2. Cervicograph
Introduced by “Philpott and Caste” in 1972
Action line is 4 hours to the right and parallel to the
alert line
In normal labour the cervicograph (cervical dilatation)
should be either on the alert line or to the left of it.
When it falls to the right of alert line it is abnormal and
need to be critically asssessed
When it falls to the right of action line it should be
reasssessed by a senior person.
Decision be made either termination of labour
(casearean /forceps/suction cup) or augmentation
(amniotomy /oxytocin)
3. Only after the phase of maximum slope which starts at 4
cm is plotted in WHO modification of Philpott’s
cervicograph
4. Contraction Frequency Intensity Duration Shading
Good 3-4/10
minutes
No
indendibility
of uterus
40-50
seconds
Block
Fair 2/10 minutes Slight
indentibility
of uterus
30-40
seconds
Double
shade
Poor 1-2/10
minutes
Easy
indentibility
of uterus
15-30
seconds
Single shade
6. Parameters assessed in
partogram
Mother Labour Fetus
Blood pressure Cervical dilatation Fetal heart
rate/moulding
Pulse rate Vertex station I –Intact membranes
Urine analysis Uterine contractions C-Clear liquor
Temperature Drugs and fluids M-Meconium staining
7. Case 1
25 years old Primi comes to Labour room at 4 am
with a h/o 9 months amenorrhea due on that day
with intermittent pain abdomen, radiating to the
thighs of 6 hours duration. She has blood stained
discharge p/v since half an hour. On examination,
the Uterus was contracting and relaxing, 2
contractions of moderate intensity in every 10
minutes lasting for 20 seconds are felt. The fetal
head was engaged and the fetal heart was good.
On p/v examination, Cervix was effaced and 4
cms dilated. Membranes were present. Vertex is
felt at -2 station. She is admitted to the Labour
room.
8. Case 1
Enema is given. Injection Ringer lactate drip is
started at 100ml/hour .Her progress in labour is
being monitored .After 4 hours uterine
contractions are more intense now 3 every 10
minutes, lasting for 40 seconds. She is c/o pain.
Hence sedation was given. Now on P/v
examination she is 8 cm dilated and vertex is at 0
station. Bag of membranes is present. At 10 am
the patient starts pushing .She is encouraged to
bear down and a baby is delivered at 11.05 am
invertex presentation. After the expulsion of
placenta and membranes she is kept in labour
room for 2 hours.
10. Case 2
25 years old G2P1 comes to Labour room at 6 am
with a h/o 9 months amenorrhea due on that day
with intermittent pain abdomen, radiating to the
thighs of 2 hours duration. She has blood stained
discharge p/v since half an hour. On examination,
the Uterus was contracting and relaxing, 2
contractions of moderate intensity in every 10
minutes lasting for 25 seconds are felt. The fetal
head was engaged and the fetal heart was good.
On p/v examination, Cervix was effaced and 4
cms dilated. Membranes were present. Vertex is
felt at -3 station. She is admitted to the Labour
room.
11. Case 2
Enema is given. Injection Ringer lactate drip
is started at 100ml/hour .Her progress in
labour is being monitored .At 10 am after 4
hours uterine contractions are more intense
now 3 every 10 minutes, lasting for 45
seconds. Now on P/v examination she is fully
dilated and vertex is at +1 station. Bag of
membranes is present .She is encouraged to
bear down and a baby is delivered at 10.45
am in vertex presentation. After the expulsion
of placenta and membranes she is kept in
labour room for 2 hours.
13. Case 3
25 years old Primi comes to Labour room at 4 am
with a h/o 9 months amenorrhea due on that day
with intermittent pain abdomen, radiating to the
thighs of 6 hours duration. She has blood stained
discharge p/v since half an hour. On examination,
the Uterus was contracting and relaxing, 2
contractions of moderate intensity in every 10
minutes lasting for 20 seconds are felt. The fetal
head was engaged and the fetal heart was good.
