hours or progression less than 1 cmh or presence of clinical signs of obstructed labour impending uterine rupture, bandls ring, bloodstained urine, severe caput or. The partograph is an inexpensive tool designed to provide a continuous pictorial overview of labour and has.
The development of the partograph or partogram provided health. A study to assess the knowledge regarding partograph among. Obstructed labour comprises one of the five major causes of maternal mortality and morbidity in developing countries 3, 4. Documentation of the partograph in assessing the progress. The number of maternal deaths as a result of obstructed labour andor rupture of the uterus varies between 4% and 70% of all maternal deaths, amounting to a maternal mortality rate as high as 410100,000 live births 5.
Prolonged and obstructed labor is the most common reason for obstetric fistula an estimated 6. Obstructed labour, also known as labour dystocia, is when the baby does not exit the pelvis during childbirth due to being physically blocked, despite the uterus contracting normally. Partograph use this form for monitoring active labour name of facility. Obstructed labour is the failure of the fetus to descend through the birth canal, because there is an impossible barrier obstruction preventing its descent despite strong uterine contractions. Experiences with world health organization and other types of partographs in low resource settings suggest that. Partograph, initiation, completion, standard, criteriabased audit, labour t he maternal mortality ratio in uganda has remained high. The use of the partograph is hindered by poor knowledge,911,15 lack of the charts in the labor wards,10,11 shortage of health care personnel,10 timeconsuming tasks for the low numbers of staff,16 and poor appreciation of its advantages in preventing obstructed labor. The partograph used in the training material was who modified partograph which excludes latent phase of labour monitoring and the instructions were written in english on partograph paper. Woman gives the history of prolong labour and the labour pain become severe and frequent and bearing down.
This occurs as a result of the active forces of labor. Obstructed labour can be prevented by a simple and costeffective health intervention tool, the partograph. A crosssectional study of partograph utilization as a. Obstruction usually occurs at the pelvic brim, but occasionally it may occur in the cavity or at the outlet of the pelvis. Obstructed labour british medical bulletin oxford academic. Request pdf the partograph for the prevention of obstructed labor obstructed labor is an important cause of maternal and perinatal mortality and morbidity. Labour dystocia or obstructed labour is associated with significant maternal. Obstructed labour is an important cause of maternal deaths in communities in. Partograph will recognize impending obstruction early.
Pdf the partograph for the prevention of obstructed labor. Prevention of prolonged and obstructed labor fistula care plus. Labour and delivery care blended learning module for. The delivery of a healthy baby and maintenance of a safe delivery for the mother are two goals of all maternity health care providers. Globally, there was an estimated number of 287,000 maternal deaths in 2010. The obstruction usually occurs at the pelvic brim, but occasionally it may occur in the pelvic cavity or at the outlet of the pelvis. The training material was developed by the mamoni hss programme in consultation with obstetrical and gynaecological society of bangladesh. Jul 19, 2012 obstructed labour means that, in spite of strong contractions of the uterus, the fetus cannot descend through the pelvis because there is an insurmountable barrier preventing its descent. Who midwifery education module 3 managing prolonged and. Obstructed labor is an important cause of maternal and perinatal mortality and morbidity.
In obstructed labour the membranes may rupture several hours before labour starts. Endorsed by the world health organization who, the partograph is a singlepage set of graphs and tables of measurements to be filled out during labor. Jan 18, 20 globally, there was an estimated number of 287,000 maternal deaths in 2010. Relevant measurements might include statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs. A partograph is often used to track labour progression and diagnose problems. Obstructed labor is one of the biggest causes of maternal death and its prevention is. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph.
On the basis of this, the module explains what makes obstructed labour more likely to occur, what happens in obstructed labour, how signs of obstructed labour can be identified, and steps to be taken for effective management. Obstructed labour means that, in spite of strong contractions of the uterus, the fetus cannot descend through the pelvis because there is an insurmountable barrier preventing its descent. When the partograph is routinely used, prolonged and obstructed labor can be recognized before there are complications. The partograph graphically represents key events in labor. Oct 23, 2017 there is some evidence that appropriate use of partograph in monitoring the progress of labour could decrease delivery related complications. It is therefore important not only to identify the cause of prolonged labour but to take timely steps to prevent and manage prolonged labour. Nov 30, 2019 in developing countries, prolonged and obstructed labour is one of the leading causes of maternal and neonatal morbidity and mortality. Normallyprogressing labor will have a plotting on the left of the alert line. The second half of the module introduces you to the basic techniques of newborn. Mar 07, 2011 if labour is not progressing normally the plotting will be to the right of the alert line. The aim of the present study was to determine the extent to which health care workers are making use of the partograph in monitoring the progress of labour through checking. The use of the partograph would engender a remarkable reduction.
