Managing Complications in Pregnancy and Childbirth: - IAWG

C-66 Normal labour and childbirthcervical dilatation (centimetres) on the vertical axis against time (hours)on the horizontal axis.VAGINAL EXAMINATIONSVaginal examinations should be carried out at least once every 4 hoursduring the first stage of labour and after rupture of the membranes. Plotthe findings on a partograph.• At each vaginal examination, record the following:- colour of amniotic fluid;- cervical dilatation;- descent (can also be assessed abdominally).• If the cervix is not dilated on first examination it may not bepossible to diagnose labour.- If contractions persist, re-examine the woman after 4 hours forcervical changes. At this stage, if there is effacement anddilatation, the woman is in labour; if there is no change, thediagnosis is false labour.• In the second stage of labour, perform vaginal examinations onceevery hour.USING THE PARTOGRAPHThe WHO partograph has been modified to make it simpler and easierto use. The latent phase has been removed and plotting on thepartograph begins in the active phase when the cervix is 4 cm dilated. Asample partograph is included (Fig C-10, page C-67). Note that thepartograph should be enlarged to full size before use. Record thefollowing on the partograph:Patient information: Fill out name, gravida, para, hospital number, dateand time of admission and time of ruptured membranes.Fetal heart rate: Record every half hour.Amniotic fluid: Record the colour of amniotic fluid at every vaginalexamination:• I: membranes intact;