Partograph

Outline of presentation
Definition.
Objectives of partograph.
Importance of partograph.
Components of partograph.
Benefits of using partograph.
Management of labour using partograph.

DEFINITION
Partograph It is composite graphical record of key data
(maternal and fetal) during labour entered against time
on a single sheet of paper .

PARTOGRAM It is the process by which normal and

abnormal progress of labour and also fetal response in
labour can be identified.

Objectives of using partograph

Early detection of abnormal progress of labour.
Prevention of prolonged labour.
Increase the quality and regularity of all observations
of mother and fetus.
Early recognition of maternal or fetal problems.
To provide a basis of decision making.
To facilitate research.
To defend one’s actions – no documentation – no
defense.

Importance of using partograph :

It allows an instant visual assessment of the rate of
Cervical dilatation and comparision with an expected
normal, so that abnormal progress can be recognized .
Early and appropriate actions taken to correct it where
possible.

WHO REQUIRE PARTOGRAM RECORDING OFor all

women who are in labour.

Components of Partogram Mother information

Fetal well-being
• Fetal heart rate
• Character of liquor
• Moulding Labour progress
• Dilatation
• Descent
• Uterine contraction Medications
• Oxytocin
• Pain relief (e.g. pethidine) Maternal well-being
• BP, Pulse, Temperature
• Urine – albumin, glucose, acetone • Urine output

What need to be recorded?

Begin plotting at the “zero” hour on the partogram

Enter the outcome of delivery 1 2 All entries made in
relation to time when the observations are made 3
Notes should be legible, dated and timed.

Components
a. Patient identification Name
b. Date and time of admission
c. Gestation
d. Medical / Obstetrical issues

b. Fetal heart rate recorded every 30minutes.

. The condition of the membranes and liquor amnii.
Mark ‘I’ for intact membrane. ‘
C’ for clear liquor amnii. ‘M’ for meconium stained
liquor.
d. Moulding .

e. Cervicogram
* It is a graphic representation of cervical dilatation and
descent of the presenting part .
* It is an essential part of the partogram .
* It offer the chance of early detection of abnormal
progess of labour.
* First, alert line starts at 3cm cervical dilatation and
ends at 10cm at the rate of 1cm/hour.

f.Uterine Contractions 5 strong contractions in 10

minutes 2 weak contractions in 10 minutes 3 moderate
contractions in 10 minutes

g.Assess maternal condition regularly by monitoring : O

Drugs , IV fluids , and oxytocin , if labour is augmented
O Pulse , Blood pressure O Temperature O Urine
volume analysis for protein, acetone, glucose and
volume.

Benefits of a partograph
O A single sheet of paper can provide details of
necessary information at a glance.
O No need to record labour events repeatedly.
O Can predict deviation from normal progress early.
O It facilitates handover procedure.
O Introduction of partograph in management of labour
{WHO 1994} has reduced the incidence of prolonged
labour and caesarean section rates. There is
improvement in maternal morbidity, perinatal morbidity
and mortality.

PARTOGRAM History Friedman's partogram –

1954 2 phases of labour (base on dilatation of the
cervix ) Latent phase (dilatation < 3 cm) Active phase
(>3 cm dilated) Latent phase Active phase Philpott and
Castle - 1972 Introduced the concept of “ALERT” and
“ACTION” lines. ALERT LINE – represent the mean rate
of slowest progress of labour ACTION LINE – appropriate
action should be taken. Normal labour is plotted to the
left alert line

Friedman′s Division of Labor :

The active phase is further into 3 parts :
* Acceleration phase.
* Phase of maximum slope and
* Decceleration phase.

Normal Progress of Labor

* latent phase : 8 hours or less .
* active phase : progress of the cervical dilatation
remains on the alert line or between the alert and the
action lines ( 1cm/hour ).
* second stage : reasonable rotation and descent of the
presenting part within 1 hour or less .

Protracted active phase-the rate of cervical

dilatationAbnormal progress of labour o Disorders of
1st stage <1.2cm/hr in primipara and < Arrest
disorder-no cervical dilatation in 2 hrs after active
phase of labour. o Secondary arrest is defined when the
active phase of labour commences normally but stops
or slows significantly for 2 hrs or more prior to full
dilatation of cervix.1.5cm/hr in multipara.

Protraction of descent-descent of presenting part iso

Disorders of 2nd stage <1cm/hr in nullipara and <
Arrest of descent-no progress of descent is observed.2
cm/hr in multipara.

