Name: Gravidity: Parity: Gestation: Spontaneous la

Age: Risk Factors: Time of ROM:

Pelvis Duration of labour (on arrival)

Date: LATENT PHASE ACTIVE PHASE

Time
Duration in hours

Fetal heart rate (bpm)

FETAL CONDITION

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
Decelerations (Yes/No)
N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N

Type* (E/V/L)

Liquor* (I/C/B/M)

Application*
Presenting part*
Caput (0 1+ 2+)
Moulding (0 1+ 2+ 3+)
Position e.g. LOA >
10 10

X I 9 9

8 8
PROGRESS OF LABOUR

7 7
Cervical dilitation
Cervical length

6 6

5 5

4 4
Head above
3 3
pelvis
2 2

1 1
X I
CONTRACTIONS
5 5
PER 10 MINUTES
CONTRACTIONS

4 4
> 40 sec 3 3
> 20 - 40 sec 2 2
< 20 sec 1 1

Units Units
OXYTOCIN
Rate Rate

200 200
BLOOD PRESSURE 190 190
& PULSE 180 180
170 170
160 160
150 150
MATERNAL CONDITION

140 140
130 130
120 120
110 110
100 100
90 90
80 80
70 70
60 60

Volume Volume
Protein Protein
URINE Ketones Ketones
Blood Blood
Glucose Glucose
TEMPERATURE ºC TEMP

TIME

MANAGEMENT/
MEDICATION/
I.V. FLUID

PAIN RELIEF

SIGNATURE
& RANK

* Liquor: I = intact C = clear * Presenting part: Breech = Br Vertex = Vx * Application: good = G *early = E late = L
B = blood stained M = meconium stained Face = F Brow = Bw poor = P variable = V