PARTOGRAPH
I. Partograph
II. Recording the findings in the
partograph
III. Distinguishing normal from
abnormal labor pattern
PARTOGRAPH
The partograph is a graphical
presentation of the progress
of labor, and of fetal and
maternal condition during
labor.
PARTOGRAPH
Guides birth attendant to
identify women whose labor is
delayed and therefore decide
appropriate action
Progress of labor
Maternal and fetal well-being
D
I
L Alert line Action line
A
T
A
T
I
O
N
Recording the findings
in the partograph
X
Start plotting on alert line in the
intersection corresponding
cervical dilatation finding
X
X
X
4pm
Indicate the time the IE was made (and
therefore, the observation was plotted)
Write this in the vertical line itself where you
plot the “X”, NOT the space after it
X
X
4pm 8pm 10pm
Perform internal examination every 4
hours, or more often if necessary, and
plot findings each time
Also, do not forget to write the time each
observation was made
X
X
4pm 8pm 10pm
Connect the “X”s to demonstrate
the pattern of labor
EXAMPLE
x
10am
A G2P1 is being assessed by a
nurse in a birthing facility. Her initial
IE at 10am showed 4 cm dilated
cervix.
EXAMPLE
x
10am 2pm
At 2 pm, another IE showed 8 cm dilated
cervix.
EXAMPLE
x
x
x
10am 2pm 4pm
At 4pm, the patient is 9 cm dilated,
station -1, intact BOW.
Distinguishing normal from
abnormal labor pattern
X X
X X
X
4pm 6pm 8pm 10pm
Progress of labor is normal if plotting
stays on or to the left of the alert line
(green part)
X
X
4pm 6pm 8pm 10pm
Note that based on the structure of
the partograph as soon as 4 cm is
reached the cervix should dilate
normally at a rate of ≥ 1 cm/hour.
X
X
4pm 6pm 8pm 10pm 12am 2am
Plotting that passes the alert line
(yellow part) more so if it reaches
or passes the action line (red part)
indicates abnormal progress of labor
X
X
X
4pm 6pm 8pm 10pm 12am 2am
x
3pm 7pm
X
X
X
X
8pm 12mn 2am 3am
X
x
9pm 1am 3am
What to do if partograph passes alert
line?
Reassess woman and consider criteria for referral.
Empty bladder.
Transport services.
Hydrate but omit solid foods.
Upright position/ walking
Monitor intensively.
Reassess in 2 hours and refer if no progress.
IV. Other findings to note
and record during IE
Status of membranes
Write
“ I ” if intact
If ruptured, note color of amniotic fluid,
write
“ C ” if clear
“ M ” if meconium stained
“ A ” if absent
“ B ” if bloody
q 4hr
Blood Pressure
Pulse rate
Temperature (centigrade)
Urine voided (yes or no)
* More frequently, if indicated
q 1hr
Number of contractions in
10 minute period
FHR (1 full minute)
LATENT PHASE - record only
other findings (BP, FHT etc).
Remains in latent phase for
next 8 hours – transfer to
hosp.
Case 1
A G1P0 was admitted at 11 pm, IE showed
a 4cm dilated cervix, intact BOW.
At 3 am, IE reveals 8 cm dilated cervix,
75% effaced, station 0.
At 5 am, she is fully dilated
Answer
X
11pm 3am 5am
A G1P0 was admitted at 11 pm, IE
showed a 4cm dilated cervix, intact BOW.
At 3 am, IE reveals 8 cm dilated cervix,
75% effaced, station 0.
At 5 am, she is fully dilated
Case 2
A G5P3 was admitted at 5am. Her
cervix is dilated 5cm. At 9am, your IE showed
6 cm dilated cervix. At 1 pm, another IE done
showed 8 cm dilated cervix, 25% effaced,
station -1, ruptured membranes
Answer
X
X
5am 9am 1pm
A G5P3 was admitted at 5am. Her cervix is dilated 5cm. At
9am, your IE showed 6 cm dilated cervix. At 1 pm, another
IE done showed 8 cm dilated cervix, 25% effaced, station -
1, ruptured membranes
Progress of labor
Maternal and fetal well-being
D
I
L Alert line Action line
A
T
A
T
I
O
N
THANK YOU &
GOD BLESS US ALL !
