Download Complete project materials on Factors Affecting The Utilization Of Partograph In The Management Of Labour In General Hospital
CHAPTER ONE
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INTRODUCTION
Background of the Study
According to world health organization 2015 a partograph is a pre-printed paper with a visual graphical representation of observations on women and foetus during the course of labour. The observation comprised of the progress of labour material condition as well a foetal condition.
These observations are displayed on the partograph for easy and quick review of ongoing labour and timing of management decisions. The partograph is used as a tool for risk assessment and is effective in detecting abnormal labour during the first stage of labour.
When used correctly the partograph help to identify problems and intervention can be timely initiated thereby preventing morbidity and mortality. The graph is plotted when the woman is in active phase of labour. It was developed by friedman an obstriaan who had used it to monitor cervical dilatation and called it the cervicograph (friedman, 1955).In 1972, philpott further developed the cervicographinto the partograph which became a practical tool for recording all intrapartum observation in addition to cervical dilatation.
Philpott in 1972 designed alert and action lines which helped to captured prolonged labour ( philtpott 1972 ). In 1988 safe motherhood initiative launched the used of partograph to an international standard in 1994, WHO, extensively tested its efficacy established its scientific loasis and rationgate for its use in prevention of prolonged labour. In a study conducted by mohammed and chaonsuvivatwong 2008 it was stated that the partograph was introduced in Indonesia in 1998, and the yew version of the world health organization was brought into Indonesia in 2000 partograph was introduced in Nigeria in 1990s. In which Kaduna state was included.
Material mortality rate continue to be the major index of the widening discrepancy in the level of care and the outcome of productive health between advanced and developing countries (Barns 2014) This observation is supported by the global internal mortality pattern in which animal records exceed 515,000 from complications of pregnancy and childbirth, during in developing countries (WHO, 2014).
The tragedy of material mortality figures continues to rise inspite of the apparent commitment by stakeholders ( society of gynaecology and obstetric of Nigeria 2014 ). The majority of the deaths and complications could be prevented by cost effective and affordable health interventions like the use of partograph in the management of labour (WHO, 2014) and indeed thesame measures that could prevent material death would also prevent morbidity and improved neonatal outcome.
Partograph is an effective tool for monitoring labour and when used effectively while prevent prolonged or obstructed labour which account for about 8% of material death (WHO, 2015). The partographthis serves as an early warming system and assist in early decision in hospitals and ongoing evaluation if the effect of interventions regarding augmentation or termination of labour or patient transfer to a wetter equipped facility has proven effective (orfi, 2017).
In Nigeria where only tertiary health facilities used the partograph on regular basis (oladap, 2016) the current situation is in contradiction with the WHO recommendation that health facilities. The WHO guidelines regarding the partograph that should we use das a tool for labour management WHO (2014)
Specifically suggests that decision regarding number of vaginal examination augmentation of labour mode of delivery to be taken in relation to labour mode of delivery to be taken in relation to labour progression as plotted (recorded) on the partograph (van bogonent, 2014) most of this work was not done using the tool as strictly as the WHO guidelines have recommended.
The WHO partograph was modified to make it simpler and easier for use in the latent phase of labour. In the active phase of labour the graph plotting ceruical dilatation in relation to time will normally remain in or to the left of the alert line, and its crossing this line is a warming sign that labour may be prolonged.
The action line is 4hours to the right of the alert line, therefore if a plot reaches the action a decision must be made about the cause of the slow progress and appropriate action taken. Unless the woman is new delivery she must be transferred to a hospital if she is not already in a facility equipped with obstetric emergencies.
Summarily partograph can be used to asses the progress of labour and to identify when intervention is necessary studies have shown that using partograph can be highly effectively in reducing complications from prolonged labour for the mother (postpartum hemneorrhage, sepsis, uterine imptureetc) and for the need born (death,arorexia, infection etc) likewise it reduce operative intervention and improving the neonatal outcome.
1.2. STATEMENT OF THE PROBLEM
It is clear that using the partograph is evidence based practice. The aim of using partograph is to facilitate maximum monitoring of mother and foetus during labour. Incase of problem arising in a expected normal birth health care providers should be able to make quick climical decisions.
Despite the use of partograph tool and the availability trained health care personnel to make use of such challenges, women in such areas continue to experience series of birth related complication which cause severe psychological and physical harm to women leading to serious economic and social changes as well as adverse material and fetal outcomes managing complication is expensive for both the mother or neonate and the hospital.
This complication deliveries are persistently found in general hospital ikara leading to high maternal and parental mortality rate together with other complications such as postpartum hemorrhage maternal infection fetal hypoxia among others despite adequate supply of partograph. It was what prompted the researchers to carryout a research on the utilization of partograph in the management of labour among nurses and midwifes in general hospital ikara Kaduna state`
OBJECTIVE OF THE STUDY
To determinate the extent of staff knowledge on the utilization of partograph in the management of labour.
To know the attitude of the members of staff toward the utilazation of partograph.
To identify factors affecting utilization of partograph
SIGNIFACANCE OF THE STUDY
The finding of the study will be used:
Assess the level of knowledge that the staff has regarding the use of partograph which may be used to improved material and foetal outcome.
The finding can be used by the government to strengthen the weakness in the utilization of partograph serve as guide for further research in the area and also to add to the existing literature.
RESEARCH QUESTION
The study is expected to provide answers to the following questions.
1. To what extent are the health workers in general hospital ikara aware of the use of partograph in the management of labour?
2. What is the attitude of members of the staff toward the utilization of partograph in the management of labour?
3. What are the factors affecting the utilization of partograph in the management of labour?
SCOPE OF STUDY AND LIMITATION
This research covers factors affecting the utilization of partograph in the management of labour ingeneral hospital ikara Kaduna state
The limitation of this study include the bureau critic process involved in the collection of data. The researcher has to collect introduction letter from the department to the hospital management to permit the researcher to distribute the questionnaires and also the failure to meet the respondents at the scheduled time due to shift duty of the staff
OPERATION DEFINITION OF TERMS
Utilization: using of available resources in accordance or judiciously
Partograph: It is a graphical record of cervical dilatation in centimetres against duration of labour in hows
Management: This is the utilization of human and material resources to achieve objective
Labour: The process by which the foelus placenta and membranes are expelled through the birth canal
Health : Is a state of an indundual not merely the absence of a disease or ir infirmity
Cave: Is a help or support giving to an individual.
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