PARTOGRAM

LEENA L RAJU
 INTRODUCTION
• Partograph is a Greek word which means “Labour
Curve”. Partograph or Partogram is a simple,
Inexpensive tool which gives continuous pictorial
overview of labour. It is the easy way to detect
prolonged labour.
• The common obstetric Emergencies are obstructed
labour and prolonged labour. To prevent life threatening
situations in labour it is important that the signs of
Obstructed & Prolonged labour identified early in
Peripherals where the emergency management facilities
are not available.
 THE CONCEPT OF PARTOGRAPH

• It is a record of all observations made on a

woman in labour
• Decision making tool
• Implies a functioning referral system with
essential Obstetric service
• It improves Efficiency and Effectiveness of
Maternity Services
CONT.............
• A Partograph is a tool to help in the
management of labour for the identification of
women who are not likely to have a normal
delivery and who need medical assistance.
• Partograph is a chart in which the salient
features of labour are entered in a graphic form
and it provides the opportunity for early
identification of deviations from normal.
 BACKGROUND:
• Friedman is the first Obstetrician to
provide a tool for the assessment of
individual labour (Cervicograph).In 1972,
Philpott developed Partogram from
Cervicograph in Zimbabwe and Later
Philpott and Castle introduced an ‘Action
Line’ & ‘Alert Line’ in the Partogram. John
Studd promoted the use of Partograph in
United Kingdom.
PURPOSE OF THE PARTOGRAPH
• To detect abnormal progress of labour as early as
possible
• To prevent prolonged labour
• To recognize CPD long before obstructed labour
• To assist in early decision on transfer,
augmentation or termination of labour
• To increase the quality and regularity of all
observations of mother and fetus
• To recognize maternal or fetal problems as early
as possible
 FUNCTIONS OF PARTOGRAPH

• Give early warning in prolonged labour.

• Moving to the right of the alert line serves as a
WARNING for extra vigilance and specific
management decisions must be made.
• Other observations on the progress of labour
also recorded.
 COMPONENTS OF THE PARTOGRAPH:
• Part I Assessment of fetal condition
• Part II Progress of labour
• Part III Assessment of maternal condition
• Part IV Outcome of labour
PART I - ASSESSMENT OF FETAL CONDITION

• This part of graph is used to monitor and

assess fetal condition
• A) Fetal Condition includes -Fetal Heart Rate
(FHR) and Membranes and liquor.
• B) Moulding of the fetal skull bones.
 CONT................
A) Fetal Condition
Fetal Heart Rate
120 – 160 b.p.m. Is normal and > 160 b.p.m.
Tachycardia.
< 110 b.p.m. Bradycardia and < 100 b.p.m. severe
Bradycardia
ii) Membranes and liquor

Intact Membranes - I
Ruptured Membranes + Clear liquor - C
Ruptured Membranes + Blood stained liquor - B
Ruptured Membranes + Absent liquor - A
Ruptured Membranes + Meconium stained liquor - M
B) Moulding the fetal skull bones:
- It is important indication for adequacy of pelvis for fetal
head. Decrease in Moulding with high head in the
pelvis is a sign of Cephalo Pelvic Disproportion
(CPD).It is plotted as follows:
Separated bones, sutures felt easily O
Bones just touching each other +
Overlapping bones (reducible) ++
Severely overlapping bones (non-reducible) +++
 Part II Progress of labour:
This section has as its central feature a graph of cervical dilation
against time.
Alert Line (Health facility line)
The alert line drawn from 4cm of cervical dilatation to the point of
expected full dilatation at the rate of 1cm / hr.
Moving to the right of alert line indicates referral of Mother to
hospital.
Action Line (Hospital line)
Action line has drawn 4 hours to the right of alert line and parallel to it.
It is critical line specific management division must be made.
The progress of labour is monitored by
1. Cervical dilation
2. Descent of the head – abdominal palpation of the head
3. Uterine contractions – frequency/10mts and duration
 CONT...............
• Cervical Dilation: It gives most important information and
also it is the surest way of assessing progress of labour. When
progress is normal and satisfactory plotting cervical dilation
remains on the Alert line or left of it. If woman admitted in
active phase recording the cervical dilation starts on the alert
line.
• Descent of the Head: It is assessed by abdominal
Examination by using rule of fifths to assess engagement. Rule
of fifths means the palpable fifths of the fetal head are felt
above the level of Symphysis pubis by abdominal
examination.2/5 or less than that of the fetal head felt above
the level of Symphysis pubis indicates head is engaged. By per
vaginal examination findings can be confirmed that the lowest
part of vertex has passed or is at the level of ischial spines.
• Uterine contraction: In normal labour uterine
contractions become more frequent and last
longer as labour progresses. The observations of
duration of contractions assessed by number of
contraction in 10mts period, the time the
contraction felt abdominally, to the time the
contraction passes off. In Partogram each square
represents one contraction. If contraction last for
20 seconds or less fill square with dots. If
between 20-40 seconds by diagonal line and >40
seconds fill the square completely by shading.
 Part III Assessment of Maternal
Condition

• Assess maternal condition regularly by

monitoring. Drugs, IV fluids, Pulse - Half
hourly, BP-4th hourly, Temperature - 4th
hourly and Urine volume, analysis for protein
and acetones every 2 to 4 hourly.
 Points to remember while using
Partograph
1. It is only a tool for managing labour progress
2. Only start partograph who don’t have complications and doesn't require Referral
3. Only be started when a woman is in labour
4. If progress of labour is satisfactory, the plotting cervical dilation remain on/to the
left of the Alert line
5. If labour is satisfactory, the dilation should move to right of the Alert line
6. Cervical dilation plotted as ‘X’, descent of fetal head plotted as ‘O’, uterine
contractions are plotted with differential shading
7. Descent of fetal head always assessed by Rule of fifths felt above the pelvic brim,
immediately before doing vaginal examination
8. Assessing descent of the head helps in detecting progress of labour
9. Moulding with high head indicates CPD and requires immediate referral
10. Infrequent vaginal examination (once in every 4hrs)
11. When the woman arrives to the hospital the time of admission is O time
12. A woman whose cervical dilation moves to the right of the Alert line must be
transferred for obstetric interventions
 When Partogram should be initiated
• When CD is 3cm or more
• Uterine contractions one or more in 10mts
and last for at least 20 seconds
 Quick action warranted in labour
during following conditions
• Delay in cervical dilatation is 1cm/hr
• Delay in descent of the head
• FHR < 120 or > 160/mt on 3 observation
• ROM and Meconium stained liquor
• ROM and Absence of liquor and fetal skull Moulding with
bones touching each other / overlapping / severe overlapping