Partograph is a graphical representation of the progress of labor over time. It tracks key maternal and fetal parameters including cervical dilation, fetal head descent, fetal heart rate, and uterine contractions. The normal partograph shows labor progressing at a rate of 1 cm cervical dilation per hour along an alert line, with actual labor progress falling within an action line parallel to and 4 hours to the right of the alert line. Abnormal partographs can indicate issues like a prolonged active phase, obstructed labor, or poor contractions that require intervention like oxytocin administration. The partograph is an important tool for monitoring labor and identifying risks or complications.

1. Partograph
BSc. Clinical Medicine
Dr Augustine Cyimana
BScHB, MBChB, MMed (MMOG)-[UNZA],FCOG[ECSA]
First version: 07-11-17
Latest version: 07-10-19

2. Definition
• Partôs ≡partum ≈ labour
• Graph ≈ graphical presentation of
information
• ≈ partograph (labourgraph)► praghical
presentation of progress of labour
• It represents graphical presentation of feto-
maternal parameters(vertical axis) against
time(horizontal axis).

3. Definition
• Labour is a process of delivery (expulsion)
of the fetus (baby) through the genital tract
characterised by progressive cervical
effacement and dilatation with sequence of
regular painful uterine contraction and
descent of the presenting part.

4. Features of Partograph
• Maternal
• general information – name, age, parity, gravid, date and time of
admission etc
• Vitals – temp., BP, pulse, R/R etc
_ urinalysis input/output, drugs etc
• Fetal monitoring
• FHR
• Moulding
• liquor
• Progress of labour
• Cervical Dilatation
• Descent
• Contraction

5. Normal Partograph

6. Fetal Monitoring -FHR
• Normal range 120 – 160/min
• Listen for atleast ½ a minute
• Monitor and record every 30min

7. Fetal Monitoring - Moulding
• Overlapping of scalp bones
• Grades
• 1: sutures apposed
• 2: sutures overlapping but reducible
• 3: sutures overlapping and not reducible
• Shows degree of fetal head compression
through the pelvis in CPD and obstruction

8. Fetal Monitoring - Liquor
• Record nature and colour of amniotic fluid
after every V/E.
• I: membranes intact
• R: membranes ruptured
• C: membranes ruptured, clear liquor
• M: meconium stained liquor. Record grade
• B: blood stained liquor

9. Progress of Labour – Cervical Dilatation
• Open partograph when in active phase of labour
at 4 cm dilatation
• Alert line-a line starts at 4cm of cervical
dilatation to the point of expected full dilatation
at the rate of 1cm per hour.
• Action line –parallel and 4 hours to the right of
alert line(chosen based on research)

10. Progress of Labour – Descent
• Assessed by abdominal palpation
• Part of head palpable above symphysis
pubis.
• Divided into five parts

11. Progress of Labour - Contractions
• Record number of contractions in 10min
and duration
• <20 seconds
• 20 – 40 seconds
• > 40 seconds

12. Satisfactory Progress
• Progressive cervical dilatation at least 1cm
per hour during the active phase
• Progressive regular uterine contractions
Progressive descent of presenting part with
progress of labour.
• Cervix well applied to presenting part
• Onset of expulsive (pushing) phase
• Normal FHR and stable maternal condition

13. Abnormal partographs

14. Partograph – Prolonged Active Phase Of Labour

15. Partograph – Obstructed Labour

16. Partograph- Poor Contractions Corrected by Oxytocin