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All your pregnancy questions answered

Partogram

• What is a partogram?

The partogram is a series of charted measurements which are used to assess the progress of labour. Information recorded includes:

1. Maternal - BP , heart rate, temperature, Contractions - length, frequency, strength

2. Maternal- cervical dilatation

3. Baby-descent of the babies head

4. Baby - heart rate, liquor.

5. Drugs administered etc.

• How is this maintained?

When you are admitted in labour, an initial evaluation is done to see if you are in active labour and your BP, pulse, temperature, contractions are charted on the graph. In addition to this the amount of cervical dilatation is also charted, along with details of the babies heart rate and the colour of the liquor if you are leaking. You will be seen there after at intervals of 2-4 hours and the progress of your labour will be monitored.

Your labour is divided into 3 stages:

1. The first stage-is from the onset of labour contractions till the cervix is fully dilated which is about 10cm dilatation of the cervix. The cervix is the 'mouth' of the uterus which is closed during pregnancy and has to dilate [open] to about 10cm for the baby to come out. This is further divided into a 'latent' phase which is from onset of contractions till about 3cm dilatation and an 'active' phase which is from 3cm to full dilatation of 10cm.

2. The second stage-is from full dilatation of the cervix till complete delivery of the baby

3. The third stage-is the delivery of the placenta [afterbirth]

The latent phase till 3cm dilatation may be of very variable duration and is not very important in deciding the outcome of your labour. However once you cross 3cm dilation with active contractions your cervix should dilate at the rate of at least 1.2cm/hour for primigravid patients [1st delivery] and 1.5cm/hour for multigravid patients [2nd and more deliveries]. This progress is charted on a graph called a partogram and if you do not dilate at the required rates some intervention needs to be taken. If the dilatation is tardy and the contractions are of poor strength then labour needs to be augmented with drugs [Pitocin/Syntocinon/Prostaglandins] to improve the contractions. If the dilatation is slow in spite of good contractions then your doctor will seriously consider an operative delivery such as a caesarean section. During this first stage of labour you need not 'push' or bear down. You need only to take deep breaths during the contractions. Your partogram will have a sloping 'alert' and a parallel 'action' line. If your graph crosses the alert line your doctor will re-evaluate and see what needs to be done to improve the progress of your labour. If your curve crosses the action line then in all probability some operative intervention may be required.