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Partogram

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. Relevant measurements might include statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs.^[1]

It is intended to provide an accurate record of the progress in labour, so that any delay or deviation from normal may be detected quickly and treated accordingly. However, a Cochrane review came to the conclusion that there is insufficient evidence to recommend partograms in standard labour management and care.^[2]

Many partograms showing cervical dilation versus time include an alert line. It starts at the position where there is 3^[3] or 4^[4] cm of cervical dilation. It is then continued diagonally at a rate of 1 cm per hour in primigravidae and 1.5 cm in multigravidae.^[3] An action line is parallel to the alert line, and is located 4 hours to the right of the alert line.^[3]

Components

Patient identification
Time: It is recorded at an interval of one hour. Zero time for spontaneous labour is time of admission in the labour ward and for induced labour is time of induction.
Fetal heart rate: It is recorded at an interval of thirty minutes.
State of membranes and colour of liquor: "I" designates intact membranes, "C" designates clear and "M" designates meconium stained liquor.
Cervical dilatation and descent of head
Uterine contractions: Squares in vertical columns are shaded according to duration and intensity.
Drugs and Fluids
Blood pressure: It is recorded in vertical lines at an interval of 2 hours.
Pulse rate: It is also recorded in vertical lines at an interval of 30 minutes.
Oxytocin: Concentration is noted down in upper box; while dose is noted in lower box.
Urine analysis
Temperature record

Advantages

Provides information on single sheet of paper at a glance
No need to record labour events repeatedly
Prediction of deviation from normal progress of labour
Improvement in maternal morbidity, perinatal morbidity and mortality

Usage

A partogram is contained in the Perinatal Institute's "Birth notes".^[5]

Use of a partogram in established labour is recommended by the National Institute for Clinical Excellence (NICE) http://www.nice.org.uk/ in the "Intrapartum Care" guideline.^[6]

References

^ http://staff.um.edu.mt/csav1/lectures/partogram.pdf
^ Lavender, T.; Hart, A.; Smyth, R. M. (2008). "Effect of partogram use on outcomes for women in spontaneous labour at term". The Cochrane Library. doi:10.1002/14651858.CD005461.pub2. edit
^ ^a ^b ^c Preventing Prolonged Labor by Using Partograph by Ganesh Dangal. The Internet Journal of Gynecology and Obstetrics. Retrieved Feb 2014
^ The Alert and Action lines from OpenLearn Labour and Delivery Care HEAT Module. Retrieved Feb 2014
^ "Perinatal Institute". www.perinatal.org.uk.
^ "Intrapartum care: care of healthy women and their babies during childbirth". NICE guidelines [CG190]. December 2014. Retrieved 6 December 2014.

UpToDate Contents

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1. 正常分娩および遷延分娩、分娩停止 overview of normal labor and protraction and arrest disorders

English Journal

Partograph as a tool for team work management of spontaneous labor.

Orhue A, Aziken ME, Osemwenkha AP.SourceDepartment of Obstetrics and Gynecology, Human Reproduction Research Program Unit, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
Nigerian journal of clinical practice.Niger J Clin Pract.2012 Jan-Mar;15(1):1-8.
It is presently being debated whether the partograph is a useful tool for labor supervision and, if useful, where should the action line be located between 2, 3 or 4 h to improve the fetomaternal outcome. This review adduces facts to show that this debate is because there is a poor understanding of
PMID 22437079

Intrapartum care at a tertiary hospital in Cambodia: A survey using the Bologna Score.

Sandin-Bojö AK, Hashimoto M, Kanal K, Sugiura Y.SourceKarlstad University, Department of Nursing, Karlstad and The Women's Department, The central hospital of Karlstad, Sweden.
Midwifery.Midwifery.2011 Dec 13. [Epub ahead of print]
BACKGROUND: developing countries strive to reduce maternal- and child mortality, partly through establishing health centres/hospitals with skilled birth attendants. The aim of this study was to describe childbirth care, by the use of the Bologna Score at a tertiary hospital in Cambodia with approxim
PMID 22172744

Japanese Journal

(4)周産期医療システム改善への取り組み : 地域の情報共有化と母体搬送システム(<特集>第60回学術講演会シンポジウム4「産婦人科医不足の解消を目指して」)

鈴木真
日本産科婦人科學會雜誌 60(12), 1964-1974, 2008-12-01
… All the information on perinatal medical care, including pregnancy check-up, fetal echographic images and measurement data and partogram is computerized and facilitated for data analysis and installation of the Internet type perinatal electronic chart system with the comprehensive electronic medical report system. …
NAID 110007008124

電子経過記録(ケアフロー)による電子助産録の運用

難波未来,中村真由美,稲田信子,渡邊仁美,藤井春美,湯浅珠美
看護情報研究会論文集 : JAMI-NS 5, 39-41, 2004-06-18
NAID 10013330961

計画分娩による骨盤位管理成績

野田芳人,巽英樹,吉原一,島田信宏,西島正博
北里医学 21(1), 123-136, 1991-02-28
当院では開院以来原則的に骨盤位例においても計画分娩の方針で,厳重な胎児監視のもとで,骨盤位分娩を管理してきた。今回1976年1月より1985年12月までの10年間の単胎正期産13727例中,636例(4.6%)の正期産骨盤位例の成績をまとめ,検討を加えた。1)正期産骨盤位の計画分娩率は61%で,前回帝切などの子宮術創例を除外した修正帝切率は初産婦36%,経産婦12%であった。2)仮死出生率は初産婦 …
NAID 110004693990

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