The document discusses the partograph, a graphical tool used to monitor labor progress and identify abnormalities in maternal and fetal conditions. It outlines the components and objectives of partograph use, including early detection of labor complications and facilitating timely medical interventions. Advantages include continuity of care and legal documentation, while disadvantages involve assumptions of uniform labor progression and variations in clinical interpretations.

1. PARTOGRAPH PRACTICE
Ch.Vanitha,
M.Sc Nursing,Ph.D.
Obstetrics and Gynecological
Nursing
Mamata college of nursing.

2. PARTOGRAPH
 Partograph is a Greek word which means
“Labour Curve”. Partograph or Partogram
is a simple, Inexpensive tool which gives
continuous pictorial overview of labour
 Partograph is a single sheet of paper

3. DEFINITION
 Partograph is a chart in
which the salient features of
labour are entered in a
graphic form and it provides
the opportunity for early
identification of deviations
from normal.
 Partograph is a composite
graphical record of key data
(maternal and fetal) during
labour, entered against time
on a single sheet of paper

4. WHO Partographs: Original and
Modified
Original WHO Partograph Modified WHO PartographModified WHO Partograph

6. OBJECTIVES
Early detection of abnormal progress of a
labour
prevention of prolonged labour
Recognize cephalo pelvic disproportion
long before obstructed labour
Assist in early decision on transfer ,
augmentation , or termination of labour
Early recognition of maternal or fetal
problems

7. Indications
 All primigravida
 High risk pregnancy
 Malpresentations and malpositions
 Trial of labour in contacted pelvis

8. Components of partograph
Fetal condition
• Fetal heart rate
• Amniotic fluid and
Membranes
• Moulding
Labour
• Cervical Dilatation
• Uterine contraction
Interventions
• Drugs and IV fluids
Maternal condition
• BP, Pulse, Temperature

10. 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
I:

11. Moulding
 Increasing moulding 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 …………… …………...++
 severely overlapping bones ( notable ) ……..+++

12. Active phase
 Active phase labor is a time of rapid change in
cervical dilatation, effacement, and station.
Alert line ( health facility line )
 Plotting should be started when the women enters the
active stage with 1 or more uterine contractions per 10
mins. Write the time accordingly in the row.

13. If labor progress normal
Plotting of cervical dilatation remains on the alert
line or to the left of it.
In between Alert and Action Lines
This means “warning” : Refer as soon as alert line is
crossed and do not wait for referral till the action
line is crossed. Observation and ARM.
If At or Beyond Action Line
This means “danger” : decision needed on
management by obstetrician .

14. Cervical dilatation
 It is the surest way to assess progress of labour.

16. Decent of fetal head by abdominal
and Vaginal examination

19. Interventions &Maternal condition
 Drugs , IV fluids , and oxytocin , if labour is
augmented
 Pulse -1/2hourly
 Blood pressure and temperature-4th hourly
 Urine volume

20. ADVANTAGES
 A picture is worth a thousand words
 Helps in continuity of care and providing
information
 Easy Handover Procedure
 No major capital investment other than skilled
attendant
 Documented evidence for Medico Legal
purpose
 Educational value for all grades of staff

21. DISADVANTAGES
 Assumes that all women progress at same rate –
May influence intervention rate
 Clinical findings have subjective variations
 Lack of knowledge
 Non availability of printed partograph
 Duplication of recording.

25. Example
 Mrs.Radha was admitted at 5:00 am on 12.5.2015
 Membranes ruptured at 4:00 am.Gravida-3, para 2
 Hospital number 7886.On admission, the cervix
was 2 cm dilated 09:00 am:The cervix is 5 cm
dilated
 3 contractions in 10 minutes, each lasting 20-40
seconds,FHR-120,Membranes ruptured, amniotic
fluid is clear and Skull bones separated, sutures
easily felt.
 BP- 120/70, Temp- is 36.8 C and PR-80 per minutes
01:20 pm: spontaneous delivery of a live female
infant and weighing 2.850 grams