Using the partograph
The best diagnostic tool for identifying prolonged labour is to plot the stages of labour on the partograph, at the same time as regularly assessing fetal and maternal condition (see also Study Session 4). The partograph record will give you an early warning if labour may be prolonged to the point where an obstructed uterus seems likely and referral is essential. So always remember to use it when attending any delivery.
What are the two things you must do to minimise the chances of a woman who is in labour developing a fistula?
The two things you should do are:
- Closely monitor the progress of labour using the partograph to check that the record of cervical dilatation stays on or to the left of the Alert line.
- Urgently refer the mother to a health facility if she has an obstruction (the record of cervical dilatation is approaching the Action line on the partograph), with pre-referral IV fluid infusion or bladder catheterisation if appropriate.