The Partograph
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
– 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 • Multiple pregnancy
hemorrhage • Malpresentation
• Severe pre-eclampsia • Very premature baby
and eclampsia • Obvious obstructed
• Fetal distress 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 and
A 4 hours to
T the right of
I alert line
O
N
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
X
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 5am
At 5 am, another IE showed 8 cm dilated
cervix.
EXAMPLE
x
x
x
1am 5am 7am
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 … D9
• 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…
D9
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 Monitor every 4 hrs
• 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).
D8
If she remains in latent phase for next 8
hours (labor is prolonged), transfer her
to hospital. D8
EXERCISES
• Indicate whether the progress of labor in
the following partographs are normal or
abnormal.
x
Case 1
10pm 2am
Case 2
X X
X
X
8pm 12mn 2am 3am
X
Case 3
X
x
9pm 1am 3am
Case 4 X
x
9pm 1am 3am
EXERCISES
• Plot the observations in the following
cases.
Case 5:
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, G1P0 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
8:30
Case 6:
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 6:
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
X X
Date Today
X
6pm 10pm 12am 2am
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
