Identification of high risk labours by labour nomogram.

Abstract

Psychological factors are rather less important than in women, and social factors are different and of less importance. Basically this is because the needs of reproduction can be satisfied by the man by the simple act of ejaculation into the vagina. There is no absolute needs to make provision for offspring, though the social desirability of children having two parents and of fathers being responsible for mother and children do in most cultures apply constraints.The pleasure of the male, like that of the female, can be experienced at different levels. There is satisfaction at being found sexually acceptable and in a loving relationship a pleasure at being able to elicit a sexual response. There is pleasure during the excitement stage and the intense visceral sensation of orgasm at the time of ejaculation. As in the woman this is accompanied by a loss of sensory awareness, a merging of personality with that of the partner, followed by a relaxation as deep as the climax was intense.The foregoing description of human sexual response is given in the most general terms. IntroductionOxytocic stimulation of inert labour has become accepted obstetric practice; it results in shorter labour, a decreased incidence in caesarean section and second-stage instrumentation, and improved maternal and neonatal conditions at the end of labour. 13 Some workers4 have used partograms to achieve these aims. Philpott's partogram5 aids the recognition of abnormal labour by clarifying recordings, and can indicate the correct timing of oxytocic stimulation by the use of "alert lines" and "action lines" based on cervical dilatation. These lines were constructed from data obtained from the slowest 10% of African primigravidae. Friedman's sigmoid curve of labour6 is a valuable pictorial representation of normal labour progression, but it is inadequate for the management of individual patients because it starts at the undefinable time of the onset of labour at zero centimetres and the latent period is of varying length. These factors obscure the position of an early assessment of cervical dilatation along the slope.The confusion surrounding the time of onset of labour can be resolved by using the time of admission in labour as the starting point.3 In a large study of normal spontaneous labour no patients entered hospital at a dilatation of zero centimetres, and 63%h of normal primigravidae and 86% of normal multigravidae entered hospital at a cervical dilatation of 3 cm or more when the latent phase had been completed.8Using the patient's admission as the reference point, we have constructed curves showing cervical dilatation times of normal labour for varying dilatations on admission. These data have

Study of Course of Labour by Using Modified Who Partograph

“…The average first and second stage duration reported by various authors was 7hrs and 45 minutes respectively. 6,7,8,9,10 In the present study, the rate of cervical dilatation was 1.3 cm per hour in primigravida and 1.7 cm per hour in multigravidas. The rate was slower in women with abnormal labour pattern.…”

Obstetric outcome in primigravidae with a prolonged deceleration phase

“…The management of patients in spontaneous labour was standardised, with a strict protocol for augmentation, using partograms and the labour stencil (Studd et al, 1975). The deceleration phase was considered to be prolonged when more than three hours elapsed from 8cm to full cervical dilation.…”

Partogram: clinical study to assess the role of Partogram in primigravidae in labor

“…19 In England, Studd et al studied 741 consecutive spontaneous labours to identify high-risk labours that needed oxytocin stimulation. 20,21 Uterine contractions were augmented if progress extended two hours past the limit indicated by the Partogram. This resulted in shorter labours, fewer instrumental deliveries and Caesarean sections, and higher neonatal Apgar scores than in those labours that were not stimulated.…”

“…10,20,21 Friedman"s curves were based on observations of cervical dilatation and fetal station graphed against time in hours from the onset of labour. An S-shaped curve of typical cervical dilatation plotted against time was described, and normal durations of labour were defined.…”