National Partogram

Name: Age: BHT. No.:

Gravida: Parity: Blood Group: Date and Time:
Special Problems: Special Instructions:

Time of
V/E
Hours 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
>180
170
Fetal Heart Record

160
in 1 Stage

150
140
130
st

120
110
100
< 100
CTG
1
free interval +
duration of
Contraction

2
contraction

3
4
5
Oxy dose
ml-h / dpm
10
09
08
Cervical Dilatation

07
06
05
Abdo Descent

04
03
02
01
0
-3
-2
Vaginally
Descent

-1
0
+1
+2
Liquor
Position
Caput
Moulding
Pulse
BP
Temp
Action
nd
2 Stage Fetal Heart Rate Record Time: Fully dilated: ……………… Commenced pushing: …………………. (Mark )
Time

>180
170
160
150
140
130
120
110
100
<100
 Post Partum Modified Early Warning System
Date and Time………....…Mode of delivery - ND / FD / Vac / EmLSCS / ElLSCS Birth Wt………………Sex - M / F

0 15 30 45 60 75 90 105 120
Restless or Drowsy
Alert & Orientated
Respiratory >20 >20
Rate 16-20 16-20
10-15 10-15
<10 <10
170 170
160 160
150 150
140 140
Pulse Rate

130 130
120 120
110 110
100 100
90 90
80 80
70 70
60 60
50 50
40 40
200 200
190 190
180 180
170 170
160 160
150 150
140 140
Systolic

130 130
BP

120 120
110 110
100 100
90 90
80 80
70 70
60 60
50 50
130 130
120 120
110 110
Diastolic

100 100
90
BP

90
80 80
70 70
60 60
50 50

Urine <30ml
output >30ml

Uterus Soft
Hard
Level of Rising
Fundus Same

Bleeding PV Yes
No
Bladder
PV if done
Printed by : Printland

PR if done
Other
Baby