PARTOGRAM
A presentation by Roll no. 26 to 30.
Why is it 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
What is partogram?
● Partogram is a graphical information about the
progress of labour in terms of women’s cervical
dilation and descent of fetal presenting part, against
time (Philpott and Castle).
● Regular recording of important clinical parameters
has been maintained covering the well being of the
woman and baby.
Significance
● Is a managerial tool used to record all observations
mad e on a woman and fetus in labour in one chart
● Partogram helps identify at an early stage those
women whose labour is slow.
● A managerial tool for prevention of prolonged
labour.
Components of partograph
● Patient identification;
● Time — recorded at hourly interval. Zero time for
spontaneous labor is the time of admission in the
labor ward and for induced labor is the time of
induction;
● Fetal heart rate — recorded at every 30 minutes;
● State of membranes and color of liquor : to mark ‘I’
for intact membranes, ‘C’ for clear and ‘M’ for
meconium stained liquor;
● Cervical dilatation and descent of the head
Components of partograph
● Uterine contractions — the squares in the vertical
columns are shaded according to duration and
intensity
● Drugs and fluids;
● Blood pressure (recorded in vertical line) at every 2
hours and pulse at every 30 minutes;
● Oxytocin — concentration in the upper box and dose
(m IU/min) in the lower box;
● Urine analysis;
● Temperature record
● Shared Decision making including assessment and
plan.
Plotting of Partogram
● Active phase- Active phase of labor starts from 5 cm
of cervical dilatation (earlier 4 cm). Fixed 1 cm/hour
'alert' line and the corresponding 'action line' has
been changed with evidence-based time limits at
each cm of cervical dilatation during active first
stage of labor. It allows the variability in the rates of
progress of labor between women
Plotting of partogram
● Duration and frequency of uterine contractions are
recorded. The strength of uterine contractions is no
longer recorded, as it is difficult to quantify clinically.
● The parameters are highlighted when there is
deviations fom expected observations of any labor.
The corresponding response is recorded by the care
provider.
Plotting of partogram
● Labor Care Guide (WHO) is designed for an individual
woman's care. This is aimed for positive child birth
experience.
● In the 'assessment; the care giver has to record the
overall assessment. The care plan is formulated in
discussion with the woman. In the 'plan' section, the
care plan is documented.
Recordings as regard to areas:
● Women
● Baby
● Labor progress
● Medications
● Shared decision making
Assessment
● Fetus: FHR every 30 minutes and every 15 minutes in
second stage
● Woman: Pulse; BP, temperature, urine output every
hour; uterine contractions (frequency) per 10 min (:2,
>5) and duration ( 60 sec).
Labour progress
● Cervix [dilatation (cm) with hour] (plot X}; descent (Plot
O}.
● Medication: oxytocin; analgesic, IV fluid
● Shared decision making fllowing assessment and
plan.
Advantages
● A single sheet of paper can provide details of
necessary infrmation at a glance;
● No need to record labor events repeatedly; {
● It can predict deviation from normal progress of
labor early. So, appropriate steps could be taken in
time;
Advantages
● It facilitates handover procedure;
● Introduction of partograph in the management of
labor (WHO, 1994) has reduced the incidence of
prolonged labor and cesarean section rate. There is
improvement in maternal morbidity, perinatal
morbidity and mortality.
THANK
YOU