The Partograph
MARJORIE D. VENTURA RN, MAN
Basic Emergency Obstetric Care
Bayambang District Hospital
OBJECTIVES
General:
To understand the concept of the WHO
partograph.
Specific:
1. To be able to record the
observations accurately on the
graph.
2. To be able to interpret the recorded
findings, recognize deviation from
the norm, and decide on timely
referral
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
Version 2
Version 1
N5
Monitor during labor…
► Progress of labor (POL)
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
Conditions that do not need
the use of partograph
► Antepartum hemorrhage ► Multiplepregnancy
► Severe pre-eclampsia and ► Malpresentation
eclampsia ► Very premature baby
► Fetal distress ► Obvious obstructed labor
► Previous cesarean section
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
A and 4
T hours to
I the right
O of alert
N
line
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
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. Her initial IE at 1 am
showed 4 cm dilated cervix.
EXAMPLE
x
1am 5a
m
At 5 am, another IE showed 8
cm dilated cervix.
EXAMPLE
x
x
x
1am 5a 7am
m
At 7 am, the patient was 9 cm
dilated, 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 criteria for
referral.
► Alert transport services
► Encourage woman to empty bladder
► Encourage upright position and walking if
woman wishes.
► Monitor intensively.
► If referral takes a long time, refer
immediately. DO NOT WAIT TO CROSS
ACTION LINE.
If plotting reaches the
action line…
Refer urgently to hospital unless
birth is imminent
The parts of the partograph
Progress of labor
Maternal and fetal well-being
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.
EXERCISES
►Indicate whether the progress of labor in the
following partographs are normal or abnormal.
x
Case 1
x
10p 2am
m
Case 2
X X
X
X
8pm 12mn 2am3am
X
Case 3
X
x
9pm 1am 3am
Case 4 X
x
9pm 1am 3am
EXAMPLE
►Plot the observations in the following cases.
Lory, G1P0 was admitted today at 4 am, IE
showed a 6cm dilated cervix, cephalic, intact
BOW. BP=120/70, PR=86/min, afebrile.
FHT=148/min.
She had moderate contractions (3 in 10 min). At
6 am, the BOW ruptured with clear amniotic
fluid. IE showed 8 cm dilated cervix. Vital
signs were the same.
At 9 am, cervix was 9 cm. She delivered
spontaneously at 9:40 am. 10 u oxytocin was
given IM. Placenta was delivered complete at
9:50 am.
X
Lory, G1P0 X
Date Today X
4am 6am 9am
0 0
I C
3
140 140
86 86
120/70 120/70
9:45
9:42
EXERCISES
►Plot the observations in the following cases.
Case 1:
Maria, G2P1 was admitted today at 2 am, IE
showed a 5cm dilated cervix, cephalic, intact
BOW. BP=110/70, PR=88/min, afebrile.
FHT=140/min.
She had moderate contractions (3 in 10 min). At
6 am, the BOW ruptured with clear amniotic
fluid. IE showed 8 cm dilated cervix. Vital
signs were the same.
At 8 am, cervix was 9 cm. She delivered
spontaneously at 8:30 am. 10 u oxytocin was
given IM. Placenta was delivered complete at
8:35 am.
X
Maria, G2P1 X
Date Today X
X
2am 6am 8am
0 0
I C
3
140 140
88 88
110/70 110/70
5 8
8:35
8:32
Case 2:
Lourdes, G4P2 was admitted at 1 pm today due
to watery vaginal discharge. The cervix was 3
cm, cephalic, (-) BOW with clear amniotic fluid.
BP=120/80, PR=80/min, T-36.5.
At 5pm, contractions were moderate, 3 in 10
min. IE showed cervix 4 cm dilated. Vital signs
remained the same.
At 9 pm, your IE showed 6 cm dilated cervix.
At 1 am, another IE done showed 8 cm dilated
cervix, meconium stained fluid. BP-110/70,
PR-92/min, T-37.5, FHT-140/min
Lourdes, G4P2
Date Today X
X
5pm 9pm 1am
4 8 12
C M
3
140
36.5 37.5
80 92
120/80 110/70
4 6 8
Case 3:
Marites, G1P0 was admitted at 6 pm.
BP=120/80, PR-84/min, T=36.5. FHT=150/min,
cervix 5 cm dilated, (+) BOW. She had 2-3
uterine contractions in 10 min.
After 4 hours, IE showed 7 cm dilated cervix.
Vital signs and FHT were the same.
At 12 am, another IE done showed 8 cm dilated
cervix, negative BOW, clear AF. FHT= 140/min.
Another IE after 2 hours was the same.
FHT=144/min, Vital signs same
Marites, G1P0
Date Today X X
X
X
6pm 10p 12am 2am
m
1 2
I I C C
2-3 3
150 1403 140 144
36.5 36.5 36.5
84 84
120/80 120/80 120/80
5 7 8 8
ILove You,
Parto!