Moving to the right of alert line

O This is a warning sign.
O Transfer the woman from health center to hospital
O Decision needed on further management.(usually by
obstetrician or resident )

When progress in active phase remains on or left of the

alert line / latent phase is less than 8 hours
O Do not augment with oxytocin if latent and active
phases go normally
O Do not intervene unless complications develop
O Artificial rupture of membranes ( ARM )
O No ARM in latent phase
O ARM at any time in active phase

MANAGEMENT OF LABOUR BETWEEN ALERT AND

ACTION LINES (Alert or Referral zone) 1. Health facilities
with Basic EmOC
O Transfer the woman to hospital unless the cervix is
almost fully dilated
O ARM may be performed if membranes are still intact
and first stage of labour is advanced and delivery is
expected soon.

2. Health Facility with Comprehensive EmOC OPerform

ARM at vaginal examination
OContinue routine monitoring
ORepeat vaginal examination 4 hrs or earlier if delivery
is expected sooner
ODo not intervene or augment – unless complications
develop

MANAGEMENT OF LABOUR AT OR BEYOND THE ACTION

LINE 1. Full medical and obstetric assessment
2. Consider IV infusions / catheterization / analgesics
(tramadol, pethidine, etc)
3. Options
O Perform CS - if fetal distress or obstructed labour or
operative vaginal delivery if in 2nd stage without
severe fetal distress and/or obstructed
. O Oxytocin – if no contraindications
O Supportive only – if satisfactory progress is
established and dilatation could be anticipated at
1cm/hr or faster.

Case no-1
Hospital - Roshan hospital Regi .no-13456
Patients name - Mrs.Kamla Age-28
DOA -11-12-24 Time-8 am
Gestional age -36 weeks

Patient was admitted in the hospital at 8amon 11-12-2024 ,after

internal examination the cervix 4cm dilated and fetal head is 2/5
ruptured the bag of water at 6am
At 8am she is 7cm dilated
At 11am she is 8cm dilated
Oxytocin rate incereasd
Remarks- patient had a abnormal progress of labour because it was
not following the alert line but it reaches the action line so it shows a
danger sign so informed the doctor

Case no 2
Hospital - Roshan hospital Regi no - 13453
Patients name - Mrs.Sonali Age-28
DOA -13-11-24 Time-1am
Gestional age -36 weeks

Patient was admitted in the hospital at 1am on 13-11-2024 ,after

internal examination the cervix 8cm dilated and fetal head is 2/5
ruptured the bag of water at 11pm
At 1 am she is 8cm dilated
At 3am she is 10cm dilated

Remarks- patient had a normal progress of labour and delivered

normaly
Case no -3
Hospital - Roshan hospital Regi no-13287
Patients name - Mrs,Rupali Age-23
DOA -15-11-24 Time-10pm
Gestional age -34 weeks

Patient was admitted in the hospital at 10 pm on 15-11-2024 ,after

internal examination the cervix 4cm dilated and fetal head is 2/5
water of bag was present
At10 pm am she is 4cm dilated
At 1 am she is 6cm dilated
At 3am she is 10 cm dilated
Oxytocin given slow
Remarks- patient had a abnormal progress of labour but between
patient had good progress of and delivered normaly

Case no 4
Hospital - Roshan hospital Regi no -
13564

Patients name - Mrs. kirshna Age-25

DOA -12-12 -24 Time-2pm
Gestional age -36 weeks

Patient was admitted in the hospital at 2pm on 12-12-2024 ,after

internal examination the cervix 6cm dilated and fetal head is 2/5
ruptured the bag of water at 12pm
At 12pm she is 7cm dilated
At 3pm she is 8cm dilated
Oxytocin rate incereasd
Remarks- patient had a abnormal progress of labour because it was
not following the alert line but it reaches the action line so it shows a
danger sign so informed the doctor

Case no 5

Hospital - Roshan hospital

Patients name - Mrs.Sweta Age -28
DOA - 18-11-24 Time-9am
Gestional age -34 WEEKS

Patient was admitted in the hospital at 9am on 18-11-2024 ,after

internal examination the cervix 2cm dilated and fetal head is 2/5
ruptured the bag of water at 7am
At 9 am she is 2cm dilated
At 12pm she is 6cm dilated
At 2pm dilatation 8 cm
Oxytocin rate incereasd
Remarks- patient had a normal progress of labour because it was
following the alert and had a normal delivery vital sings of the
patient was stable as well as FHR.

