Maternal Condition Assessment PDF

## Assessment of Maternal Condition **Recorded at the foot of the Partograph containing:** - Pulse: every half hour. - BP: every 4 hrs or more frequently. - Temp: every 4 hrs or more frequently. - Urine: Protein, Acetone, Volume every 2 to 4 hour. - Oxytocin regime. - Drug and I.V. fluid. **Part I...

## Assessment of Maternal Condition **Recorded at the foot of the Partograph containing:** - Pulse: every half hour. - BP: every 4 hrs or more frequently. - Temp: every 4 hrs or more frequently. - Urine: Protein, Acetone, Volume every 2 to 4 hour. - Oxytocin regime. - Drug and I.V. fluid. **Part IV: Outcome of Labor** Based on the observations of part one, two and three and after the delivery the baby the outcome is written. **Per vaginal examination findings can be confirmed that the lowest part of vertex has passed or is at the level of ischial spines.** ### Uterine Contractions - Observations are every one hour in latent phase. - Observations are every half hour in active phase. - **Frequency:** Number of contractions in a 10 minutes period. - **Duration:** Measured in seconds from the time the contraction sets in to the time the contraction passes off - **Recording Uterine Contractions**: On the Partograph below the time line, there are 5 blank squares going across the length of the graph (Each square represents 1 contraction). The duration is represented by different shading as follows: - If contraction last less than 20 seconds fill square with dots. - If between 20-40 seconds fill square by diagonal line. - If contraction last more than 40 seconds fill the square completely by shading. **Recording Contractions** | Number of Contractions in 10 minutes | Duration of Contractions | |---|---| | 1/2 | < 20s | | 1 | 20-40s | | 2 | > 40s | | 3 | Each lasting less than 20 seconds | | 4 | Each lasting 20-40 seconds | | 5 | Each lasting more than 40 seconds | *In the center of Partograph is a graph. Along the left side are numbers 0-10 against squares (Each square represents 1cm dilatation).* *Along the bottom of the graph is numbers 0-24 (Each square represents 1hour).* - The dilatation of Cervix is plotted with an 'X'. - When labor goes from latent phase to active phase the dilatation recorded on alert line. - If woman admitted in active phase recording the cervical dilation starts on the alert line. - If the progress is satisfactory, the plotting of the cervical dilatation will remain on or to the left of the alert line. - Moving to the right of alert line indicates referral of mother to hospital. **Descent of the Head ** - It may not take place until the cervix has reached about 7 cm of dilatation. - This is measured by abdominal palpation and expressed in number of finger widths (fifths of the head) above the pelvic brim. - It is also recorded in the central part of the Partograph with an "O". **Definition** It is graphic recording of the progress of labor, fetal condition and maternal condition against time in single paper sheet. **Objectives** - To detect abnormal progress of labor. - Serves as an "Early warning system". - To recognize cephalopelvic disproportion (CPD) before obstruction occurs. - Assists in early decision on transfer, augmentation, or termination of labor. - To recognize maternal or fetal problems as early as possible. **Contraindications** - Woman has 9-10 cm dilatation on admission. - Elective CS. - Emergency CS immediately on admission. - Pregnant woman before 30 weeks of gestation. **Components of the Partograph** - **Part I:** Assessment of fetal condition. - **Part II:** Progress of labor. - **Part III:** Assessment of maternal condition. - **Part IV:** Outcome of labor. **Progress of Labor** *This part of graph is used to monitor and assess progress of labor as follows:* - **Alert Line:** - The alert line drawn from 4cm of cervical dilatation to the point of expected full dilatation at the rate of 1cm / hr. Moving to the right of alert line indicates referral of mother to hospital. - **Action Line:** - Action line has drawn 4 hours to the right of alert line and parallel to it. It is critical line specific management decision must be made. **The progress of labor is monitored by:** **Cervical dilatation** can be assessed through vaginal examination done at admission and once in 4 hour. - In latent phase (slow period of cervical dilatation is form 0-3 cm with gradual shortening of the cervix). The latent phase should normally not take longer than 8 hours. - In the active phase (faster period of cervical dilatation form 3-10). **Membranes and Liquor** *It is recorded immediately below the fetal heart rate recording.* - **Intact membranes** - **Ruptured membranes + clear liquor** - **Ruptured membranes + meconium stained liquor** - **Ruptured membranes + blood stained liquor** - **Ruptured membranes + absent liquor** **Moulding the fetal skull bones** - It is an important indication for adequacy of pelvis for fetal head where the decrease in moulding with high head in the pelvis is a sign of cephalopelvic disproportion (CPD). - It is recorded immediately beneath the state of membrane and liquor and plotted in the Partograph as follows: - **No moulding** - **Separated bones, sutures felt easily** - **Bones just touching each other** - **Overlapping bones** - **Severely overlapping bones** **Fetal Heart Rate** **Normal Fetal heart Rate (w 120-160)** *It is recorded immediately below the fetal heart rate recording.