2. What is Partograph or Partogram ?
• Is a tool which graphically represents key
events during labour.
• The partograph is an inexpensive and
accessible tool that can effectively monitor
the progress of labour
4. It helps the
•to identify slow progress
in labour early,
•to prevent prolonged
and obstructed labour.
Why should we use a partograph ?
5. First Obstetrician to describe the progress of labour
• E.A. Friedman was the first
obstetrician to describe the
progress of labour graphically in
• He reported the change in cervical
dilatation occurring in labour.
• The progress was recorded in
centimetres of dilatation per hour.
• The resulting graph was an S-
6. Types of partographs:
• Philpott and Castle developed a
partograph, a practical tool for recording
all intrapartum details, not just cervical
• Since the 1990's, WHO
• has published three different types of the
8. B. The modified WHO
partograph for use
in hospitals was
published in 2000
No latent phase
Active labour starts
from 4 cm
9. C. simplified partograph
This version simplifies the partograph for
use at primary level.
Colour codes (green, yellow and red)
help the user to identify normal
labour (green) and distinguish it from
slow progress (yellow: watch out;
10. Why latent phase is removed
• Latent phase is most often a "retrospective diagnosis".
• Having a arbitrary time limit for latent phase of 8 h increases the
risk of incorrect diagnosis of labour and could thus increase the risk
of non-indicated interventions and morbidity.
• On the other hand, the risks of "prolonged latent phase" in the
presence of intact membranes and no other complications is almost
• Lastly, the "transfer" from latent to active phase (broken line) by
health workers was reportedly a major source of confusion and
error in partography.
11. Observations charted on the Partograph
A) The Progress of labour
• Cervical dilatation
• Descent of fetal head
• Uterine contractions – duration,
B) Fetal condition
• Fetal heart rate
• Membranes and liquor
• Moulding of the fetal skull
C) Maternal condition
• Pulse/ BP / Temp
• Urine – volume, acetone, protein
• Drugs & IV Fluids
• Oxytocin regime
12. Starting a Partograph
A partograph should be started only when
a woman is in active phase of labour-
• Cervical dilatation must be 4 cms or more
13. Starting a Partograph
• 1st part is patient particulars.
• Name, Gravida, Para, Hosp. No.
• DOA, TOA
• Ruptured membrane, Hours
15. What is alert line ?
• an oblique line on the
Cervical Dilatation Area
of the partograph that
goes from 4 to 10 cm of
• Represents the rate of
cervical dilatation 1 cm
per hour. This rate is
considered to be the slowest
rate of cervical dilatation
among nulliparae in normal
16. What is action line ?
• An oblique line in the Cervical Dilatation Area of the partograph that
runs parallel and four hours to the right of the Alert Line
• If the cervical dilatation graph reaches or crosses the Action line, it
indicates dangerously slow progress of labour.
• In this case, full medical assessment must be performed and decision
must be made about the cause of the slow progress, and appropriate
18. left of or on the alert line
• Do not augment with oxytocin or intervene unless
• ARM may be done at any time in the active phase
19. Between Alert and Action lines
In a Health Centre:
Transfer to hospital with facilities
for Cesarean section, unless
Cervix is almost fully dilated
ARM may be performed if
membranes are still intact and
observe labour for a short
period before transfer
Perform ARM if membranes are
intact and continue routine
20. At or Beyond Active Phase Action Line
Full medical assessment
Consider IV infusion/bladder
Delivery if fetal distress or
Oxytocin augmentation if no
Supportive therapy (only if
satisfactory progress is now
established and dilatation
could be anticipated at
1cm/hr or faster)
21. Descent of fetal head
It is measured in terms of fifths above the pelvic brim
• The width of the 5 fingers is a guide to the expression in fifths
of the head above the brim. A head that is mobile above the
brim will accommodate the full width of 5 fingers
• Plotted with “0” on the lower part of cervicograph.
23. As the head descends, the portion of the head remaining above
the brim will be represented by fewer fingers
24. • It is generally accepted that the head is
engaged when the portion of the head above
the brim is represented by 2 fingers are less
27. Fetal Heart Rate
• Patient in left lateral position
• Just after the contraction has
passed its strongest phase
• For 1 full minute,
• every 30 min
• if abnormal every 15mins
• If abnormal over 3
observations, take action
• At the top of the Partograph
• Every half hour
28. Fetal Heart Rate
Borderline- Be alert
>180 Fetal Tachycardia
<100 Fetal Bradycardia
& Fetal distress
Fetal Tachycardia is the initial sign of fetal distess
31. Fetal condition- Moulding
State of Moulding Record
• Bones are separated &
sutures felt O
• Bones are just touching
each other 1+
• Bones are overlapping 2+
• Bones are severely
overlapping and not
Recorded at the foot of
• IV Fluids
• Other Drugs: Drotin,
34. Oxytocin dose calculation
• One ampoule of oxytocin contains 5 Units of
• Dissolve in 500 ml NS.
• Conc. is 10 Unit per Litre (10 U/L).
• Half ampoule is dissolved in 500 ml NS
• Conc. Is 5 Unit per Litre (5 U/L)
35. Oxytocin dose calculation
• 15 drops is equivalent to 1ml of fluid.
• Suppose we have taken oxytocin@5 U/L
• Each Litre of fluid contains 5 unit drug
• Each Litre of fluid contains 5000 mili-unit (mU)
• Each ml of fluid contains 5 mili-unit (mU)
• Each 15 drops of fluid contains 5mU
• The rate is 15 drops per min to start with.
36. Maternal Condition
Recorded at the foot of the
• Pulse: every half hour
• BP: every 4 hrs or more
• Temp: every 4 hrs or
• Urine: Protein
37. Can the partograph be used only for normal ( vertex)
• Use of the partograph is not restricted to vertex
• It can be used in all situations where vaginal birth can be
expected. For example, it can be used in monitoring progress of labour
in breech presentation. However in this situation, descent of the fetal
head and moulding are not assessed and recorded on the partograph.
• The partograph can also be used in face presentation.
• Vaginal birth is not anticipated with transverse lie and brow
presentation and hence the partograph is not used.
38. How should the labour progress be monitored in
second stage of labour ?
• The condition of mother and the fetus should be monitored
more frequently in the second stage of labour.
• The cervix is fully dilated and while no further recordings of
cervical dilatation are required,
• it is important to monitor other information e.g. frequency
and strength of uterine contractions, descent of the fetal
head, fetal heart rate, colour of amniotic fluid, medications