The partograph is a graphical tool used to monitor labor. It records key maternal and fetal data over time on a single sheet. The World Health Organization developed and tested the partograph. It allows early detection of abnormal labor and prevents prolonged labor by recognizing issues like cephalopelvic disproportion before obstructed labor occurs. Using a partograph can reduce complications for both mother and baby by ensuring early intervention when needed.
2. The PARTOGRAPH was first introduced in 1954 by
Friedman. Graphically depicting the dilatation of the cervix
during labour.
Philpott and Castle in 1972 developed Friedman's concept into
a tool for monitoring labour by adding the action and alert
lines.
3. A partograph is a graphical record of key data
(maternal & fetal) during labour, entered against
time on a single sheet of paper.
It was developed and extensively tested by the world
health organization WHO
4. 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
5. Early recognition of maternal or fetal problems
The partograph can be highly effective in reducing
complications from prolonged labor for the mother
(postpartum hemorrhage, sepsis, uterine rupture) and
for the newborn (death, anoxia, infections, etc)
6. Part I : Fetal Condition ( At Top )
Part II : Progress Of Labour ( At Middle)
Part III : Maternal Condition ( At Bottom )
Outcome : ………………
7. Name
DOA/Time
Gravida/Parity
Age
Gestational week
IP Number
ROM
LMP
EDD
Labour duration (Hr)
Faculty/ Clinic Name
8. 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
11. Molding is alteration of the shape of the fore-coming head
while passing through the resistant birth passage during labor.
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 ) ……………………...++
Severely Overlapping Bones ( Non – Reducible ) ……..+++
12. Cervical dilatation
Descent ofthe 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
13. It starts from onset of labour until the cervix reaches 4 cm dilatation
Once 4 cm dilatation is reached , labour enters the active phase
Lasts 8 hours or less
Each lasting <20 seconds
At least 2/10 min contractions
ACTIVE PHASE
Contractions at least 3 / 10 min each lasting< 40
seconds
The cervix should dilate at a rate of 1 cm / hour or faster
14. The alert line drawn from 4cm dilatation represents
the rate of dilatation of 1cm / hour
Moving to the right or the alert line means referral to
hospital for extra vigilance
ACTION LINE ( HOSPITAL LINE)
It is drawn 4 hours to the right of the alert line and
parellel to it.
This is the critical line at which specific management
decisions must be made at the higher level of health
care facility.
15. It is the most important information and the surest way toassess
progress of labour.
When progress of labour is normal and satisfactory, plotting of
cervical dilatation remains on the alert line or to left of it.
If a woman arrives in the active phase of labour , recording of
cervical dilatation starts on the alert line
16. It should be assessed by abdominal examination
immediately before doing a vaginal examination,
using the rule of fifth to assess engagement
The rule of fifth means the palpable fifth of the fetal
head are felt by abdominal examination to be above
the level of symphysis pubis
When 2/5 or less of fetal head is felt above the level
of symphysis pubis , this 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
17.
18. Observations of the contractions are made every hour in
the latent phase and every half-hour in the active phase
Frequency- How often are they felt ?
Assessed by number of contractions in a 10 minutes
period.
Duration - How long do they last ?
Measured in seconds from the time the contraction is first
felt abdominally , to the time the contraction phases off
Each square represents one contraction
19. Less than 20 seconds:
Between 20 and 40 seconds:
More than 40 seconds:
20. Stop oxytocin infusion if there is evidence of uterine
hyperactivity or fetal distress
Augment with oxytocin only after artificial
rupture of membranes.
21. Assess maternal condition regularly by monitoring
Drugs , IV Fluids , Oxytocin
Pulse
Blood Pressure
Temperature
Urine Volume ,
Analysis For Protein
And Acetone
22.
23. DariaDaria was admitted in active labour at22:00
Gravida 1 Para 0
Fetal heart rate 130 beats per minute
Fetal head 5/5 palpable
Cervical dilatation 5 cm Three contractions in 10 minutes
eachlasting 30 seconds Intact membranes
The bones are separated and the sutures can be felt easily
Pulse 70 per minute
Blood pressure 120/80 mm Hg
Temperature 36.8
At 2:00Fetal head 2/5 palpable
Cervical dilatation 9 cm Four contractions in 10 minutes,
eachlasting more than 40 secondsIntact membranes
The bones are still separated and the sutures can be felt easily
24. Nima Bhaskar,textbook of Midwifery and Obstetrical
Nursing.2nd edition,Emmess publications, Newdelhi 2016,205-
209
D.C Datta, textbook of obstetrics 8th edt,jaypee publication,
Newdelhi,2017,607-608
Myles textbook for midwives 16th edt,2014,339
Kamini rao textbook of midwifery and obstetrics for nurses,1st
edt.elsevier publication 2011,449
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