* - **Listen:** - Woman is in left lateral position. - Just after the contraction has passed its strongest phase. - For 1 full minute, every half hour, if FHR is abnormal measurement should be every 15mins. - If abnormal over 3 observations, take action. - **Record:** - At the top of the Partograph. - Every half hour. - The line of 120-160 is darker to remind the normal fetal heart rate. - Note: (FHR>160 is tachycardia, FHR<120 is bradycardia and indicate fetal distress, and when the FHR<100 indicate sever bradycardia). **Abnormal pattern include:** - **Fetal bradycardia:** - The fetal heart rate < 120 bpm for 10 minutes a moderate bradycardia 100-119bp/min not serious and may result from the compression head during labor. - Marked bradycardia less than 100bpm/min is sign of hypoxia. - **Fetal tachycardia:** - The fetal heart rate >160bpm for 10 minutes a moderate tachycardia of 160:180 is not serious, marked tachycardia (≥180bpm) may be caused by fetal hypoxia- maternal fever - maternal anemia. **Toco Transducer** - Placed over the uterine funds to detect the tension of maternal abdominal wall as an indirect measure of the intrauterine pressure and converts the pressure into an electronic signal that is recorded on graph paper. **Advantages:** - Easy to apply. - No complications for mother or fetus. - Non-invasive. **Disadvantages:** - Difficult using with obese woman. - Restrict women movement. - Difficult in detecting intensity of contraction. - Affected with mother position. **Direct(Internal fetal monitoring)** **Advantages:** - It is the most accurate method for assessing FHR and uterine contractions. **Disadvantages:** - Requires partial dilation of the cervix (at least 3cm). - Requires skilled particitioner to apply scalp electrode and IUPC. - Insertion of IUPC and FSE is uncomfortable for the mother. - Requires sterile equipment. - IUPC may be impossible to insert the fetus at low station. - Thick fetal hair may make the attachment of fetal scalp electrode is difficult. **Ultrasound Transducer** - Placed on the mother's abdomen (over the fetal back) that conducts the sounds of the fetal heart to a computer. The rate and pattern of the fetal heart are displayed on the computer screen and printed onto special graph paper. **Interpretation** **Uterine activity** - There are several factor used in assessing uterine activity: - **Frequency:** the amount of time between starting one contraction to the start of the next contraction - **Duration:** the amount of time from starting contraction to the end of the same contraction. - **Resting Tone:** a measure of how relaxed the uterus is between contractions. - **Interval:** the amount of time between the ends of one contraction to the beginning of the next contraction. - **Uterine activity may be:** - **Normal:** less than or equal 5 contraction in 10 minute. - **Abnormal:** more than 5 contraction in 10 minutes. **Acceleration** - It is a transient increase in FHR of 15 bpm or more and lasting for 15 sec. **Deceleration** - Decrease in FHR of 15 p/min from the baseline for 15sec. - **Early Deceleration** - **Late Deceleration** **Technique** - **Intrauterine pressure catheter (IUPC):** is a device placed inside a woman's uterus to monitor uterine contractions during labor. - The catheter measures the pressure within the amniotic space during contractions and can be used only after the membranes of the amniotic ruptured and cervix must be dilated 2-3cm. - Can measure the frequency, duration and intensity of uterine contraction. - **Fetal scalp electrode (FSE) (spiral electrode):** small spiral electrode inserted via cervix attached to the presenting part shows a continuous fetal heart rate on the fetal monitor strip. **CTG: Cordia toco graphy** **Definition of CTG** - It is called electronic fetal monitoring that is a technical means of recording fetal heart rate (Cardio) and uterine contractions(toco), which performed during pregnancy, typically in the third trimester or continuously during labor. - CTG is include the external mode,which uses external transducer placed on maternal abdomen to assess FHR& UA, Internal mode which uses spiral electrode applied to fetal presenting part to assess FHR&UA. **Indications** - **Maternal conditions:** - Medical Problems include:(hypertension - diabetes). - Augmentation of labor or induction. - Previous cesarean birth - Prolonged rupture of membrane - Antepartum haemorrhage - Post-term pregnancy(>42 weeks gestation). - Premature labor. - **Fetal conditions:** - Fetal Growth Restriction. - Prematurity (<37 weeks gestation). **Methods of fetal heart rate and uterine contraction monitoring.** - **Indirect (external monitoring).** - **Direct (internal monitoring).** - **Indirect(External fetal monitoring):** - Used to detect fetal heart rate and activity of uterine contractions by two separate transducers, one for the measurement of fetal heart rate and the second one for assessing uterine contraction. - **Ultrasound Transducer:** - Placed on the mother's abdomen( over the fetal back) that conducts the sounds of the fetal heart to a computer. The rate and pattern of the fetal heart are displayed on the computer screen and printed onto special graph paper. **Abnormal fetal heart rate** - Abnormal fetal heart rate. - Oligohydramnios 500cc of amnion. - Congenital malformation. - Multiple pregnancies. - Breech presentation (Mal-presentation).