1. Mrs.Sharmila Jose
Lecturer
LFCON

2. Partograph

3. Definition
 It is a composite graphical record of cervical
dilatation and descent of head against duration of
labour in hours. It also gives information about
fetal and maternal conditions that are all
recorded on a single sheet of paper.
 The WHO partograph has been modified to make
it simpler and easier to use. The latent phase has
been removed and plotting on the partograph
begins in the active phase when the cervix is 4 cm
dilated.

4. History
 The first obstetrician to provide a tool for
the assessment of individual labour was
Friedman. It was devised in 1954 , based on
observations of cervical dilatation and
foetal station against time elapsed in hours
from onset of labour.

5. Uses of Partograph
 Early detection of abnormal progress of a labour.
 Prevention of prolonged labour
 Recognize cephalopelvic disproportion long before
obstructed labour occurs.
 Assist in early decision on transfer , augmentation
, or termination of labour.
 Increase the quality and regularity of all
observations of mother and fetus.
 Early recognition of maternal or fetal problems.

6.  The partograph can be highly effective in reducing
complications from prolonged labor for the mother
(postpartum hemorrhage, sepsis, uterine rupture and
its sequelae) and for the newborn (death, anoxia,
infections, etc.).
 The partograph is used to plot the following
parameters for the progress of labor: cervical
dilatation, descent of fetal head, and uterine
contractions. It will also be used for monitoring fetal
conditions with the following parameters: fetal heart
rate, membranes and liquor and moulding of fetal skull.

7.  Additionally, the partograph can be used to
monitor maternal condition: pulse, blood pressure,
temperature, urine, drugs, IV fluids, and oxytocin.

8. Functions of Partograph
 The partograph is designed for use in all
maternity settings , but has a different level of
function at different levels of health care
 In health center, the partograph’s critical
function is to give early warning if labour is likely
to be prolonged and to indicate that the woman
should be transferred to hospital (ALERT LINE
FUNCTION )

9.  In hospital settings, moving to the right of alert
line serves as a warning for extra vigilance , but
the action line is the critical point at which
specific management decisions must be made
 Other observations on the progress of labour are
also recorded on the partograph and are essential
features in management of labour

10. Components of the
Partograph
 Patient information
 Part 1 : Fetal condition ( at top )
 Part 11 : Progress of labour ( at middle )
 Drugs administered
 Part 111 : Maternal condition ( at bottom )
 Patient information
 Fill out name, gravida, para, hospital number, date
and time of admission and time of ruptured
membranes.

11.  Part 1 : Fetal condition
 this part of the graph is used to monitor and assess
fetal condition
 1 - Fetal heart rate
 2 - membranes and liquor
 3 - moulding the fetal skull bones
 Caput

12. Fetal heart rate
 Basal fetal heart rate
 < 160 beats/mi =tachycardia
 > 120 beats/min = bradycardia
 >100 beats/min = severe bradycardia
 Record every half hour.

13. Membranes and liquor
 Intact membranes ……………………………………….I
 Ruptured membranes + clear liquor …………………….C
 Ruptured membranes + meconium- stained liquor
……..M
 ruptured membranes + blood – stained liquor
…………B
 ruptured membranes + absent liquor…………………....A

14. Moulding the fetal skull
bones
 Molding is an important indication of how
adequately the pelvis can accommodate the
fetal head
 Increasing molding with the head high in the
pelvis is an ominous sign of cephalopelvic
disproportion
 Separated bones . sutures felt easily ………….O
 Bones just touching each other ………………………..+
 Overlapping bones (reducible 0 ……………………...++
 Severely overlapping bones ……..+++
( non – reducible )

15. Part11 – Progress of
labour
 Cervical dilatation
 Descent of the fetal head
 Uterine contractions

16. Vaginal examination
 Vaginal examination may be used to assess
descent by relating the level of the fetal
presenting part to the ischial spines of the
maternal pelvis.
 Vaginal examinations should be carried out at
least once every 4 hours during the first stage of
labor and after rupture of the membranes. At
each vaginal examination, record the following:
1. Color of amniotic fluid;
2.Cervical dilatation;
3. Descent of the presenting part (can also be
assessed abdominally).

