The partograph is a monitoring and decision-making tool used to monitor labor and identify complications early. It provides a single sheet that graphically records the progress of labor, as well as the maternal and fetal conditions, allowing providers to monitor labor at a glance. Key information recorded on the partograph includes cervical dilation, fetal heart rate, uterine contractions, maternal vital signs, and status of the amniotic sac. Crossing of delineated alert or action lines indicates abnormal labor requiring potential interventions or referral.

1. Partograph

2. Partograph
• Is a monitoring and decision making tool for service
providers to monitor active labour
• Graphic recording of the progress of labor and
assessment of maternal and fetal well being
• All labor record is on a single sheet of paper and gives
a picture of the progress of labour maternal and foetal
condition at a glance
• Tool to monitor labour and identify complications early,
decide to manage them or make timely referrals
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3. PartographContd…
Partogram tells us three things:-
1 How well is the labour progressing
2 How is mother coping with labour stress
3 How is baby coping with labour stress

4. PartographContd…
 It is the graph of the progress of labour
 Progress of labour is measured by:-
1. Contractions–duration and frequency in 10 minutes
2. Dilatation of the cervix every 4 hours

5. Filling a Partograph
Identification data
• Name
• Age
• Parity
• Registration number
• Date and time of
admission
• Time of rupture of
membranes
Partograph
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6. Partograph-CervicalDilatation
• ‘x’ axis is time in hours
• ‘y’ axis is dilatation of cervix in
cms
• Two important lines in the
cervical dilatation section
• Alert line from 4 cms at ‘0’ hours
to 10 cms after 6 hours or
earlier
• Action line from 4 cms at 4
hours to 10 cm at 10 hours or
end of labour and delivery
• Long vertical lines indicate for
hour and each small square
indicates half an hour

7. Partograph-Cervical Dilatation
Progress of Labor
• Begin plotting when active
labour starts at 4 cms
cervical dilatation or more
• Plot the initial findings on the
alert line
• Note the time
• Repeat P/V after 4 hours
and plot the cervical
dilatation
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8. Partograph-CervicalDilatationNormal
Progress
• Put ‘X’ on the alert line at the
level of meeting point with the
line of cervical dilatation
• When cervical dilatation is at
the rate of 1 cm per hour or
more, it is normal progress of
labour and the plotting will be
on the alert line or to its left if
rapid dilatation.
• Alert line runs at the rate 1 cm
per hour

9. Partograph-CervicalDilatation
ProgressInterpretation
• If the ‘X’ goes to the left of alert
line = progress is faster than
1cm/hour
• If the ‘X’ goes to the right of the
alert line = progress is slower
than 1 cm per hour-refer
• The woman should reach the
FRU within 2 hours before her
cervical dilatation reaches the
action line
• If the ‘X’ reaches the action line
which is 4 hours to the right of
alert line–deliver mother now

10. Slow Progress-Why and What To Do
• Intact membranes and head < 3/5 palpable per
abdomen, perform ARM
• Intact membranes and head > 3/5 palpable in PHC, refer
to higher facility
• Clear liquor draining, but poor contractions, oxytocin
infusion at higher facility

11. Plotting Contractions
Chart the contractions every half an hour
• Number of contractions in 10 mins
• Duration in seconds.
• Less than 20 seconds
• Between 20 and 40 seconds
• More than 40 seconds
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12. Plotting Maternal Condition
• Graphs of maternal condition
• Record maternal pulse every
half hour and mark with a dot ‘•’
• Record maternal BP every 4
hours using a vertical arrow,
with upper end signifying
systolic BP and lower end
diastolic BP
• Record the temperature every
4 hours and note on
temperature graph in digits as
degree C.
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13. Plotting Foetal Condition
• Count fetal heart rate every half
hour for one full minute after a
contraction
• Plot on the meeting point of the
vertical line of time and horizontal
line of FHR with a ‘•’. Join the dots
of new reading with the previous
one
• Normal heart rate 120 to 160/min
• Two dark horizontal lines in the FHR
section indicate the range of normal
FHR. Fetal distress: FHR <120/min
or >160/min-Arrange for referral
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14. Partograph-RecordingStatus of Membranes
Record status of membranes and
amniotic fluid
• Membranes intact-mark ‘I’
• Membranes ruptured-note date
and time of rupture in the
identification data section
• Clear liquor-mark ‘C’
• Meconium stained liquor-mark ‘M’
• Blood stained liquor-mark B
• Colour tell condition of foetus
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15. Partograph Interpretation and Indications for
Referral to FRU
• FHR is <120 or > 160 beats/min
• Meconium and/or blood stained amniotic fluid
• When cervical dilatation plotting crosses the alert line
and moves towards the right side of the alert line
• Contractions not increasing in duration, intensity and
frequency
• Pulse rapid > 110/min or BP >140/90 mmHg or temp >
380C
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16. Radha Gangaram 26 Years G3P2L2A0 XYZ1
11/06/09,5:00Hrs 11/06/09, 04:00 Hrs
C C C C C C C
9 AM 1 PM
12 AM
11 AM
10 AM
36.8 C 37 C
C

17. Thank you
Skills lab – Day - 1