PARTOGRAPH

Outline of presentation
 Definition
 Objective of partograph
 Importance of partograph
 Component of partograph
 Benefit of partograph
Definition: The partograph is the graphical presentation
of the progress of labour, and of fetal and maternal
condition during labour.
Objectives of Partograph
 Early detection of abnormal progress of labour.
 Prevention of prolonged labour.
 Recognize cephlopelvic disproportion long before
obstructed labour.
 Assist in early decision on transfer, augmentation, or
termination of labour.
 Early recognition of maternal and fetal problems.
 Highly effective in reducing complication from
prolonged labour for the mother (PPH, sepsis,
uterine rupture) and for the newborn( death, anoxia,
infection)
 Reduce in incidence of C/S rate.
  Increase the quality and regularity of all observation
of mother and fetus.
Components of partograph
Mother information
Fetal well being
Progress of labour
Maternal condition
Mother information
Name, Gravida, Para, Hospital number
Date and time of admission
Time of rupture membrane
Fetal well being
Fetal heart rate
Character of liquor (amniotic fluid)
Moulding the fetal skull bones
Fetal Heart Rate: The rate of the fetal heart
indicates the state of fetus inside the uterus. Record
every half hour. Fetal heart rate plotted as (•)
 Character Of Liquor (Amniotic Fluid)
Record the colour of amniotic fluid at every vaginal
examination.
 Intact membranes………………………………………………I
 Ruptured membranes + clear liquor…………………..C
 Ruptured membranes + meconium stain liquor…M
 Ruptured membranes + blood stained liquor……..B
 Ruptured membranes + absent liquor………………..A

Moulding of Fetal Skull

Moulding is a state of reduction or loss of space between
skull bones.
Increasing moulding with the head high in the pelvic is an
ominous sign of Cephalopelvic disproportion
 Separated bones, suture felt easily……………………..O
 Bones just touching each other……………………………+
 Overlapping bones (reducible)…………………………..++
 Severely overlapping bones (not reducible)………. +++

Progress of Labour
Cervical dilatation
Descent of fetal head
Uterine contraction
Cervical dilatation
 It is an essential part of partograph.
 Dilatation of cervix plotted as “X”
 Descent of fetal head plotted as “O”
 First vaginal examination done on admission is
recorded.
 Subsequent vaginal examination is done every 4
hours.
 First alert line start at 4 cm cervical dilation and end
at 10 cm at the rate of 1 cm /hour
 The action line is drawn to the right of the alert line;
this is critical line at which specific management
decision must be made at the hospital.
 Normal labour is plotted to the left alert line.
Descent of Fetal Head
 Descent of fetal head plotted as “O”
 It should be assessed by abdominal examination
immediate before doing a vaginal examination using
the “Rule of fifth”.
Uterine contraction
Observation of contraction is made half hourly in the
active phase.
Palpate the number of contraction in 10 minutes and
duration of each contraction in seconds.
 Less than 20 seconds……………………………
 Between 20 to 40 seconds……………………
 More than 40 seconds………………………….

Medication
Oxytocin
Drugs
I/V fluid
 Maternal well being
Pulse: Record every 30 minutes and mark with the (•)
BP: Record every 4 hours and mark with arrows.
Temperature: Record every 2 hours and mark with a (•)

Urine: volume, protein, acetone