Page 1 of 2: partogram

redash · Credits: 4278 My Scrapbook

a rural health centre with partogram should refer a primi gravida when she is

a. progressing to the left of the alert line
b. progressing to the right of the alert line
c. has reached the action line
d. has crossed the action line

friendy · Credits: 736 My Scrapbook

kindly explain wat elert line n action line r????

redash · Credits: 4278 My Scrapbook

no idea.

nadu · Credits: 17728 My Scrapbook

may be this will helpful !

WHO partogram helps

EDITOR, - James G Thornton and Richard J Lilford's review of active management of labour1 was accepted for publication too late for it to include the results of the multicentre trial of the World Health Organisation partogram.2 Although not a randomised controlled trial (it would be impossible to conduct such a trial free from bias), this trial of the impact of use of the partogram with an agreed protocol for managing labour on the outcome of labour is important because of its scientific rigour, the fact that it was a multicentre study, and, in particular, the large number of women in labour included (35 484). Its findings largely reinforce Thornton and Lilford's conclusions but add force to the argument for monitoring all labours with a partogram incorporating alert and action lines similar to Philpott and Castle's original design.3
The crucial factor in active management of labour is the timing of interventions, whether these be amniotomy, augmentation with oxytocin, caesarean section, or transfer to a central unit. A partogram is able to indicate the optimum timing of these. Before they introduced the WHO partogram all eight centres participating in the trial (in Indonesia, Malaysia, and Thailand) practised ad hoc management of labour, which varied from late amniotomy in conjunction with early oxytocin to early amniotomy combined with augmentation with oxytocin. The partogram was introduced with a protocol that defined labour strictly and encouraged delaying all interventions (except amniotomy) until the active phase action line was reached.

The results were a reduction in prolonged labour by 41% and in emergency caesarean sections by 3% despite a reduction in the number of labours augmented by oxytocin by 54%. A fall in the mean number of vaginal examinations during labour probably contributed to the 59% reduction in cases of postpartum sepsis. Intrapartum stillbirths and neonatal morbidity tell.

Although the trial protocol suggested that use of oxytocin should be delayed until the action line was reached, even this may be regarded as overactive management. Among those labours in which the action line was reached caesarean section was most likely if oxytocin had been started earlier, but the eventual mode of delivery was little influenced by the introduction (or not) of oxytocin when the action line was reached.4 Amniotomy once the active phase of labour was reached reduced the likelihood of progress in labour moving beyond the alert line. The necessity for and timing of transfer in delayed labour from a peripheral to a central unit would be clarified by early amniotomy in the active phase.4

The participants in the WHO trial agreed that the partogram improved the discipline of and communication about management of labour and freed midwives' time; this may be an important element of the partogram's success as more time can be devoted to "companionship."

Thornton and Lilford's review and the WHO trial point the way towards effective management of labour worldwide. Both papers agree that reduced but timely intervention is the key to success.

but still can't interprit !

nadu · Credits: 17728 My Scrapbook

here is a little clear one...........

After onset of active phase (3 cm cervical dilatation), a 1 cm/h line was used to indicate "alert". A zonal partogram was developed by dividing the active phase partographs into 5 time zones: A (area to the left of "alert" line), B (0-1 h after "alert" line), C (1-2 h after "alert" line), D (2-3 h after "alert" line) and EF (> 3 h after "alert" line).

For the action line, different lag times after the alert line were defined according to the time zones. Sensitivity, specificity, cesarean section rates and rupture rates were calculated for the different lag times after the alert line, and a receiver-operating characteristic curve was constructed.

In women undergoing trial of labour following caesarean section, prolonged active phase of labour is associated with increased risk of uterine rupture. A zonal partogram may be helpful in assessing this risk in actively labouring women who cross the partographic "alert" line.

nadu · Credits: 17728 My Scrapbook

Guest · Credits: 79189 My Scrapbook My Reading List 262569 Books

so what is the answer?

basharkhanem · Credits: 198 My Scrapbook

hi ,when ever there is delay in the mechanism of labour more than 1cm|2h that associated with active ut. contraction (rt shift) youe shoud be consern

any replay

suneet · Credits: 6840 My Scrapbook

THE ANSWER IS TO THE RIGHT OF ALERT LINE

dr_nidhi · Credits: 13101 My Scrapbook My Reading List 5 Books

i guess it should be when it has reached the action line.....since its about referring a patient from a peripheral center which means one should consider the transportation time as well......

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