RECORDING PROGRESS OF LABOUR

PARTOGRAM

PROF DR MN MOHD AZHAR

ROYAL COLLEGE OF MEDICINE PERAK
WHY IS IT IMPORTANT TO RECORD THE
PROGRESS OF LABOUR

Documentation is important

 To provide continuity of care.

 To provide a basis of decision making.
 To facilitate research.
 To allow audit and review.
 To defend one’s actions – no documentation – no
defense.
TOOL FOR RECORDING THE
PROGRESS OF LABOUR

PARTOGRAM
PARTOGRAM

PARTOGRAM is a graphical information about

the progress of labour in which the salient
information about the fetal well-being, maternal
well-being and the progress of labour are
recorded into a chart.
PARTOGRAM
IT’S SIGNIFICANT:

Is a managerial tool used to record all

observations made on a woman and fetus in
labour in one chart.

Partogram helps to identify at an early stage

those women whose labour is slow.

A managerial tool for prevention of prolonged

labour.
PARTOGRAM
WHO REQUIRE PARTOGRAM RECORDING

For all women who are in labour (i.e. either low or

high risk group).
 PARTOGRAM
Friedman's partogram - 1954
2 phases of labour (base on dilatation
of the cervix )
Active phase
Latent phase (dilatation < 3 cm)
Active phase (>3 cm dilated)

Latent 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

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
PARTOGRAM

WHAT NEED TO BE
RECORDED
 PARTOGRAM RECORDING
3
Notes should be
legible, dated and
timed.

4
1 Enter the outcome
of delivery
Begin plotting at the
“zero” hour on the
partogram

2
All entries made in
relation to time when
the observations are
made
PARTOGRAM RECORDING
Mother information

 Name
 Age
 Parity
 Gestational period
 Date/time of admission
 Time of rupture membrane
 Short antenatal history
PARTOGRAM RECORDING

Fetal information

 Fetal heart rate

 Membrane and amniotic

fluid

 Moulding
PARTOGRAM RECORDING

Fetal information

Fetal heart rate monitoring

1. Safe and reliable way of knowing

fetus is well.

2. Listen after each contraction for

one minutes.

3. Recorded ½ hourly (each square

is ½ hour)
PARTOGRAM RECORDING

Fetal information

Character of amniotic fluid

1. State of liquor can assess in

monitoring fetal condition.

2. Observation to be recorded

- Membrane intact record as “I”

- Membrane rupture:
a) liquor clear record as “C”
b) meconiun stained liquor “M”
c) liquor absent record as “A”
PARTOGRAM RECORDING

Fetal information

Moulding of fetal skull

1. Provide information about the

adequacy of pelvis to
accommodate fetal head

2. Record the degree of moulding

0 → bones separated
+ → bones touching but can
be separated.
++ → bone over lapping
+++ → bones over lapping
severely
PARTOGRAM RECORDING

Labour Progress

 Cervical dilatation

 Descent

 Uterine contraction
PARTOGRAM RECORDING

Labour progress
Dilatation and Descent

1. Latent (0-3 cm) and Active (3-10

cm) phase.

2. Dilatation of cervix plotted as “X”

axis and Descent plotted as “O”
axis.

3. First vaginal examination done

on admission is recorded.

4. Subsequent vaginal examination

is done every 2-4 hourly.

5. Transfer from latent to active

phase.
 PARTOGRAM RECORDING
Labour progress recording
in latent phase

Plot dilatation as “X”

Latent phase Plot descent as “O”

At admission:
+
+

- Dilatation → 2 cm
- Descent → -2

2 hours after admission:

- Dilatation → 2 cm
- Descent → -1

As the dilatation is only 2 cm therefore

the labour progress is in the latent
phase
 PARTOGRAM RECORDING
Labour progress recording
in active phase
Plot dilatation as “X”
Latent phase
Plot descent as “O”
Active phase
+

Latent phase
+

+
+

0 hours 2 hours 4 hours

(admission)

Dilatation
“O” 2 cm 4 cm 7 cm

Descent
“X” -2 -1 +1
 PARTOGRAM RECORDING

Cervical dilatation

Latent phase
+

If labour progress well plotting

+

of cervical dilatation should

+

always remain to the left of alert

line.

If it cross to right of action line

this warns that labour may be
prolonged.
PARTOGRAM RECORDING

Labour progress
Uterine Contractions

1. Observation is made ½ hourly

2. Assess the frequency, duration.
3. Each square represent 1
contraction felt in 10 minutes.
4. Frequency – highlight the
numbers of square.
5. Duration – shade the contraction
in the square.

< 20 sec - Mild

20-40 sec - Moderate

> 45 sec - Strong

PARTOGRAM RECORDING
Labour progress

Recording the uterine on the

partogram

Nos. of
Contraction
in 10 mins

2 weak contractions
in 10 minutes
5 strong contractions
in 10 minutes

3 moderate contractions
in 10 minutes
PARTOGRAM RECORDING

Mother condition

 Vital signs – BP, Pulse, TºC

 Urine analysis – acetone,

albumin, glucose
 Urine volume
 Medications or drug given
PARTOGRAM RECORDING

Mother condition

 Vital signs recording

BP – 4 hourly or more
frequent if indicated
Pulse - ½ hourly

TºC – 4 hourly

 Urine analysis – dipstick

acetone → Nil or +
albumin → Nil or +
glucose → Nil or +

 Urine volume
 PARTOGRAM RECORDING
Analyzing the progress of
labour from the partogram
Active phase
If progress is satisfactory the
Latent phase
+
plotting will remain on or to the left
+
of the alert line.
+

+
+

If labour is not progressing

normally the plotting will be to the
right of the alert line.
 PARTOGRAM RECORDING

LABOUR PATTERNS

Active phase
Latent phase
Normal labour

Prolonged latent phase

Primary dysfunctional
labour

Secondary arrest
RECORDING PROGRESS OF LABOUR - PARTOGRAM

THANK YOU

PROF DR MN MOHD AZHAR

ROYAL COLLEGE OF MEDICINE PERAK