PARTOGRAM

OBJECTIVES

At the end of this session you are expected to be able

to:
1. Define the partogram
2. Explain the importance of using partogram in labour.
3. Describe the principles that are used to design the
partogram
4. Describe the parameters of labour and frequency
plotting on the partogram
5. Describe the principles of using the partogram at the
health facilities.
 Definition

The partogram
Is a tool used in labour to monitor the
parameters of progress of labour, maternal
and fetal wellbeing, and treatment
administration .
 PRACTICAL VALUE OF USING THE PARTOGRAM

• Offers an objective basis for monitoring the progress of

labour, maternal and fetal wellbeing overtime

• Enables early detection of abnormalities of labour

 Prevention of obstructed labour and ruptured
uterus.i.e to detect deviations from the normal more effectively. This
is the purpose of the ''alert line'.
 To know when to intervene. This is the purpose of the ''action line'. If
the ''progress line' of a mother's cervical dilatation moves to the right
of the alert line, be extra vigilant.
 PRACTICAL VALUE OF PARTOGRAM cont

• Complications of obstructed labour and

ruptured uterus contribute up to 70% of
maternal deaths in some areas (Cobort et al
1998)

• Proper use of partogram has proved so

useful in reduction of both maternal and
perinatal mortalities and morbidities
RECOMMENDATIONS ON THE USE OF PARTOGRAM

Based on the evidence-based reports on its

effectiveness in monitoring of labour.

WHO
Recommends its use in all labour wards and
for all women (WHO 1994)

Zambia
Its use is obligatory at all levels of obstetric
care
 PRINCIPLES USED TO DESIGN THE PARTOGRAM

The partogram depends on the principles that;

1. The latent phase should not last longer than 8 hours
2. The latent phase ends and active phase starts when
the cervix is 4cm
3. During active phase – the cervix should dilate at not
less than 1 cm per hour(normally prime 1.25cm and
multigravida is 1.5cm).
 PRINCIPLES USED TO DESIGN THE PARTOGRAM cont

4. A lag time of 4 hours is usually acceptable the slowing

of labour and the need to intervene, this is the distance
between alert line and the action line.

Note:
The WHO partogram uses fixed alert and action lines
and transfers her to the alert line as soon as she
reaches 4 cm.
 Important Parts of the Partogram

1. Mothers information=name, gravidity,parity,hosp.

no.,date of admission and time of admission.

2. Upper part for fetal observations

 Fetal heart rate, liqour, fetal head moulding

3. Central part:

 Cervicograph and uterine contractions

4. Low part for maternal observations

PR, BP, Temperature, urine output,

 1. The Cervicograph

• The most important part of the partogram

• Used to plots the following:
1. Dilatation of the cervix in cm 4 hourly
2. Descent of the fetal head in fifths above the brim,
against duration of labour.
 2. Other Plotted Parameters
i. Uterine contractions
Strength and frequency and duration of uterine
contractions per 10 minutes (1/2 hourly)
ii. Fetal status
Liqour, moulding, caput formation
iii. Maternal status
 PR, BP & body temperature (hourly)
 Urine (volume, colour, acetone, protein)
iv. Drugs and I.V fluids
 Oxytocin - drops/minute
 Antibiotics
 PRINCIPLES OF USING THE PARTOGRAM

1. Basic health facilities

 Used to monitor labour which is expected to be normal.
– Those with risk factors should already have
been referred.
• Referral is decided when the progress line of the
cervical dilatation deviates to the right of an alert line
Normal labour
 Principles cont
2. Health facilities.
• Used to monitor both high and low risk labour
• Intervention points
a. Active management of labour
When the progress line of the cervical dilatation deviates to the
right of an alert line.
Includes
– Amniotomy
– Selective acceleration of labour with oxytocin,
– Personal support in labour by midwives,
b. Caesarean section
When the progress line of the cervical dilatation touches the
action line.
 Intervention of Labour

Considerable factors for intervention of

labour
1. Cervical dilatation and descent
2. Presentation,
3. Fetal condition e.g fetal distress
4. Maternal condition
5. Strength and frequency of uterine
contractions
6. Moulding/caput formation score
 Intervention of Labour cont

• Consider all these factors, do not be guided only by

the dilatation of the cervix in relation to the action
line and by the descent of the fetal head, critical
though these are.
• Intervention needs to be earlier in a multip than in a
prim.
 Abnormal Partogram
Include the following
1. Protracted dilatation of cervix-less than 1cm/hr

2. Arrested dilatation of cervix- remains the same dilatation

3. Protracted descent of the presenting part-slow than required

4. Arrested descent of the presenting part- same descent

5. Prolonged second stage of labour-

 Causes of Abnormal Partograpm

Divided into 3 Ps
1. Passenger related
 Refers to the fetus: Big baby, hydrocephaly,
2. Power related
 refers to the expulsive efforts of the uterus and mother:
Poor uterine contractions etc
3. Passage related
 Refers to the bony and soft tissue of the pelvis, vagina
and perineum: Contracted pelvis - CPD
 Summary

1. The partogram is a tool used to monitor the

progress of labour
2. Proper use is associated with prevention of
obstructed labour and ruptured uterus, and
consequently reduction of both maternal and
perinatal mortalities and morbidities