The partograph is a graphical tool used to monitor labor. It records key maternal and fetal data over time on a single sheet. The World Health Organization developed and tested the partograph. It allows early detection of abnormal labor and prevents prolonged labor by recognizing issues like cephalopelvic disproportion before obstructed labor occurs. Using a partograph can reduce complications for both mother and baby by ensuring early intervention when needed.

1. PRESENTATIONBY,
Ms. KEERTI H
(OBG Nursing)

2.  The PARTOGRAPH was first introduced in 1954 by
Friedman. Graphically depicting the dilatation of the cervix
during labour.
 Philpott and Castle in 1972 developed Friedman's concept into
a tool for monitoring labour by adding the action and alert
lines.

3.  A partograph is a graphical record of key data
(maternal & fetal) during labour, entered against
time on a single sheet of paper.
 It was developed and extensively tested by the world
health organization WHO

4.  Early detection of abnormal progress
of a labour .
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

5.  Early recognition of maternal or fetal problems
 The partograph can be highly effective in reducing
complications from prolonged labor for the mother
(postpartum hemorrhage, sepsis, uterine rupture) and
for the newborn (death, anoxia, infections, etc)

6.  Part I : Fetal Condition ( At Top )
 Part II : Progress Of Labour ( At Middle)
 Part III : Maternal Condition ( At Bottom )
 Outcome : ………………

7.  Name
 DOA/Time
 Gravida/Parity
 Age
 Gestational week
 IP Number
 ROM
 LMP
 EDD
 Labour duration (Hr)
 Faculty/ Clinic Name

8.  This part of the graph is used to monitor and assess
fetal condition
1 - Fetal heart rate
2 - Membranes and liquor
3 - Moulding the fetal skull
bones

9.  Fetal heart rate
> 180 beats/min =Tachycardia
< 160 beats/min = Bradycardia
< 100 beats/min = Severe Bradycardia

10.  Intact Membranes ……………………………………….I
 Ruptured Membranes + Clear Liquor …………………….C
 Ruptured Membranes + Meconium- Stained Liquor ……..M
 Ruptured Membranes + Blood – Stained Liquor …………B
 Ruptured Membranes + Absent Liquor…………………....A

11.  Molding is alteration of the shape of the fore-coming head
while passing through the resistant birth passage during labor.
 Increasing Molding with the head, high in the pelvis is an
ominous sign of cephalopelvic disproportion.
 Separated Bones Sutures Felt Easily ……………….….O
 Bones Just Touching Each Other ………………………..+
 Overlapping Bones ( Reducible ) ……………………...++
 Severely Overlapping Bones ( Non – Reducible ) ……..+++

12.  Cervical dilatation
 Descent ofthe fetal head Fetal position
 Uterine contractions
 This section of the paragraph has as its central feature
a graph of cervical dilatation against time
 It is divided into a latent phase and an active phase

13.  It starts from onset of labour until the cervix reaches 4 cm dilatation
 Once 4 cm dilatation is reached , labour enters the active phase
 Lasts 8 hours or less
 Each lasting <20 seconds
 At least 2/10 min contractions
ACTIVE PHASE
 Contractions at least 3 / 10 min each lasting< 40
seconds
 The cervix should dilate at a rate of 1 cm / hour or faster

14.  The alert line drawn from 4cm dilatation represents
the rate of dilatation of 1cm / hour
 Moving to the right or the alert line means referral to
hospital for extra vigilance
ACTION LINE ( HOSPITAL LINE)
 It is drawn 4 hours to the right of the alert line and
parellel to it.
 This is the critical line at which specific management
decisions must be made at the higher level of health
care facility.

15.  It is the most important information and the surest way toassess
progress of labour.
 When progress of labour is normal and satisfactory, plotting of
cervical dilatation remains on the alert line or to left of it.
 If a woman arrives in the active phase of labour , recording of
cervical dilatation starts on the alert line

16.  It should be assessed by abdominal examination
immediately before doing a vaginal examination,
using the rule of fifth to assess engagement
 The rule of fifth means the palpable fifth of the fetal
head are felt by abdominal examination to be above
the level of symphysis pubis
 When 2/5 or less of fetal head is felt above the level
of symphysis pubis , this means that the head is
engaged , and by vaginal examination , the lowest
part of vertex has passed or is at the level of ischial
spines

18.  Observations of the contractions are made every hour in
the latent phase and every half-hour in the active phase
 Frequency- How often are they felt ?
 Assessed by number of contractions in a 10 minutes
period.
 Duration - How long do they last ?
 Measured in seconds from the time the contraction is first
felt abdominally , to the time the contraction phases off
 Each square represents one contraction

19.  Less than 20 seconds:
 Between 20 and 40 seconds:
 More than 40 seconds:

20.  Stop oxytocin infusion if there is evidence of uterine
hyperactivity or fetal distress
 Augment with oxytocin only after artificial
rupture of membranes.

21. Assess maternal condition regularly by monitoring
Drugs , IV Fluids , Oxytocin
 Pulse
 Blood Pressure
 Temperature
 Urine Volume ,
Analysis For Protein
And Acetone

23.  DariaDaria was admitted in active labour at22:00
 Gravida 1 Para 0
 Fetal heart rate 130 beats per minute
 Fetal head 5/5 palpable
 Cervical dilatation 5 cm Three contractions in 10 minutes
eachlasting 30 seconds Intact membranes
 The bones are separated and the sutures can be felt easily
 Pulse 70 per minute
 Blood pressure 120/80 mm Hg
 Temperature 36.8
 At 2:00Fetal head 2/5 palpable
 Cervical dilatation 9 cm Four contractions in 10 minutes,
eachlasting more than 40 secondsIntact membranes
 The bones are still separated and the sutures can be felt easily

24.  Nima Bhaskar,textbook of Midwifery and Obstetrical
Nursing.2nd edition,Emmess publications, Newdelhi 2016,205-
209
 D.C Datta, textbook of obstetrics 8th edt,jaypee publication,
Newdelhi,2017,607-608
 Myles textbook for midwives 16th edt,2014,339
 Kamini rao textbook of midwifery and obstetrics for nurses,1st
edt.elsevier publication 2011,449
 Internet souces (Images)