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The World Health Organization is a specialized agency of the United Nations with primaryresponsibility for international health matters and public health.

Through this organization,which was created in , the health professions of some countries exchange theirknowledge and experience with the aim of making possible the attainment by all citizens of theworld by the year of a level of health that will permit them to lead a socially andeconomically productive life. By means of direct technical cooperation with its Member States, and by stimulating suchcooperation among them, VHO promotes the development of comprehensive health services, theprevention and control of diseases, the improvement of environmental conditions, thedevelopment of health manpower, the coordination and development of biomedical and healthservices research, and the planning and implementation of health programmes.

These broad fields of endeavour encompass a wide variety of activities, such as developingsystems of primary health care that reach the whole population of Member countries; promotingthe health of mothers and children; combating malnutrition; controlling malaria and othercommunicable diseases including tuberculosis and leprosy; having achieved the eradication ofsmallpox.

Progress towards better health throughout the world also demands international cooperation insuch matters as establishing international standards for biological substances, pesticides andpharmaceuticals; formulating environmental health criteria; recommending international non-proprietary names for drugs; administering the International Health Regulations; revising theInternational Classification of Diseases, Injuries, and Causes of Death; and collecting anddisseminating health statistical information.

Further information on many aspects of WHOs work is presented in the Organizationspublications. The document may, however, be freely viewed, abstracted;reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercialpurposes.

The views expressed in documents by named authors are solely the responsibility of those authors. Mrs Helen Kerr prepared the background document for theworking group. Financial support for the production of this document was provided by the UnitedNations Population Fund. Lennox and Or Barbara E. It does not set out to teach the principles and physiology of labour. It is assumed that a tutor working with thisUsers Manual for teaching purposes will have acquired a working knowledge of theseprinciples and can pass this information on to the trainees as appropriate.

Consequentlythis manual concentrates on the practical aspects of using the partograph as a managerialtool in labour and not on theoretical aspects. A partograph is used to record all observations made on a woman in labour.

Itscentral feature is a graph, where dilatation of the cervix as assessed byvaginal examination is plotted. By noting the rate at which the cervix dilates, it is possibleto identify women whose labours are abnormally slow and who require special attention. These women are at risk of developing prolonged and obstructed labour due tocephalopelvic disproportion CPD , which may lead to serious problems, such as ruptureduterus and death of the fetus.

Other problems that may result from slow progress in labourinclude postpartum haemorrhage and infection. By helping to identify at an early stage those women whose labour is slow, thepartograph should prevent some of these problems.

It is also a very clear way of recordingall labour observations on one chart, making it easy to detect any other abnormalities. It does not help to identify other risk factors which mayhave been present before labour started. On start a partograph when you have checked that there are no complications of the pregnancy that require immediate action. Page Understand the concept of the partograph.

Record the observations accurately on the partograph. Understand the difference between the latent and the active phases of labour. Interpret a recorded partograph and recognize any deviation from the norm. Monitor the progress of labour, recognize the need for action at the appropriate time, and decide on timely referral. Explain to mothers and other members of the community the significance of the partograph.

Cervical dilatation? Descent of the fetal head - Abdominal palpation of fifths of head felt above the pelvic brim? Uterine contractions - Frequency per 10 minutes - Duration shown by differential shading The fetal condition? Fetal heart rate? Membranes and liquor? Starting the Partograph A partograph chart must only be started when a woman is in labour. You must be sure that she is contracting enough to start a partograph. In the latent phase? Contractions must be 2 or more in 10 minutes, each lasting 20 seconds or more.

In the active phase? Contractions must be 1 or more in 10 minutes, each lasting 20 seconds or more. The latent phase slow period of cervical dilatation is from cm with a gradual shortening of the cervix. The active phase faster period of cervical dilatation is from 3 cm to 10 cm full cervical dilatation.

In the centre of the partograph is a graph. Along the left side are numbers against squares: each square represents 1 cm dilatation. Along the bottom of the graphare numbers each square represents 1 hour. The dilatation of the cervix is plotted recorded with an "X". The first vaginalexamination, on admission, includes a pelvic assessment and the findings are recorded.

Thereafter, vaginal examinations are made every 4 hours, unless contraindicated. However, in advanced labour, women may be assessed more frequently, particularly themultipara. Page 6 Example: Plotting cervical dilatation when admission is in the active phase Look at Fig. In the section labelled active phase there is an "alert" line, astraight line from cm. When a woman is admitted in the active phase, the dilatationof the cervix is plotted on the alert line and the clock time written directly under the Xin the space for time.

If progress is satisfactory, the plotting of cervical dilatation will remain on or to the left of the alert line. The latent phase normally should not take longer than 8 hours. When admission is in the latent phase, dilatation of the cervix is plotted at 0 time andvaginal examination made every 4 hours. Observations on Fig. Admission was at and the cervix was 1 cm dilated.?

At the cervix was 2 cm dilated.? At the cervix was 3 cm dilated when she entered the active phase of labour.? At the cervix was 10 cm fully dilated.? Latent phase lasted 8 hours and active phase lasted 3 hours. When dilatation is cm, plotting must be in the latent phase area of thecervicograph. When labour goes into the active phase, plotting must be transferred by abroken line to the alert line. The recordings of cervical dilatation and time are plotted 4hours after admission, then transferred immediately to the alert line using the letters "TR",leaving the area between the transferred recording blank.

The broken transfer line is notpart of the process of labour.


Sistema Informático Perinatal




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