OVERVIEW OF PARTOGRAPH
Mrs. Vinaya Kumary. T
Professor cum Vice Principal
Joitiba College of Nursing
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INTRODUCTION
The partograph (sometimes known as
partogram/cervicogram) is usually a pre‐printed paper
form on which labour observations are recorded. The aim
of the partograph is to provide a pictorial overview of
labour and to alert midwives and obstetricians to monitor
the deviations in maternal or fetal well‐being and labour
progress
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DEFINITION
• A partograph is a graphical record of
the observations made of a women in
labour for assessing progress of labour
and salient conditions of the mother
and fetus.
• It was developed and extensively
tested by the world health organization
WHO
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History Of Partogram
Friedman's partogram devised in 1954 was based on
observations of cervical dilatation and foetal station
against time elapsed in hours from onset of labour. The
time of onset of labour was based on the patient's
subjective perception of her contractility. Plotting cervical
dilatation against time yielded the typical sigmoid or 'S'
shaped curve and station against time gave rise to the
hyperbolic curve. Limits of normal were defined
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…CONTD
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Philpott and Castle
In 1972 introduced the concept
of "ALERT" and "ACTION" lines.
The aim of this study was to
fulfill the needs of paramedical
personnel practicing obstetrics
in Rhodesian African
primigravida.
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…Contd
• Action line drawn four hours to the right of the alert
line showing that if the patient has crossed the alert
line, active management should be instituted within 4
hours, enabling the transfer of the patient to a
specialized tertiary care centre.
• The action line was subsequently drawn two hours to
the right of the alert line.
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Studd's labour stencils
It was introduced in 1972. These
stencils predicted the expected pattern
of progression of labour based on the
extent of dilatation achieved by the
time the patient is admitted (zero
time). Curves showing the average
course of cervical dilatation were
constructed for various dilatation on
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admission.
WHO PARTOGRAPH
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OVERVIEW
In 1987, WHO introduced Partograph under Safe
Motherhood initiative, revised in 2000
The partograph can be used by health workers with
adequate training in midwifery who are able to:
observe and conduct normal labour and delivery.
Perform vaginal examination in labour and assess cervical
dilatation accurately
plot cervical dilatation accurately on a graph against time
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OBJECTIVES
• Early detection of abnormal progress of a labour
• Prevention of prolonged labour
• Recognize cephalopelvic disproportion long before
obstructed labour
• 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.
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FUNCTIONS OF PARTOGRAPH
The partograph is designed used in all maternity settings
• 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 )
• 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 are essential features in
management
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of labour
COMPONENTS OF THE PARTOGRAPH
• Part I: fetal condition (at top)
• Part II: progress of labour (at middle)
• Part III: maternal condition (at bottom)
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Mother information
Fetal well-being
• Fetal heart rate
• Character of liquor
• Moulding
Labour progress
• Dilatation
• Descent
• Uterine contraction
Medications
• Oxytocin
• Pain relief (e.g. pethidine)
Maternal well-being
• BP, Pulse, Temperature
• Urine – albumin, glucose, acetone
• Urine output
PART I : 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
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Recording fetal heart rate
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
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Moulding the fetal skull bones
• Molding is an important indication of how adequately the
pelvis can accommodate the fetal head
• separated bones sutures felt easily ……………….….O
• bones just touching each other ………………………..+
• overlapping bones ( reducible 0 ……………………...++
• severely overlapping bones ( non – reducible ) ……..+++
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PART II – PROGRESS OF LABOUR
• Cervical dilatation
• Descent of the fetal head
• Fetal position
• Uterine contractions
• this section of the paragraph has as its central feature
a graph of cervical dilatation against time
• it is divided into a latent phase and an active phase
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Cervical dilatation
It is the surest way to assess progress of labour
LATENT PHASE:
• It starts from onset of labour until the cervix reaches 3-4
cm dilatation
• once 4 cm dilatation is reached, labour enters the active
phase
• It lasts 8 hours or less
• each lasting < 20 seconds
• at least 2/10 min contractions
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ACTIVE PHASE:
• Contractions at least 3 / 10 min
• each lasting < 40 sceonds
• The cervix should dilate at a rate
of 1 cm / hour or faster
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Alert line (Health facility line)
• The alert line drawn from 3 cm dilatation represents
the rate of dilatation of 1 cm / hour
• Moving to the right of the alert line means referral to
hospital for extra vigilance.
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Action line (hospital line)
• The action line is drawn 4 hour to the right of the alert
line and parallel to it
• This is the critical line at which specific management
decisions must be made at the hospital
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• When labor goes from latent to active phase, plotting of
the dilatation is immediately transferred from the latent
phase area to the alert line
Abnormal labor progress
Descent of the fetal head
• The rule of fifth abdominal examination to assess
engagement
• It is the palpable of the fetal head by abdominal
examination
• When 2/5 or less of fetal head is felt above the level of
symphysis pubis, means that the head is engaged and by
vaginal examination, the lowest part of vertex has passed
or is at the level of ischial spines
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Assessing descent of the fetal PV;
0 station is at the level of the ischial spine
Fetal position
Occiput transverse positions
Occiput anterior positions
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Uterine contractions
• Observations of the contractions are made every hour in
the latent phase and every half-hour in the active phase
• Frequency: Assessed by number of contractions in a 10
minutes period
• Duration: Measured in seconds from the time the
contraction is first felt abdominally, to the time the
contraction phases off
• Each square represents one contraction
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Palpate number of contraction in ten minutes
and duration of each contraction in seconds
• Less than 20 seconds:
• Between 20 and 40 seconds:
• More than 40 seconds:
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PART III: MATERNAL CONDITION
Name / DOB /Gestation
Medical / Obstetrical issues
Assess maternal condition regularly by monitoring:
• drugs, IV fluids and oxytocin, if labour is augmented
• pulse, blood pressure
• Temperature
• Urine volume, analysis for protein and acetone
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Recording of maternal condition
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ELECTRONIC PARTOGRAPH/
COMPUTERIZED LABOR MANAGEMENT
Full electronic capture of patient information during
childbirth including,
•CTG's,
•partograms,
• all labour events, outcome information,
•fetal blood sampling results and cord blood gases direct
from the blood gas analyser
•The Fetal Monitoring System and
The mother Monitoring System with The system´s in-
vivo generated individual Partograms with real time
dilatation and head station measurements.
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•
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• This system provides accurate continuous measurements
of dilatation and station.
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The Fetal Monitoring System
is a computer based training system that can be
accessed over the anywhere, anytime, from within a
.hospital or from a home
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The Mother Monitoring System
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