Case no -6
Hospital - Roshan hospital
Patients name - Mrs. muskan Age-26
DOA -16-11-24 Time-1pm
Gestional age - 36weeks

Patient was admitted in the hospital at 1pm on 16-11-2024 ,after

internal examination the cervix 8cm dilated and fetal head is 4/6
ruptured the bag of water at 12pm
At 1pm she is 8cmcm dilated
At 3pm she is 10cmcm dilated
Oxytocin given at alow rate
Remarks- patient had a normal progress of labour and was following
the alert line reaches delivery very soon vital singns of the patient
was stable as well as the FHR

Case no -7
Hospital - Roshan hospital
Patients name - Mrs. Rajkumari Age-26
DOA - 19-11-24 Time-3pm
Gestional age -32 weeks

Patient was admitted in the hospital at 3pm on 19-11-2024 ,after

internal examination the cervix 6cm dilated and fetal head is 2/5
ruptured the bag of water at 2pm
At 3 pm she is 6cm dilated
At 6pm she is 6cm dilated
At 9 pm dilataion 6cm
Remarks- patient had a abnormal progress of labour because it was
not following the alert line but it reaches the action line so it shows a
danger sign so informed the doctor patient BPwas high and was the
action line and immediate C –section was performed

Case no -8
Hospital - Roshan hospital Regi. N0 - 15432
Patients name - Mrs – Reshma Age-23
DOA -12-12-24 Time-3am
Gestional age -35weeks

Patient was admitted in the hospital at 3am on 12-12-2024 ,after

internal examination the cervix 6cm dilated and fetal head is 2/5
ruptured the bag of water at 2am
At 7 am she is 7cm dilated
At 11am she is 8cm dilated
Oxytocin rate incereasd
Remarks- patient had a abnormal progress of labour because it was
not following the alert line but it reaches the action line so it shows a
danger sign so informed the doctor

Case no 9
Hospital - Roshan hospital
Patients name - Mrs. Suman Age-28
DOA -21-11-24 Time-12 am
Gestional age -36 weeks

Patient was admitted in the hospital at 12am on 21-11-2024 ,after

internal examination the cervix 4cm dilated and fetal head is 2/5
water of was not ruptured vitals of the patient was stable as well
FHR
At 12 am she is 4cm dilated
At 4am she is 8cm dilated
AT 8am she is 10cm dilated
Oxytocin low rate given
Remarks- patient had a normal progress of labour because it was
following the alert line throughout the labour the vitals FHR
maintained stable

Case no-10
Hospital - Rosha hospital Regi.no15468
Patients name - Mrs –Manju Age-25
DOA -22-11-24 Time-5am
Gestional age -35 weeks

Patient was admitted in the hospital at 5am on 22-11-2024 ,after

internal examination the cervix 7cm dilated and fetal head is 2/5
ruptured the bag of water at 4am
At 7 am she is 7cm dilated
At 11am she is 8cm dilated
At 2pm fulli dilated
Oxytocin rate incereasd
Remarks- patient had a normal progress of labour because it was
following the alert line and was not in a danger phase and delivered
normally the vitals and FHR was normal

Case no -11

Hospital - Roshan hospital Regi.no-15345

Patient name - Mrs . Kamala Age - 24
DOA - 14-12-24 Time At 4pm
Gestational age - 33 weeks

Patient was admitted on 14-12-24 at 4pm after the internal

examination the cervix is 4cm dilated and the head is 2/4 water not
ruptured
At4pm dilatation -4cm
At8pm dilatation -8cm
At 12am dilatation -10 cm
Remarks -Patient had a normal progress of labour The line reaches
the alert line and patient had a normal delivery

Case no 12
Hospital name -Roshan hospitalRegi no. 15678
Patients name - Mrs . KALI Age -26
DOA - 11-12-24 Time -7pm
Gestational age – 36 weeks

Patient was in the admitted in the hospital on 11-12-24 at 7pm after

doing the internal examination the cervical dilation was 3cm the
vitals of the patient was stable and the FHR bag of water was
present

At 7 pm dilation – 3cm
At 11pm dilation – 5 cm
At 4 am dilation -7cm
REMARKS –At primary statges the progress was normal following
the alert line but in the second stage of labour the FHR become low
and patient was shifted for a c-section

Case no 13
Hospital - Roshan hospital Regi .no -15678
Patient name – Mrs. deepa Age - 26
DOA - 14-12 -24 Time – 5 pm
Gestional age - 36 weeks