On p/v examination, Cervix was effaced and 4
cms dilated. Membranes were present. Vertex is
felt at -2 station. She is admitted to the Labour
room.
14. Case 3
Enema is given. Injection Ringer lactate drip is
started at 100ml/hour .Her progress in labour
is being monitored .After 4 hours at 8 am
uterine contractions are more intense now 2
every 10 minutes, lasting for 40 seconds. She
is c/o pain. Hence sedation was given. Now on
P/v examination she is 6 cm dilated and vertex
is at 0 station. Bag of membranes is present.
15. Case 3
Artificial rupture of membrane was done and
injection oxytocin started at 2U in 1 RL/15
drops per minute is started .After 45 minutes
the oxytocin is titrated to 2U /30 drops/min as
the uterus. At 10 am the patient starts pushing
.She is encouraged to bear down and a baby
is delivered at 11.05 am in vertex presentation.
After the expulsion of placenta and
membranes she is kept in labour room for 2
hours.
17. Case 4
28 years old G2P1 comes to Labour room at 6 am
with a h/o 9 months amenorrhea due on that day
with intermittent pain abdomen, radiating to the
thighs of 2 hours duration. She has blood stained
discharge p/v since half an hour. On examination,
the Uterus was contracting and relaxing, 3
contractions of moderate intensity in every 10
minutes lasting for 35 seconds are felt. The fetal
head was engaged and the fetal heart was good.
On p/v examination, Cervix was effaced and 4
cms dilated. Membranes were present. Vertex is
felt at -2 station. She is admitted to the Labour
room.
18. Case 4
Enema is given. Injection Ringer lactate drip is
started at 100ml/hour .Her progress in labour
is being monitored .At 8 am after 2 hours
uterine contractions are more intense .On P/v
examination she is fully dilated and vertex at
+2 station .The patient starts pushing .She is
encouraged to bear down and a baby is
delivered at 8.45 am in vertex presentation.
After the expulsion of placenta and
membranes she is kept in labour room for 24
hours.
20. Case 5
25 years old Primi comes to Labour room at 4 am
with a h/o 9 months amenorrhea due on that day
with intermittent pain abdomen, radiating to the
thighs of 6 hours duration. She has blood stained
discharge p/v since half an hour. On examination,
the Uterus was contracting and relaxing, 2
contractions of moderate intensity in every 10
minutes lasting for 20 seconds are felt. The fetal
head was engaged and the fetal heart was
144/min. On p/v examination, Cervix was effaced
and 4 cms dilated. Membranes were present.
Vertex is felt at -2 station. She is admitted to the
Labour room.
21. Case 5
Enema is given. Injection Ringer lactate drip is
started at 100ml/hour .Her progress in labour
is being monitored .After 4 hours at 8 am
uterine contractions are more intense now 2
every 10 minutes, lasting for 40 seconds. She
is c/o pain. Hence sedation was given. Now on
P/v examination she is 6 cm dilated and vertex
is at 0 station. Bag of membranes is present.
Artificial rupture of membrane was done and
injection oxytocin started at 2U in 1 RL/15
drops per minute is started
22. Case 5
After 45 minutes at 8.45 am the oxytocin is titrated
to 2U /30 drops/min as the uterus is contracting
for 40 seconds two in every 10 min.. At 9.30 the
oxytocin is escalated to 2U/60 drops per minute
as the uterus is still having moderate contraction
at the same rate. At 10 am the patient is fully
dilated with vertex at +2 station. The fetal heart
trace in the monitor now shows decelerations with
loss of short term variability. She is encouraged to
bear down and a baby is delivered at 11.05 am in
vertex presentation after outlet forceps
application. After the expulsion of placenta and
membranes she is kept in labour room for 24
hours.
25. Advantages of partogram
No need to chart labour separately
Convenient monitoring
Predicts maternal and neonatal outcome
Indications of when to act
Secondary arrest of dilatation and descent are
accurately and timely detected
Reduces incidences of obstructed labour
Improves maternity care by midwives and tells
when to refer
