Partograph
Source : Basic Emergency Obstetric
Care
Dr. Jose Fabella Memorial
Hospital,
& WHO
By: ARACELI F. SURAT
I. The Partograph
•A tool to help in management of labor
•Guides birth attendant to identify
women whose labor is delayed and
therefore decide appropriate action
OBJECTIVES
I. To understand the concept of the
WHO partograph
To explain to mothers the
significance of the graph
II. To record the observations accurately
on the graph
II. To interpret the recorded findings,
recognize deviation from the norm,
and decide on timely referral
Monitor during labor…
•Progress of labor
•Cervical dilatation
•Contraction pattern
•Maternal well being
•Pulse, temperature, blood pressure
•Urine voided
•Fetal well being
•Fetal heart rate and pattern
•Color of amniotic fluid
The parts of the partograph
Progress of labor
Maternal and fetal well-being
D
I
L Alert line
A
T
A
T
I
O
N
D
I
L Alert line Action line
A
T Parallel and
A 4 hours to
T the right of
I alert line
O
N
Conditions that does not need the use of
partograph
•Antepartum hemorrhage
•Severe pre-eclampsia and eclampsia
•Fetal distress
•Previous cesarean section
•Multiple pregnancy
•Malpresentation
•Very premature baby
•Obvious obstructed labor
II. Recording the findings in the
partograph
•Start by labeling the record with pertinent
patient identifying information.
Plotting the progress of labor
•Plot only the CERVICAL DILATATION
using the symbol “X”
•Start when woman is in ACTIVE LABOR
(4 cm or more) and is contracting
adequately (3-4 contractions in 10 minutes)
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
1am
A G1P0 is being monitored by a midwife at
home. Her initial IE at 1 am showed 4 cm
dilated cervix.
EXAMPLE
x
1am 5am
At 5 am, another IE showed 8 cm dilated
cervix.
EXAMPLE
x
x
x
1am 5am 7am
At 7 am, the patient is 9 cm dilated,
station -1, intact BOW.
III. 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
If plotting passes alert line …
•Reassess woman and consider referral if
facilities are not available to deal with
obstetric emergencies, unless delivery is
imminent
•Alert transport services
•Monitor intensively
What to do if partograph passes alert
line
•Reassess woman and consider criteria for referral.
•Alert transport services.
•Empty bladder.
•Ensure adequate hydration but omit solid foods.
•Encourage upright position and walking if woman
wishes.
•Monitor intensively. If referral long, reassess in 2
hours and refer if no progress.
If partograph passes action line, refer urgently to an
EmOC facility unless imminent delivery.
If plotting reaches the action line…
•the patient must be already in an EmOC
facility, a decision made about the cause of
slow progress, and appropriate action taken
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
Monitor every 4 hours*
and record the findings
•Blood Pressure
•Pulse rate
•Temperature
•Urine voided (yes or no)
* More frequently, if indicated
Monitor more frequently and record
the findings
•Number of contractions in 10
minute period
•Fetal heart rate in 1 full minute
If woman is admitted in LATENT
PHASE of labor (less than 4 cm dilated)
– record only other findings (BP, FHT
etc).
If she remains in latent phase for next 8
hours (labor is prolonged), transfer her to
hospital.
