Partogram
Introduction
• Partogram is a composite graphical record of key data (maternal and fetal)
during labour entered against time on a single sheet of paper.
• Inexpensive, effective, pragmatic.
• Used for all labours in hospital.
• Serves as early warning system.
• Started only when a woman is in labor.
ADVANTAGES
● Single sheet of paper can provide details of necessary information.
● No need to record labor events repeatedly.
● To detect deviation from normal progress of labor early (Eg: delay
labor + dysfunctional labor).
● To assists in early decision of transfer of mother, artificial rupture of
membrane + augmentation of labor or termination of labor.
● To recognize CPD before labor becomes obstructed.
● ↓ incidence of prolonged labor + c-section rate.
● ↓ maternal morbidity, perinatal morbidity + mortality.
components
● Patient information
● Fetal heart rate
● Liquor and moulding
● Cervical dilatation and fetal head descent
● Uterine contractions
● Oxytocic and other drugs administered
● Maternal condition (vitals, urine output, urine protein
ketones etc.
PATIENT INFORMATION
All relevant information such as name, age, parity, hospital number, date and
time of admission and membrane status are entered here.
Fetal heart rate monitoring
● Ideally, FHR is checked every 15 min soon after the contraction, to note late
deceleration.
● If continuous electronic monitoring is done, it is better especially in high-risk cases.
● Counted for 1 min after cessation of contraction.
AMNIOTIC FLUID
● Record 4th hourly (at each vaginal examination, but anytime if liquor changes)
moulding
• - Record 4th hourly (at each vaginal examination)
• - Marking:
• - Significant: Provide information about adequacy of pelvis to accommodate
fetal head.
• (Moulding will not be appreciated until cervical os is 4cm dilated)
Progress of labor
1. Cervical dilatation
• Cervical dilatation: assess at each vaginal examination 4th
hourly
• Marking: ×
• Begin at 4 cm.
• Alert line: starting at 4 cm of cervical dilatation, up to the
point of expected full dilatation at the rate of 1 cm per hour.
• Action line: parallel and 4 hours to the right of the alert line.
2. Descent of fetal head
• Marking: O
• When X is marked, O is also marked.
• Assessed by abdominal palpation: this refers to the part of
the head (which is divided into five parts) palpable above
the symphysis pubis
• At 0/5, the sinciput (S) is at the level of the symphysis pubis.
3. Uterine contractions
● Below the timeline, there are five blank squares going across
the length of the graph.
● Each square represents one contraction.
● Contractions are monitored for at least 10 min by placing a hand
on the uterus.
● Based on the type of shading and the number of squares
shaded, one can easily make out the normalcy or abnormality of
the uterine contractions
● Normally:
• Latent = 1 moderate/strong contraction in 10mins
• Active = ≥ 2 moderate/strong contractions in 10mins
MATERNAL CONDITION
● Oxytocin (if augmentation of labor), Upper box = concentration U/L), lower box =
dose(drops/min)
● Drugs and IV fluids
● Pulse at 0.5 hourly
● BP at fourth hourly
● Temperature at 4th hourly
● Urine analysis on every urine sample (2-4th hourly)
➔ Protein = Nil/+
➔ Acetone = Nil/+
➔ Glucose = Nil/+
➔ Volume
Role of partogram in abnormal labour
● It is useful in identifying abnormalities of cervical dilatation and descent of
head.
● It can also detect fetal as well as maternal distress.
● It suggests when to augment labour and when to take-up for emergency
caesarean section.
● It can recognize obstructed labour, which is very important in preventing the
uterine rupture.
Active phase disorders and their diagnosis
Cervical dilatation disorder
● Protracted active phase (cervical dilatation is tardy and graph crosses the alert line
early)
● Secondary arrest of dilatation (initially the graph is on the left of or on the alert line
but later crosses the same)
● Precipitate labour (cervix dilates at the rate of 3–4 cm/h)
Descent disorder
● Protracted descent (slow descent from the beginning)
● Arrest of descent (arrest after initial normal descent)
MANAGEMENT WHEN IT CROSSES ALERT LINE
The progress of labour is reassessed.
● Per abdomen–assess contractions, descent of head and FHR.
● Per vaginal–rule out CPD, assess station and position of head, cervical
dilatation and its application of cervix to head
● Cervix should be well applied to the head, loosely hanging cervix despite
dilatation is not a good sign and membrane status.
● If CPD is diagnosed, baby should be delivered immediately by caesarean
section.
● If inertia is diagnosed, one may perform ARM (artificial rupture of
membranes) and start oxytocin, provided there are no signs of obstructed
labour and fetal distress.
● If the graph crosses action line (it should not be allowed to cross in the first
place), immediate caesarean delivery is the choice of action.
