The document discusses the partograph, a tool used to monitor labor. It notes that prolonged labor is a major cause of maternal death globally and in places like Sub-Saharan Africa and Ethiopia. The partograph is designed to allow early detection of abnormalities in labor to prevent prolonged labor through regular monitoring of cervical dilation, fetal heart rate, descent of the baby and other maternal factors. It provides guidelines on how to use the partograph to assess labor progress and determine when interventions may be needed.

1. Yisehak wansamo
oby/gyn resident,May 2023

2.  Introduction
 History parthograph
 Functions,principles and objectives of
parthograph
 References
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3.  To discuss on historical development of
partograph
 To look at the evidences of benefits of use of
partograph
 To illustrate the proper use of partograph
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4.  Globally, there was an estimated number of
287,000 maternal deaths in 2010
 Eighty five percent (245,000) of these deaths
occurred in Sub-Saharan Africa and Southern Asia
 Among the causes of these deaths were obstructed
and prolonged labour
 In Ethiopia MMR is 412/100,000 live births.
 The main direct causes of maternal death in
Ethiopia include obstetric complications such as
hemorrhage 29.9%, obstructed labor/ruptured
uterus 22.34% , pregnancy-induced hypertension
16.9%.
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5.  Assessment of progress in labour should
therefore identify those women who are less
likely to deliver normally
 Early diagnosis of slow progress and
appropriate interventions should therefore
help in preventing obstructed labour
 The partograph (or partogram) is a simple tool
that has been used for this purpose
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6. The partograph
 Is graphic recording of progress of labor and
salient condition of the mother and her fetus
 Early warning system at all levels
 Increases quality and regularity of all
observations
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8.  1972 Philpott and Castle (Studies in C and S
Africa ) – The introduction of alert and action
line.
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9.  For active labor only
 Started at 4 cms ,currently from 5 cm.
 Easier to use
 Less interventions
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10.  It isn’t a technology which may malfunction
 Requires no major capital investment or
expensive maintenance
 A picture is worth a thousand words
 Ease of use , Prevention of prolonged labor
 Avoids unnecessary use of augmentation
 Easy handover of patient
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11.  Early detection of abnormal progress of a
labour and 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
 Early recognition of maternal or fetal problems
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12.  During active phase of labor cervical dilatation
should no slower than 1 cm hr.
 A lag time of 4 hrs between slowing of labor
and the need for intervention is unlikely to
compromise fetus or the mother,so avoid
unnessary intervention
 Vaginally examination should performed 4
hourly,during membrane rupture,signs of
second stage there.
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14.  A) labor progress
 1) cervical dilatation
 alert line drawn from 4cm to 10 cm,shows rate
of cervical dilatation
 Action line –drawn 4hr right to the alert line.
 One square=1cm dilatation and 30
min,dilatation plotted with an “x” .
 If the progress is satisfactory plotting on or to
the left of alert line.
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17.  2)descent of fetal head
 Plotted with “O”
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18.  3) uterine contraction-1 square =1contraction.
 Dot represent cont
raction duration<
20 second.
Line = 20-40 second
Shadow=>40 seconds
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19.  B) fetal condition
 1)FHR listen for 1 minute after
contraction,between 120 to 160.
 The lines for 120 and 160 are darker to remind the
limits of the normal FHB.
 Rates >160 and <120 may indicate feta distress
 2)Membranes and liqour –I stands=membrane
intact
 C=ruptured and clear.
 M=stands membrane ruptured meconium stained
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20. 20

21.  Stop oxytocine if in augmentation
 Reposition the woman
 Vaginal examination to exclude cord prolapase
and observe amniotic fluid
 Adequate hydration
 Oxygen if available
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22.  Clear liquor
 Grade I - Good volume of liquor, lightly
meconium stained
 Grade II - Reasonable volume with a heavy
suspension of meconium
 Grade III - Thick meconium/particulate matter
which is undiluted
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23.  3) moulding
 No molding - The cranial bones are separate
along the suture lines(o)
 Grade I- Fetal cranial bones are touching each
other along the suture lines(+)
 Grade II- Fetal cranial bones are overlapping
but can be separated(++)
 Grade III-Fetal cranial bones are overlapping &
are not separable(+++)
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25.  C) maternal condition
 Maternal vs ,BP,T every 4 hr,PR every 30 min.
 Urine protein, acetone, iv fluids, drugs,
oxytocins.
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26.  Between the alert line and action line
 Transfer to hospital equiped with CS set up
 ARM + Oxytocine augmentation if no
contraindication
 At or beyound the action line
 Supportive therapy
 Augmentation with oxytocine
 Delivery via CS
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31.  Mrs X 25 years old GIIPI alive lady who is 9 mo
amenorrea presented pushing down pain of 12
hrs and passage liqour of 4 hrs duration,who
had regular ANC follow up four times at
LHC,where baseline Ixs determined and told
no problem.previous pregnancy was
normal.otherwise currently she has no danger
signs,no previous known DM,HTN,cardiac
illness.
 Then she was sent for basic ixs and admitted to
the ward day 7/1/15,at 2:00 am LOT
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32.  PE-GA=ASL in labor pain
 VS= BP (120/80 to 110/70). T 36.5-36.8,RR 20,20
 PR 92,88,90,88,94,92,94.90,94
 FHR 140,138,148,142,134,140,144,142,140
 Uterine contraction 3/10/35-40 sec first 2 hrs of
admission and 4/10/40-50 next 2hrs.
 Descent intially 3/5,and after 4 hr 1/5
 PV=cervix 5 cm dilated,membrane ruptured
clear,station 0,no molding,afer 4 hrs of
examination
 Cervix become 9 cm and the rest are same.
 Ixs non revealing.
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33.  1. World Health Organization Preventing
Prolonged Labour: A practical guide, the
Partograph Part I-IV. 1994 Geneva , WHO
document, WHO/FHE/MSM/93.8 2.
 2. World Health Organization partograph in
management of labour. World Health
Organization Maternal Health and Safe
Motherhood Programme. Lancet 1994;343:1399404.
 3. Lavender T, Wallymahmed AH, Walkinshaw
SA. Managing labor using partograms with
different action lines: a prospective study of
women's views
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34.  4. Matthews M. The partograph for the
prevention of obstructed labour. Clin Obstet
Gynecol 2009; 52: 256-69
 5. The WHO Partograph: Training Video
 6.uptodate
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35. Thanks!!
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