REPRODUCTIVE HEALTH

1. PARTOGRAPH
MR. JONES H.M-MBA
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2.  Partos - partum - labour
 Graph - graphical presentation of information
 The partograph is a graphic record of the progress of
labour and relevant details of the mother and fetus.
 It was introduced as an early warning system to
labour that was not progressing normally.
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3.  This would allow for timely transfer to occur to a
referral centre, for augmentation or Caesarean section
as required.
 The partograph indicates when augmentation is
needed, and can point to possible cephalopelvic
disproportion before labour becomes obstructed.
 It increases the quality and regularity of observations
made on the mother and fetus, and it also serves as a
one page visual summary of the relevant details of
labour.
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4.  The partograph has been used in a number of
countries, and has been shown to be effective in
preventing prolonged labour, in reducing operative
intervention, and in improving the neonatal
 It is important to ensure that adequate supplies of the
form are always available.
 It is a tool which is only as good as the healthcare
professional who is using it.
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5. FEATURES OF A
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
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6. HOW TO USE A
PARTOGRAPH
 It is opened on admission only if the cervical os is
4cm dilated and above and during management of
first stage if woman is in active labour.
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7. MATERNAL WELLBEING
 Record pulse rate every 30 minutes, blood pressure
and temperature 4hourly,
 Urinalysis - Testing for protein, ketones (if available)
and glucose after voiding, and record all fluids and
drugs administered.
 If the findings become abnormal, increased frequency
of observation and testing will be required, and
intervention may be implemented.
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8. FETAL WELLBEING
FETAL MONITORING -FHR
 Monitor and record every 30min
 Listen to fetal heart immediately after the strongest
part of a contraction, with the woman lying on her
back.
 The range for the fetal heart rate during labor is 120
to 160 beats per minute.
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9. FETAL MONITORING -
MOULDING
 Moulding is a defined as the shaping of the fetal head
to the size of the birth canal.
 Record moulding of the fetal skull, after each vaginal
examination.
 1: sutures apposed
 2: sutures overlapped but reducible
 3: sutures overlapped and not reducible
 Note if moulding is present and assess the degree of
moulding such as o, +1, +2, +3
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10. FETAL MONITORING -
LIQUOR
 Record nature and colour of amniotic fluid after every
Vaginal Examination
 I: membranes intact
 R: membranes ruptured
 C: membranes ruptured, clear liquor
 M: meconium stained liquor. Record grade
 B: blood stained liquor
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11. NORMAL PARTOGRAPH 11

12. PROGRESS OF LABOUR –
CERVICAL DILATATION
 Plot cervical dilatation with an
‘X’ in the space provided assessed at every vaginal
examination
 Begin plotting at 4cm
 Join ‘Xs’ with a solid line
 When labor progresses normally, plotting of cervical
dilatation remains on or to the left of the alert line.
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13.  If plotting of cervical dilatation moves to the right of
the alert line labor may be prolonged and plans must
be made for appropriate intervention, if need.
 Plot decent of the fetal head with a ‘O’ in the space
provided.
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14.  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.
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15. PROGRESS OF LABOUR –
DESCENT
 Assessed by abdominal palpation
 Descent is assessed on abdominal examination.
 Descent refers to the part of the head {divided into 5
parts} palpable above the symphysis pubis.
 Join ‘Os’ with a solid line.
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16. PROGRESS OF LABOUR -
CONTRACTIONS
 Record number of contractions in 10min and duration
 Fill in one horizontal square for each contraction felt
in a 10 minutes period
 Use dots to fill in the square for mild contractions
lasting for 20 seconds
 Use diagonal lines to fill in the square for moderate
contractions lasting 20 to 40 seconds
 Use solid color to fill in the square for strong
contractions lasting for longer 40 seconds
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17. LIQUOR
 Clear, meconium stained (thick or thin), bloody or
absent.
 Thick meconium suggests fetal distress, and closer
 monitoring of the fetus is indicated.
 Check every 30 minutes.
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18. MEDICATION
 Record drugs such as oxytocin,and intravenous fluid,
if used, in the space provided.
 Record the woman’s blood pressure, every four hours,
in the space provided.
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19. 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
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20. THE END!
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