It increases the quality and regularity of observations made on the mother and fetus, and it also serves as a onepage visual summary of. If labour is not progressing normally the plotting will be to the right of the alert line. Describe proper use of a partograph including monitoring maternal and fetal signs. Oct, 2014 the use of the partograph is hindered by poor knowledge,911,15 lack of the charts in the labor wards,10,11 shortage of health care personnel,10 timeconsuming tasks for the low numbers of staff,16 and poor appreciation of its advantages in preventing obstructed labor. A partograph is a graphical record of the progress of labour and salient conditions of the mother and foetus plotted against time in hours. It increases the quality and regularity of observations made on the mother and fetus, and it also serves as a onepage visual summary of the relevant details of labour. The treatment of obstructed labour may require cesarean section or vacuum extraction with possible surgical opening of the symphysis pubis. This combined with physical examination may identify obstructed labour. One of your major roles as a skilled birth attendant is to prevent the occurrence of obstructed labour in women in your community. The common obstetric emergencies are obstructed labour and prolonged labour. Using the partograph study session 4 using the partograph introduction. Jan 15, 2020 a partograph is often used to track labour progression and diagnose problems.
Examination general examination features of maternal distress i. Labour is considered obstructed when the presenting part of the fetus cannot progress into the birth canal, despite strong uterine contractions. The world health organization partographs are the best known partographs in low resource settings. Apr 03, 2017 a possible cause of obstructed labour is if the mother has a tumor growth or swelling of soft tissue in her pelvic cavity. Session four prevention of prolonged and obstructed labour. Pdf the partograph for the prevention of obstructed. Partogram recording latent phase labour patterns normal labour prolonged latent phase primary dysfunctional labour secondary arrest active phase 27. Partograph use is recommended for routine monitoring of labour, and helps the health care provider in identifying slow progress in labour, and may help initiate appropriate interventions to prevent prolonged and obstructed labour 3,4. Obstructed labour wikimili, the best wikipedia reader. Knowledge and utilization of partograph among obstetric care. Deviation to the right could signify prolonged labor. It increases the risk of the mother getting an infection, having uterine rupture, or having postpartum bleeding.
Partograph use for labour monitoring averaged 54% in this study. Obstructed labour is an important cause of maternal deaths in communities in which undernutrition in childhood is common resulting in small pelves in women, and in which there is no easy access to functioning health facilities with the capability of carrying out operative deliveries. The partograph, a paper tool for recording clinical data during childbirth, has demonstrated a reduction in obstructed labor when used to track patients 9. The partograph for the prevention of obstructed labor matthews mathai, md, mobstet, phd department of making pregnancy safer, world health organization, geneva, switzerland abstract. Managing prolonged and obstructed labour geneva foundation for. In developing countries, prolonged and obstructed labour is one of the leading causes of maternal and neonatal morbidity and mortality. By the end of the program the participant should be able to. A simple tool called a partograph has been shown to reduce prolonged labour, the need for. This occurs as a result of impingement of the presenting part on the bony and soft tissues of the pelvis. Completion of the modified world health organization who.
The partograph for the prevention of obstructed labor. The partograph warns while plotting the data and places the patients in an alert list for further monitoring. The causes may lie in the passage, the passenger or the power. If the labour is slow to progress, careful general, abdominal and vaginal examination is necessary. The following six divisions of labor are easy to use. Apr 18, 20 partograph use is recommended for routine monitoring of labour, and helps the health care provider in identifying slow progress in labour, and may help initiate appropriate interventions to prevent prolonged and obstructed labour 3,4. Obstruction usually occurs at the pelvic brim, but occasionally it may. Midwives knowledge and use of partographs at juba teaching.
This occurs at various times before the forces of labor begin. To test whether the use of the who partograph improves. The aim of the present study was to determine the extent to which health care workers are making use of the partograph in monitoring the progress of labour through checking the. The partograph graphically represents key events in labor and provides an early warning system. The partograph for the prevention of obstructed labor request pdf. Obstructed labour is a totally preventable labour complication. Knowledge of ocgs on the assessment of labor with the partograph showed that most of the respondents indicated that the partograph can be used for detecting prolonged labor 73. A possible cause of obstructed labour is if the mother has a tumor growth or swelling of soft tissue in her pelvic cavity. Obstructed labour is one major cause of maternal mortality. Partograph is a greek word which means labour curve. Relevant measurements might include statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs it is intended to provide an accurate record of the progress in labour, so that any delay or deviation from. Utilization of the modified who partograph in assessing the. Chapter 4 page 2 management of labour and obstructed labour use of the partograph in labour why the partograph. Ppt obstructed labour powerpoint presentation free to.
The partograph, each entry on it and its use are explained. During child birth, complication cannot be predicted or prevented. A partogram or partograph is a composite graphical record of key data maternal and fetal during labour entered against time on a single sheet of paper. Introduction even though postpartum hemorrhage and sepsis are the main causes of death, dystocia is a contributing factor in more than 70% of maternal deaths. The partograph or partogram is recommended by the world health organisation who, for monitoring labour wellbeing and progress. Documentation of the partograph in assessing the progress of.
The partograph or partogram is the most commonly used labour monitoring tool, widely supported by health professionals and recommended by the world health organisation who for use in active labour. Starting a partograph a partograph should be started only when a woman is in active phase of labour contractions must be 1 or more in 10mins, each lasting for 20secs or more cervical dilatation must be 4cms or more. Special emphasis is placed on the use of the partograph in monitoring labour. Full text the use of the partograph in labor monitoring. Complications for the baby include not getting enough oxygen which may result in death. Prolonged obstructed labour remains a major reproductive health concern in many developing countries where there is urgent need for improved nutrition, education, health systems and the establishment of well resourced obstetric care. Partograph or partogram is a simple, inexpensive tool which gives continuous pictorial overview of labour.
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