partograph case study with answers

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• Antenatal Care Module: Ethiopian Federal Ministry of Health
• Labour and Delivery Care Module: Acknowledgements
• Labour and Delivery Care Module: Introduction
• Labour Delivery and Care Module: 1. Recognition of Normal Labour
• Labour and Delivery Care Module: 2. Assessing the Woman in Labour
• Labour Delivery and Care Module: 3. Care of the Woman in Labour
• Introduction
• Learning Outcomes for Study Session 4
• 4.1  The value of using the partograph
• 4.2.1  The graph sections of the partograph
• 4.2.2  The Alert and Action lines
• 4.3  Recording and interpreting the progress of labour
• 4.4  Cervical dilatation
• 4.5  Descent of the fetal head
• 4.6  Assessing moulding and caput formation
• 4.7   Uterine contractions
• 4.8.1  Fetal heart rate as an indicator of fetal distress
• 4.8.2  Causes of fetal distress
• 4.8.3  Recording fetal heart rate on the partograph
• 4.8.4  Amniotic fluid as an indicator of fetal distress
• 4.9  Assessment of maternal wellbeing

Summary of Study Session 4

Self-Assessment Questions (SAQs) for Study Session 4

• Labour and Delivery Care Module: 5. Conducting a Normal Delivery
• Labour and Delivery Care Module: 6. Active Management of the Third Stage of Labour
• Labour and Delivery Care Module: 7. Neonatal Resuscitation
• Labour and Delivery Care Module: 8. Abnormal Presentations and Multiple Pregnancies
• Labour and Delivery Care Module: 9. Obstructed Labour
• Labour and Delivery Care Module: 10. Ruptured Uterus
• Labour and Delivery Care Module: 11. Postpartum Haemorrhage
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• Labour and Delivery Care PDF (4MB)

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• 26 hours study
• 1 Level 1: Introductory
• Course description

Labour and Delivery Care

If you create an account, you can set up a personal learning profile on the site.

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

Read Case Study 4.1 and then answer the questions that follow it.

Case Study  4.1 Bekelech’s story

Bekelech is a gravida 5, para 4 mother, whose current pregnancy has reached the gestational age of 40 weeks and 4 days. When you arrive at her house, she is already in labour. During your first assessment, she had four contractions in 10 minutes, each lasting 35–40 seconds. On vaginal examination, the fetal head was at –3 station and Bekelech’s cervix was dilated to 5 cm. The fetal heart rate at the first count was 144 beats/min.

SAQ 4.1 (tests Learning Outcomes 4.1, 4.2 and 4.3)

• a. What does it mean to say that Bekelech is a ‘gravida 5, para 4 mother’?
• b. How would you describe the gestational age of Bekelech’s baby?
• c. Which stage of labour has she reached and is the baby’s head engaged yet?
• d. Is the fetal heart rate normal or abnormal?
• e. What would you do to monitor the progress of Bekelech’s labour?
• f. How often would you do a vaginal examination in Bekelech’s case and why?
• a. As a gravida 5, para 4 mother you know that Bekelech has had 5 pregnancies of which 1 has not resulted in a live birth .
• b. At 40 weeks and 4 days the gestation is term (or full term).
• c. Bekelch’s cervix has dilated to 5 cm and she is having four contractions in 10 minutes of 35-40 seconds each, so she has entered the active phase of first stage labour. At -3 station, the fetal head is not yet engaged.
• d. The fetal heart rate is within the normal range of 120-160 beats/minute.
• e. As Bekelech’s labour is in the active phase and her cervix has dilated to more than 4 cm, you immediately begin regular monitoring of the progress of her labour, her vital signs, and indicators of fetal wellbeing distress. You record of all these key measurements on the partograph (refer again to Figure 4.1 and Section 4.2.1).
• f. You decide to do vaginal examinations more frequently than the advisory four hours, because Bekelech’s labour may progress quite quickly as she is a multigravida/multipara mother. And you keep alert to the possibility of something going wrong, because Bekelech has already lost one baby before it was born.

SAQ 4.2 (tests Learning Outcome 4.2)

Give two reasons for using a partograph.

Two key reasons for using a partograph are because:

• a. If used correctly it is a very useful tool for detecting whether or not labour is progressing normally, and therefore whether a referral is needed. When the labour is progressing well, the record on the partograph reassures you and the mother that she and her baby are in good health.
• b. Research has shown that fetal complications of prolonged labour are less common when the birth attendant uses a partograph to monitor the progress of labour.

SAQ 4.3 (tests Learning Outcomes 4.1, 4.3, 4.4 and 4.5)

• a. What indicators of good progress of labour would you record on the partograph?
• b. What indicators of fetal wellbeing would you record on the partograph?
• c. How often should you measure the vital signs of the mother and record them on the partograph in a normally progressing labour?
• d. What are the key indicators for immediate referral?
• a. Good progress of labour is indicated by: a rate of dilation of the cervix that keeps it on or to the left of the alert line; evidence of fetal descent coinciding with cervical dilation; and contractions which show a steady increase in duration and the number in 10 minutes.
• b. Fetal wellbeing is indicated by: a fetal heart rate between 120-160 beats/minute (except for slight changes lasting less than 10 minutes); moulding (overlapping of fetal skull bones) of not more than +2; and clear or only slightly stained liquor (C or M 1 ).
• c. In a normally progressing labour, you would measure the mother’s blood pressure (every 4 hours), pulse (every 30 minutes), temperature (every 2 hours) and urine (every time it is passed), and record them on the partograph.
• d. Indicators for immediate referral include: slow rate of cervical dilation (to the right of the Alert line on the partograph); poor progress of labour, together with +3 moulding of the fetal skull; fetal heartbeat persistently below 120 or above 160 beats/minute; liquor (amniotic fluid) stained with meconium, depending on the stage of labour, even with normal fetal heart rate: (refer M 1 liquor in latent first stage; M 2 liquor in early active first stage, and M 3 liquor in any stage, unless labour is progressing fast.

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Partograph exercises, maria cruz, a 23-year-old, gravida 2 para 1 was admitted today at 2am, ie showed a 5cm dilated cervix, cephalic, intact bag of water. vital signs of, bp=110/70mmhg, pr=88bpm, t=36 and fht=140bpm. she had 3 contractions in 10 minutes with a moderate intensity. at 6am, the bag of water, ruptured with clear amniotic fluid. ie showed 8cm dilated cervix. vital signs of bp=120/80 mmhg, pr=90bpm, t=36 and fht=146bpm. at 8am,, cervix was 9 cm. she delivered spontaneously at 8:30 am. 10 units oxytocin was given im. placenta was delivered complete at 8:35 am., frances rogers, a 26-year-old, gravida 1 para 0 was admitted in labor room at 14:00. on abdominal examination the contractions were 2 in 10, minutes, each lasting 20 seconds. the head was 5/5 above the brim and the fetal heart was 130/min. on vaginal examination the cervix was 2 cm, dilated, membranes were intact, no moulding felt. vital signs of blood pressure was 110/70 mmhg; her pulse 78/min; temperature 36°c. she, passed 100 ml of urine; protein and acetone were negative. at 18:00 an abdominal and vaginal examination was carried out. fetal heart rate of, 140/min. ie showed 5 cm dilated, descent of the head 3/5 above the brim, ruptured membrane with clear amniotic fluid, no moulding noted. upon, abdominal palpation, uterine contractions of 3 in 10 minutes, each lasting 50 seconds. vital signs of blood pressure of 105/70 mmhg; pulse 80/min,, temperature 37°c..

• Multiple Choice

Course : Nursing (BSN)

University : ateneo de davao university.

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