THE PARTOGRAPH

OBJECTIVES
I. To explain the concept of the WHO
partograph and its significance
 Mothers
 Members of the team of the health care
delivery network
II. To record the observations accurately on the
graph
III. To interpret the recorded findings, recognize
deviation from the norm, and decide on timely
referral
 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
FRIEDMAN’S CURVE
MONITORING 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
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
I of alert line
O
N
 CONDITIONS THAT NEED A
PARTOGRAPH
• All pregnant women in labor when
vaginal delivery is planned

*Use partograph
 CONDITIONS THAT DON’T
NEED A PARTOGRAPH
• Antepartum • Multiple pregnancy
hemorrhage • Malpresentation
• Severe pre-eclampsia • Very premature baby
and eclampsia • Obvious obstructed
• Fetal distress labor
• Previous cesarean
section
 RECORDING THE FINDINGS
IN THE PARTOGRAPH

• Start by labeling the record with

pertinent patient identifying
information.
 PLOTTING THE PROGRESS OF
LABOR ON THE GRAPH
• 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)
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

1am

A G1P0 is being monitored by a

midwife. Her initial IE at 1 am
showed 5 cm dilated cervix.
EXAMPLE
x

x
1am 5am

At 5 am, another IE showed 9

cm dilated cervix.
EXAMPLE
x
x

x
1am 5am 7am

At 7 am, the patient is 10 cm

dilated, intact BOW.
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
4cm = active
labor
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
WHEN PLOTTING PASSES THE
ALERT LINE
• Reassess woman and consider referral if
facilities are not available to deal with
obstetric emergencies, unless delivery is
imminent
• Alert transport services
• Monitor intensively
PLOTTING PASSES THE ACTION
LINE
• The patient must already be in a
CEmONC facility
• A decision must be made about the cause
of slow progress of labor
• Appropriate action must be taken
 Progress of labor

Maternal and fetal well-being

 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
 OTHER FINDINGS TO NOTE
AND RECORD EVERY 4 HOURS*
• Blood Pressure
• Pulse rate
• Temperature
• Urine voided (yes or no)
*More frequently, if indicated
MONITOR MORE FREQUENTLY
AND RECORD
• Number of contractions in 10 minute
period
• Fetal heart rate in 1 full minute
 SPECIAL CASES

If woman is admitted in LATENT

PHASE of labor (less than 4 cm dilated)
– record only other findings (BP, FHT
etc).

If she remains in latent phase for next 8

hours (labor is prolonged), transfer her to
hospital.
 EXERCISES

• Indicate whether the progress of labor in the

following partographs are normal or
abnormal.
 x
Case 1

x
10pm 2am
Case 2

X X
X

12mn 2am 4am

X
8pm
Case 3
X X

9pm 1am 3am

 EXERCISES

• Plot the observations in the following

cases.
Case 4:
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

140 3 140

88 88
110/70 110/70

8:35
8:30
Case 5:
Lourdes, G4P2 was admitted at 1 pm today due to
watery vaginal discharge. The cervix was 3 cm,
cephalic, intact BOW. 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

M
3 3

36.5 36.5 37.5

80 80 92
120/80 120/80 110/70
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
Date Today X X
X

6pm 10pm 12am 2am

2

I I C C
2-3 3
140 140 140 144
36.5 36.5 36.5
84 84
120/80 120/80 120/80
5 7 8
 RECAP
• Significance and use of the partograph
• Parts of the partograph and information contained in it
• Recording or plotting of clinical observations
• Interpretation of the recorded findings and decision on referral