THE PARTOGRAPH:

MONITORING WOMAN IN LABOR

PARTOGRAPH
 A tool advocated by WHO to be used by the nurse, midwife
and the medical doctor to assess the progress of labor and to
identify when intervention is necessary.

 The partograph must be started only when the woman is in

the active phase labor with cervical dilatation of more than
3cm (plotting – starts at 4cm) and uterine contractions of
two or more within 10 minutes, each lasting 20 seconds or
more.
3 components of the Partograph
1. Progress of Labor - Monitoring uses parameters cervical
dilatation, descent of fetal head, and uterine contractions.

2. Fetal Condition – monitoring uses parameters fetal heart

rate, amniotic membranes and liquor, and molding of fetal
skull.

3. Maternal Condition – monitoring uses parameters pulse,

blood pressure, temperature, urine, drugs, IV fluids and
oxytocin.
Some principles observed in the use of
the partograph
 The active phase of labor commences at 3cm cervical
dilatation. Plotting in the partograph is started when the
cevix is 4cm dilated.

 The latent phase of labor should not last longer than 8 hours
in the primigravidae, when the cervix dilates at a rate of 1cm
per hour.

 In the multigravidae, the latent phase lasts for about 4 hours,

when the cervix dilates at the rate of 1.5 cm per hour. In
multigravidae, cervical effacement and dilatation occur
simultenously.
Some principles observed in the use of
the partograph
 During active labor, the rate of cervical dilatation should be
not slower than 1cm per hour.

 A lag of 4 hours between a slowing of labor and the need for

intervention is unlikely to compromise the fetus or the
mother and avoids unnecessary intervention.

 Vaginal examination should be performed as infrequently as

is compatible with safe practice; once every 4 hours is
recommended.
Some principles observed in the use of
the partograph
 The partograph shows graphically the rate of progress of
labor.
o The rate of cervical dilatation
o The rate of fetal head descent
o The duration and frequency of uterine contractions
o Monitoring vital signs

• Palpation of uterine contractions is done every half hour in the

active phase (every hour in the latent phase). With the
partograph, there are only two observations made,
FREQUENCY and DURATION of uterine contractions.
Some principles observed in the use of
the partograph
 In uterine contraction monitoring, the number of contractions in
10 minutes is recorded. In the active phase, the partograph should
be started when contractions last more than 20 seconds and with
two or more contractions in 10 minutes.

 With the partograph, listening to the FHR is done immediately

after a contractions with the woman in lateral position. FHR is
recorded every half hour in the first stage of labor.

 The partograph should be enlarged to full size before use.

 Values of the partograph
 The Prevention of prolonged or augmented labor:
- Reduced risk of postpartum hemorrhage
- Sepsis
- Obstructed labor
- Uterine rupture

• Improvement in maternal outcomes: Reduced number of

augmented labor and operative interventions like cesarean section.

• Improvement in neonatal outcomes: reduced intrapartum fetal

deaths and neonatal morbidity.