|
pubmed:otherAbstract |
PIP: A facsimile of the 1-page labor chart provided by the Ministry of Health and used at all maternity clinics in Malawi is described. Malawi has 350 maternity units which take care of 45% of deliveries. Personnel range from nonprofessional to registered nurse-midwives to physicians. The most notable feature of the chart is a partogram marked with "alert" and "action" lines, for comparing cervical dilation per hour. The alert line is a diagonal line starting at 3 cm dilated and fully effaced, drawn at an angle representing the slowest 10% of normal African primigravidas. Normally vaginal delivery would be expected at the time of the end of the action line. The action line is drawn arbitrarily 4 hours to the right, allowing time for normal delivery or transfer of the patient. Fetal descent is also charted in fifths of head palpable above the pelvic brim. There is room to the left of the page to chart progress in latent phase. One side of the chart contains demographic and admission data and the progress graph. The reverse side has space for pelvic assessment, results of 2nd and 3rd stage of labor and charting of up to 6 days' postpartum stay for mother and infant. There are blanks to record whether the woman has had sleep, food or homemade medicine, and room for making referrals. In practice fetal descent is followed by abdominal palpation hourly, fetal heart rate every 30 minutes, and charted as type 1, 2, or 3. Vaginal examinations are done every 4 hours for primigravidas and every 3 in multiparas. Fetal head molding is charted as -or 1+, 2+ or 3+.
|