17.  Note: When there is a significant degree of
caput or moulding, assessment by abdominal
palpation is more useful than assessment by
vaginal exam.

18. 1.Cervical dilatation
 Cervical dilatation assessed at every vaginal
examination and marked with a cross (X). Begin
plotting on the partograph at 4 cm.
 Alert line: A line starts at 4 cm of cervical
dilatation to the point of expected full dilatation
at the rate of 1 cm per hour.
 Action line: Parallel and 4 hours to the right of
the alert line.

19.  Dilatation of the cervix is measured by the
diameter in cm. This is recorded with an X in the
center of the partograph, at the intersection of
vertical and horizontal lines. The vertical scale
represents dilatation by 10 squares of 1 cm each.
The horizontal scale represents time by 24
squares of 30 minutes each.
 When progress of labour is normal and
satisfactory , plotting of cervical dilatation
remains on the alert line or to left of it.

20. 2. Descent of fetal head:
 Descent:means that the fetal head descends through
the birth canal. The "station" of the fetal head
describes how far it has descended through the birth
canal. This station is determined relative to the
maternal ischial spines (bony prominences on each side
of the maternal pelvic sidewalls).
 Descent of the fetal head may not take place until
the cervix has reached about 7 cm of dilatation. This
is measured by abdominal palpation and expressed in
number of finger widths (fifths of the head) above
the pelvic brim. It is also recorded in the central part
of the partograph with an "O".

21. Uterine contractions
 Chart every half hour; palpate the number of
contractions in 10 minutes and their duration in
seconds.
 • Less than 20 seconds:
• Between 20 and 40 seconds:
• More than 40 seconds:
 Each square represents one contraction

22. Drugs
 Oxytocin: Record the amount of oxytocin per
volume IV fluids in drops per minute every 30
minutes when used.
 Drugs given: Record any additional drugs given.

23. Maternal condition
 B P: Record every 4 hours and mark with arrows.
 Pulse: Record every 30 minutes and mark with a
dot (.).
 Temperature: Record every 2 hours.
 Protein, acetone and urine volume: Record every
time urine is passed

25. EXERCISE
 A primigravida was admitted in the latent phase
of labour at 5 AM:
 - fetal head 4/5 palpable;
- cervix dilated 2 cm;
- 3 contractions in 10 minutes, each lasting 20
seconds;
- normal maternal and fetal condition.
 Note: This information is not plotted on the
partograph.

26.  At 9 AM:
 - fetal head is 3/5 palpable;
- cervix dilated 5 cm
Note: The woman was in the active phase of labour
and this information is plotted on the partograph.
Cervical dilatation is plotted on the alert line.
- 4 contractions in 10 minutes, each lasting 40
seconds;
- cervical dilatation progressed at the rate of 1 cm
per hour.

27.  At 2 PM:
 - fetal head is 0/5 palpable;
- cervix is fully dilated;
- 5 contractions in 10 minutes each lasting 40
seconds;
- spontaneous vaginal delivery occurred at 2:20
PM.

29. Management of labour using
the Partograph
 Progress in active phase remains on or left of the
alert line
 Do not augment with oxytocin if latent and active
phases go normally
 Do not intervene unless complications develop
Artificial rupture of membranes ( ARM )
 No ARM in latent phase
 ARM at any time in active phase

30. Between alert and action lines
 In health center , the women must be transferred
to a hospital with facilities for cesarean section ,
unless the cervix is almost fully dilated
 Observe labor progress for short period before
transfer
 Continue routine observations
 ARM may be performed if membranes are still
intact

31. At or beyond action line
 Conduct full medical assessment
 Consider intravenous infusion / bladder
catheterization / analgesia
Options
 Deliver by cesarean section if there is fetal
distress or obstructed labour
 Augment with oxytocin by intravenous infusion if
there are no contraindications

32. Advantages of Partograph
 A single sheet of paper can provide details of
necessary information at a glance.
 No need to record labor events repeatedly.
 It can predict deviation from normal duration
of labour early.
 It facilitates hand over procedure.
 It reduces the incidence of prolonged labour
and caesarean section rate.