PARTOGRAPH
OBJECTIVES
I. To discuss the concept of the
WHO partograph
II. To record the observations
accurately on the graph
III. To interpret the recorded findings,
recognize deviation from the norm,
and decide on timely referral
I. The Partograph
• Partograph is a Greek word
meaning “Labour Curve”
• A tool for monitoring the
progress of labor
• Guides birth attendant to
identify women whose labor is
delayed and therefore decide
PURPOSEs OF THE PARTOGRAPH
• To detect abnormal progress
of labor as early as possible
• To prevent prolonged labor
PURPOSEs OF THE PARTOGRAPH
• To assist in early decision on
transfer, augmentation or
termination of labor
• To increase the quality and
regularity of all observations of
mother and fetus
Progress of labor
Maternal and fetal well-being
Monitor during labor…
• Progress of labor
–Cervical dilatation
–Contraction pattern
• Maternal well being
–Pulse, temperature, BP
–Urine voided
• Fetal well being
–Fetal heart rate and pattern
–Color of amniotic fluid
Alert line
Alert line
Parallel and
Action line 4 hours to
the rightof
alert line
II. Recording the findings in
the partograph
• Start by labeling the record with
pertinent patient identifying
information.
Plotting the progress of
labor
• Plot only the CERVICAL
DILATATION using the symbol “X”
• Start when woman is in ACTIVE
LABOR (4 cm or more) and is
contracting adequately (3-4
contractions in 10 minutes)
X
Start plotting on alert line in the
intersection corresponding
cervical dilatation finding
X
X
X
4pm
Indicate the time the IE was made (and
therefore, the observation was plotted)
Write this in the vertical line itself
where you plot the “X”, NOT the space
after it
X
X
4pm 8pm 10pm
Perform internal examination every 4
hours, or more often if necessary, and
plot findings each time
Also, do not forget to write the time
each observation was made
X
X
4pm 8pm 10pm
Connect the “X”s to demonstrate the
pattern of labor
Conditions that does NOT
need the use of partograph
• Antepartum • Multiple
hemorrhage pregnancy
• Severe pre- • Malpresentation
eclampsia and • Very premature
eclampsia labor
• Fetal distress • Obvious
• Previous obstructed labor
cesarean section
III. Distinguishing normal
from abnormal labor
pattern
X
X
X
X
4pm 6pm 8pm 10pm
Progress of labor is normal if
plotting stays on or to the left of
the alert line (green part)
X
X
4pm 6pm 8pm 10pm
Note that based on the structure of
the partograph as soon as 4 cm is
reached the cervix should dilate
normally at a rate of ≥ 1 cm/hour.
X
X
4pm 6pm 8pm 10pm 12am 2am
Plotting that passes the alert line
(yellow part)more so if it reaches or
passes the action line (red part)
indicates abnormal progress of labor
If partograph passes alert
line
• Reassess woman and consider
referral.
• Alert transport services.
• Monitor intensively.
• If partograph passes action line,
refer urgently to an EmONC
facility unless imminent delivery.
If plotting reaches the action
line…
• the patient must be already in an
EmONC facility, a decision made
about the cause of slow progress,
and appropriate action taken
Maternal and fetal well-being
The parts of the partograph
Progress of labor
Maternal and fetal well-being
IV. Other findings to note
(and record) during IE
• Status of membranes, write
“ I ”if intact
• If ruptured, note color of amniotic
fluid, write
–“ C ”if clear
–“ M ”if meconium stained
–“ A ”if absent
–“ B ”if bloody
Monitor every 4 hours*and
record the findings
• Blood Pressure
• Pulse rate
• Temperature
• Urine voided (yes or no)
* More frequently, if indicated
Monitor more frequently
and record the findings
• Number of contractions in 10
minute period
• Fetal heart rate in 1 full minute
Other findings:
• Delivery of Placenta (Time)
• Oxytocin (Time given)
• Other problems-note/describe
2 am
O
I
140
37.1
88
110/70
6
• If woman is admitted in LATENT
PHASE of labor –record only other
findings (BP, FHT etc).
• If she remains in latent phase for
next 8 hours (labor is prolonged),
transfer her to hospital.
Quick action warranted in labor
during following conditions
• Delay in cervical dilatation
• FHR < 120 or > 160/min on 3
observations
• ROM and Meconium stained liquor
or absence
Points to remember while
using Partograph
• It is only a tool for managing labor
progress
• Only start partograph who don’t
have complications and doesn't
require Referral
• Only be started when a woman is in
active labor
Points to remember while
using Partograph
• If progress of labor is satisfactory,
the plotting remain on/to the left of
the Alert line
• Cervical dilation plotted as ‘X’
• Infrequent vaginal examination
( every 4hrs)
• A woman whose cervical dilation
moves to the right of the Alert line
must be transferred for obstetric
interventions
EXERCISES
Case 1:
• Maria, G1P0 was admitted today at 2 am,
IE showed a 5cm dilated cervix, cephalic,
intact BOW. BP=110/70, PR=88/min, T-36.5˚C,
FHT=140/min.
• At 6 am, She had moderate contractions
(3 in 10 min); the BOW ruptured with clear
amniotic fluid. IE showed 8 cm dilated cervix.
BP=110/70, PR=98/min, T-36.8˚C.
• At 8 am, cervix was 9 cm. T- 36.8; PR-88;
BP- 110/70; FHT-140. She delivered
spontaneously at 8:30 am. 10 u oxytocin was
given IM. Placenta was delivered complete
at 8:35 am.
Maria
G1P0
Sept. 6, 2019
0 0
I C
3
140 140
36.5 36.8 36.8
88 98 88
110/70 110/70 110/70
5 8 9
8:35
8:30
Case 2:
• Lourdes, G4P2 was admitted at 1 pm
today. The cervix was 3 cm, cephalic, intact
BOW. BP=120/80, PR=80/min,
T-36.5.
• At 5pm, contractions were moderate,
3 in 10 min. IE showed cervix 4 cm
dilated. Vital signs remained the same.
• At 9 pm, your IE showed 6 cm dilated
cervix. BP-120/80, PR-80. T-36.5. At 1 am,
IE done showed 8 cm dilated cervix,
meconium stained amniotic fluid. BP-
110/70, PR-92/min, T-37.5, FHT-140/min
140
4 6 8
Case 3:
• Marites, G1P0 was admitted at 6 pm.
BP=120/80, PR-84/min, T=36.5. FHT=140/
min, cervix 5 cm dilated, intact BOW. She
had 2-3 uterine contractions in 10 min.
• After 4 hours, IE showed 7 cm dilated
[Link] signs and FHT were the same.
• At 12 am, another IE done showed 8 cm
dilated cervix, ruptured BOW, clear AF.
FHT= 140/min, T-36.8; PR- 88; BP-120/70
• Another IE after 2 hours was the same.
FHT=144/min, T-36.5; PR- 80; BP-120/80
36.8
88 80
120/70
8
REFERENCES
1. Integrated Management of Pregnancy and
Child birth –Managing Complications in
Pregnancy and Child birth WHO
2. Safe Motherhood –Preventing Prolonged
Labour: a practical guide., WHO .
3. Community Health & Disease Surveillance
News letter., “Optimal use of Partograph
in obstetric practice., 13(12)., 6-7.
THANK YOU
so much for
listening