Patient was admitted in the hospital on 14-12-24 at 5pm after doing

internal examination the dilation 4 cm patient was suffering from
High BP FHR was stable bag of water was present
AT 5pm dilation - 4cm
At 8pm dilation -6 cm
Remarks – since patient was not maintaining a normal BP and was
not following the alert line immeditate action was taken and shifted
for a c-section
Case no-14
Hospital -Roshan hospital Regi no.15900
Patients name -Mrs. Kussuam Age -26
DOA - 19-12-24 Time -6am
Gestational age - 35 weeks
Patient was admitted in the hospital on 19-12-24 at 6am after doing
the internal examination the cervical dilation was 6 cm the vitals of
the patient was normal as well as the FHR the bag of water was
ruptured at 5 am
At 6am dilation – 6cm
At 10am dilation - 8cm
At 12pm dilation - 10cm
Remarks the progress of labour normal and following the alert line
the vitals of the patient was normal FHR was stable and patient
delivered normally

Case no -15

Hospital -Roshan hospital Regi.no.15678

Patients name -Mrs . kavita Age- 28
DOA – 18-12-24 Time – 2am
Gestational age – 36 weeks
Patient was admitted on 18-12-24at 2am after doing the internal
examination the dilation was 8cm the vitals was stable as well as FHR
the bag of water was ruptured at home
At 2am dilation -8cm
At 4 am dilation -10cm
R emarks – patient had normal progress of labour and was following
the alert line and deliverd normally the vitals of the patient was
normal

Case no 16
Hospital – Roshan hospital Regi.no -15468
Patient name -Mrs. Komal Age -28
DOA - 20-12-24 Time -12pm
Gestional age – 34 weeks

Patient was admitted in the hospital on 20-12-24 at 12pm after doing

the internal examination the dilation was 5 cm the vitals of the
patient was normal as well as the FHR
At 12 pm dilation – 5cm
At 4 pm dilation - 6 cm
At pm dilation - 10cm
The progress of the labour was normal followed the alert line the
vitals of the patient was normal and patient deliverd normally

Caseno-17
Hospital - Roshan hospital Regi no 18345
Patient name - Mrs. Rukma Age -27
DOA - 24-12-24 Time -11pm
Gestional age - 37 weks
Patient was admitted in the hospital on 24-12-24 at 11pm after doing
internal examination the cervical dilation was 6cm the vitals of the
patient was normal as well the FHR the bag of water present
At 11pm dilation – 6 cm
At 3 am dilation -8 cm
At 7 am dilation - 10cm
The progress of the labour was normal the vitals of the patient was
normal followed the alert line patient deliverd normally

Case no- 18
Hospital - Roshan hospial Regi no 15700
Patient name - Mrs. Neenu Age- 26
DOA -25-12-24 Time – 8pm
Gestional age – 37 weeks
Patient was admitted in the hospital on 25-12-24at 8pm after doing
the internal examination the dilation of the cervix was 8 cm the vitals
of the the patient was normal as well as the FHR
At 8pm dilation -8cm
At 10pm dilation – 10cm
Remarks - the progress of the labour fast following the alert line the
vitals of the patient was normal patient deliverd normally

Case no -19
Hospital - Roshan hospital Regi no 15902
Patients name - Mrs. Seema Age - 30
DOA - 27-12-24 Time – 3pm
Gestional age - 36 weeks

Patient was admitted on 27-12-24 at 3pm after internal examination

the dilation of cervix was 4 cm vitals of the patient was normal as
well as FHR bag of water was intact

At 3pm – dilation – 4cm

At 7 pm – dilation – 6cm
At 11pm - dilation 8cm
Remarks - The progress of labour was normal followed the alert
line the vitals of the patient was stable

Case no-20

Hospital - Roshan hospital Regi no 15838

Patients name - Mrs . Nuri Age - 22
DOA - 30-12-24 Time - 4am
Gestional age - 34 weeks

Patient was admitted on 30-12-24 at 4am after the internal

examination the cervical dilation was 6 cm Patient had a history of
low haemoglobin the vitals of the patient was normal hb was 8 gm
the FHR was normal
At 4 am dilation – 6cm
At 8am dilation -8cm
At 11pm dilation - 10cm

The progress of the labour was normal the vitals signs of the patient
stable followed the alert line patient was advised to transfuse I unit
of blood