Labour record

RECORD
USE THIS RECORD FOR MONITORING DURING LABOUR, DELIVERY AND POSTPARTUM NUMBER
NAME AGE PARITY
ADDRESS
PLANNED NEWBORN
DURING LABOUR AT OR AFTER BIRTH - MOTHER AT OR AFTER BIRTH – NEWBORN TREATMENT
ADMISSION DATE BIRTH TIME LIVEBIRTH  STILLBIRTH: FRESH  MACERATED   
ADMISSION TIME OXYTOCIN – TIME GIVEN RESUSCITATION NO  YES   
TIME ACTIVE LABOUR STARTED PLACENTA COMPLETE NO  YES BIRTH WEIGHT:  
GEST. AGE ____________OR PRETERM NO  YES
TIME MEMBRANES RUPTURED TIME DELIVERED   
ESTIMATED BLOOD LOSS SECOND BABY  
AZT 300MG+3TC 150MG 2X DAILY X 7
DAYS FIRST DOSE TAKEN  DISPENSED INFANT FEEDING COUNSELLING Y/N
TIME SECOND STAGE STARTS  INFANT FEEDING PRACTICE EBF  RF  MF 
ENTRY EXAMINATION  
STAGE OF LABOUR: NOT IN ACTIVE LABOUR  ACTIVE LABOUR   
PLANNED MATERNAL
NOT IN ACTIVE LABOUR TREATMENT
HOURS SINCE ARRIVAL 1 2 3 4 5 6 7 8 9 10 11 12  
HOURS SINCE RUPTURED MEMBRANES                          
VAGINAL BLEEDING (0 + ++)                          
STRONG CONTRACTIONS IN 10 MINUTES                          
FETAL HEART RATE (BEATS PERMINUTE)                          
T (AXILLARY)                          
PULSE (BEATS/MINUTE)                          
BLOOD PRESSURE (SYSTOLIC/DIASTOLIC)                          
URINE VOIDED                          
CERVICAL DILATATION (CM)
PLANNED ARV DRUG AND DOSE*                          
ARV TIME**
PROBLEM TIME ONSET TREATMENTS OTHER THAN NORMAL SUPPORTIVE CARE
0  

IF MOTHER REFERRED DURING LABOUR OR DELIVERY, RECORD TIME AND EXPLAIN.

0
*ASK IF THE MOTHER HAS TAKEN AZT 600 MG OR SD-NVP AT ONSET OF LABOUR AT HOME, AND RECORD.
**DURING LABOUR ADMINISTER ONLY 3TC AND ART EVERY 12 HOURS; RECORD TIME DRUG TO BE ADMINISTERED ABOVE THE LINE AND TIME ACTUALLY
ADMINISTERED BELOW THE LINE.
 Partograph 10 cm
USE THIS FORM FOR
MONITORING ACTIVE LABOUR
  Cervical Dilatation 9 cm

8 cm

7 cm

6 cm

5 cm

4 cm

FINDINGS TIME                        
HOURS IN ACTIVE LABOUR 1 2 3 4 5 6 7 8 9 10 11 12
HOURS SINCE RUPTURED MEMBRANES                        
RAPID ASSESSMENT B3-B7                        
VAGINAL BLEEDING (0 + ++)                        
AMNIOTIC FLUID (MECONIUM STAINED)                        
CONTRACTIONS IN 10 MINUTES                        
FETAL HEART RATE (BEATS/MINUTE)                        
URINE VOIDED                        
T (AXILLARY)                        
PULSE (BEATS/MINUTE)                        
BLOOD PRESSURE (SYSTOLIC/DIASTOLIC)                        
CERVICAL DILATATION (CM)                        
DELIVERY OF PLACENTA (TIME)                        
OXYTOCIN (TIME/GIVEN)                        
PROBLEM-NOTE ONSET/DESCRIBE BELOW                        
Postpartum record
ADVISE AND COUNSEL
1 hour (if complications every 5- 12 16 20 24
Monitoring after birth 2 hr 3 hr 4 hr 8 hr MOTHER
15 min) hr hr hr hr
Time  Postpartum care and hygiene
Rapid assessment  Nutrition
Bleeding (0 + ++)  Birth spacing and family planning
Uterus hard/round?  Danger signs
Maternal: Blood pressure  Follow-up visits
Pulse  ARV adherence (mother and baby)
Urine voided BABY
Vulva  Infant feeding
Newborn: breathing  Hygiene, cord care and warmth
Warmth  Special advice if low birth weight
 Danger signs
 HIV testing
 CTX prophylaxis
 Follow-up visits
Newborn abnormal signs (list) PREVENTIVE MEASURES
Feeding observed: Feeding well  difficulty  For mother
Initial feeding practice: EBF  RF  MF   Iron folate
Comments  Vitamin A
 Mebendazol
Planned Treatment Time Treatment given  Sulphadoxine-pyrimethamine
Mother  Tetanus toxoide immunization
 RPR test result and treatment
 ARV
Newborn For Baby
 Risk of bacterial infection and treatment
 BCG, OPV -0, Hep-0
If referred (mother or newborn ), record time and explain:
 RPR Positive  Rx
 TB test result and prophylaxis
If death (mother or newborn), date, time and cause:
 ARV prophylaxis