Pathogram

1. PARTOGRAM
RECORDING PROGRESS OF LABOUR
Done By: Ali Salam
Group 110

2. WHY IS IT IMPORTANT TO RECORD THE
PROGRESS OF LABOUR
 To provide continuity of care.
 To provide a basis of decision making.
 To allow review.
 To defend one’s actions – no documentation – no
defense.
Documentation is important

3. TOOL FOR RECORDING THE
PROGRESS OF LABOUR
PARTOGRAM

4. PARTOGRAM
PARTOGRAM is a graphical information about
the progress of labour in which the salient
information about the fetal well-being, maternal
well-being and the progress of labour are
recorded into a chart.

5. PARTOGRAM
Is a managerial tool used to record all
observations made on a woman and fetus in
labour in one chart.
Partogram helps to identify at an early stage
those women whose labour is slow.
A managerial tool for prevention of prolonged
labour.
IT’S SIGNIFICANT:

6. PARTOGRAM
For all women who are in labour (i.e. either low
or high risk group).
WHO REQUIRE PARTOGRAM RECORDING

7. PARTOGRAM
Friedman's partogram - 1954
2 phases of labour (base on dilatation
of the cervix )
Latent phase (dilatation < 3 cm)
Active phase (>3 cm dilated)
Latent phase
Active phase
Philpott and Castle - 1972
Introduced the concept of “ALERT”
and “ACTION” lines.
ALERT LINE – represent the mean rate
of slowest progress of labour
ACTION LINE – appropriate action should
be taken.
Normal labour is plotted to the left alert line

8. PARTOGRAM
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

9. PARTOGRAM
WHAT NEED TO BE
RECORDED

10. PARTOGRAM RECORDING
Begin plotting at the
“zero” hour on the
partogram
Enter the outcome
of delivery
1
2
All entries made in
relation to time when
the observations are
made
3
Notes should be
legible, dated and
timed.
4

11. PARTOGRAM RECORDING
Mother information
 Name
 Age
 Parity
 Gestational period
 Date/time of admission
 Time of rupture membrane
 Short antenatal history

12. PARTOGRAM RECORDING
Fetal information
 Fetal heart rate
 Membrane and amniotic
fluid
 Moulding

13. PARTOGRAM RECORDING
Fetal information
Fetal heart rate monitoring
1. Safe and reliable way of knowing
fetus is well.
2. Listen after each contraction for
one minutes.
3. Recorded ½ hourly (each square
is ½ hour)

14. PARTOGRAM RECORDING
Fetal information
Character of amniotic fluid
1. State of liquor can assess in
monitoring fetal condition.
2. Observation to be recorded
- Membrane intact record as “I”
- Membrane rupture:
a) liquor clear record as “C”
b) meconiun stained liquor “M”
c) liquor absent record as “A”

15. PARTOGRAM RECORDING
Fetal information
Moulding of fetal skull
1. Provide information about the
adequacy of pelvis to
accommodate fetal head
2. Record the degree of moulding
0  bones separated
+  bones touching but can
be separated.
++  bone over lapping
+++  bones over lapping
severely

16. PARTOGRAM RECORDING
Labour Progress
 Cervical dilatation
 Descent
 Uterine contraction

17. PARTOGRAM RECORDING
Labour progress
Dilatation and Descent
1. Latent (0-3 cm) and Active (3-10
cm) phase.
2. Dilatation of cervix plotted as “X”
axis and Descent plotted as “O”
axis.
3. First vaginal examination done
on admission is recorded.
4. Subsequent vaginal examination
is done every 2-4 hourly.
5. Transfer from latent to active
phase.

18. PARTOGRAM RECORDING
Latent phase
Labour progress recording
in latent phase
At admission:
- Dilatation  2 cm
- Descent  -2
2 hours after admission:
- Dilatation  2 cm
- Descent  -1
Plot dilatation as “X”
Plot descent as “O”
As the dilatation is only 2 cm therefore
the labour progress is in the latent
phase

19. PARTOGRAM RECORDING
Latent phase
Labour progress recording
in active phase
Plot dilatation as “X”
Plot descent as “O”
0 hours
(admission)
2 hours 4 hours
Dilatation
“O” 2 cm 4 cm 7 cm
Descent
“X” -2 -1 +1
Latent phase
Active phase

20. PARTOGRAM RECORDING
Latent phase
Cervical dilatation
If labour progress well plotting of
cervical dilatation should always
remain to the left of alert line.
If it cross to right of action line
this warns that labour may be
prolonged.

21. PARTOGRAM RECORDING
Labour progress
Uterine Contractions
1. Observation is made ½ hourly
2. Assess the frequency, duration.
3. Each square represent 1
contraction felt in 10 minutes.
4. Frequency – highlight the
numbers of square.
5. Duration – shade the contraction
in the square.
< 20 sec - Mild
20-40 sec - Moderate
> 45 sec - Strong

22. PARTOGRAM RECORDING
Labour progress
Recording the uterine on the
partogram
5 strong contractions
in 10 minutes
2 weak contractions
in 10 minutes
3 moderate contractions
in 10 minutes
Nos. of
Contraction
in 10 mins

23. PARTOGRAM RECORDING
Mother condition
 Vital signs – BP, Pulse, TºC
 Urine analysis – acetone,
albumin, glucose
 Urine volume
 Medications or drug given

24. PARTOGRAM RECORDING
Mother condition
 Vital signs recording
BP – 4 hourly or more
frequent if indicated
Pulse - ½ hourly
TºC – 4 hourly
 Urine analysis – dipstick
acetone  Nil or +
albumin  Nil or +
glucose  Nil or +
 Urine volume

25. PARTOGRAM RECORDING
Latent phase
Analyzing the progress of
labour from the partogram
If progress is satisfactory the
plotting will remain on or to the left
of the alert line.
If labour is not progressing
normally the plotting will be to the
right of the alert line.
Active phase

26. PARTOGRAM RECORDING
Latent phase
LABOUR PATTERNS
Normal labour
Prolonged latent phase
Primary dysfunctional
labour
Secondary arrest
Active phase