PARTOGRAPH

 Friedman (1954) first devised it.

 Partograph is a composite graphical record of cervical
dilatation and descent of head against duration of labor in
hours.
 It also gives information about fetal and maternal condition,
which are all recorded on a single sheet of paper .
 Cervical dilatation is a sigmoid curve and the first stage of
labor has got two phases—
 (1) Latent phase
 (2) Active phase
Latent phase of labor

 Itis defined as the period between the onset of

true labor pain and the point when the cervical
dilatation becomes 3–4 cm.
 Normal duration of latent phase of labor in a
primigravida is about 20 hours (average 8.6
hours) and 14 hours (average 5.3 hours) in a
multipara.
The active phase

 It has got three components.

 (i)Acceleration phase with cervical dilatation
of 3–4 cm.
 (ii) Phase of maximum slope of 4–9 cm
dilatation.
 (iii) Phase of deceleration of 9–10 cm
dilatation.
 In primigravidae, the latent phase is often long (about 8 hours)
during which effacement occurs; the cervical dilatation
averaging only 0.35 cm/h.
 In multiparae, the latent phase is short (about 5 hours) and
effacement and dilatation occur simultaneously. Because of
variable duration of latent phase, it is difficult to plot the
cervical dilatation along the graph. But it has got a distinct
advantage to sort out the cases of delay in labor, especially
after the latent phase is over (cervix 4 cm dilated).
 Dilatation of the cervix at the rate of 1 cm/h in primigravidae
and 1.5 cm in multigravidae beyond 4 cm dilatation (active
phase of labor) is considered satisfactory.
STATUS OF THE MEMBRANES

 Membranes usually remain intact until full

dilatation of the cervix or sometimes even
beyond in the second stage.
 However, it may rupture any time after the
onset of labor but before full dilatation of
cervix—when it is called early rupture.
 When the membranes rupture before the
onset of labor, it is called premature rupture.
 An intact membrane is best felt with fingers
during uterine contraction when it becomes tense
and bulges out through the cervical opening.
 In between contractions, the membranes get
relaxed and lies in contact with the head. With
the rupture of the membranes, variable amounts
of liquor escape out through the vagina and often
there is acceleration of uterine contractions.
MATERNAL SYSTEM

 General condition remains unaffected;

although, a feeling of transient fatigue appears
following a strong contraction.
 Pulse rate is increased by 10–15 beats per
minute during contraction, which settles down
to its previous rate in between contractions.
 Systolic blood pressure is raised by about 10
mm Hg during contraction.
 Temperature remains unchanged
FETAL EFFECT

 As long as the membranes are intact, there is

hardly any adverse effect on the fetus.
 However, during contraction, there may be
slowing of fetal heart rate by 10–20 beats per
minute which soon returns to its normal rate
of about 140 per minute as the intensity of
contraction diminishes provided the fetus is
not compromised.
 Partograph is a composite graphical record of key data (maternal and
fetal) during labor, entered against time on a single sheet of paper
 In cervicograph (Philpott & Caste — 1972), the alert line starts at 4 cm
(WHO) of cervical dilatation and ends at 10 cm dilatation (at the rate of
1 cm/hr).
 The action line is drawn 4 hours to the right and parallel to the alert line.
 In a normal labor, the cervicograph (cervical dilatation) should be
either on the alert line or to the left of it.
 When it falls on Zone 2 it is abnormal and need to be critically
assessed.
 When it falls in Zone 3 case should be reassessed by a senior person.
Decision is to be made either for termination of labor (cesarean section)
or for augmentation of labor (amniotomy and or oxytocin).
COMPONENTS OF A
PARTOGRAPH
 Patient identification;
 Time — recorded at hourly interval. Zero time for
spontaneous labor is the time of admission in the labor
ward and for induced labor is the time of induction;
 Fetal heart rate — recorded at every 30 minutes;
 State of membranes and color of liquor : to mark ‘I’ for
intact membranes, ‘C’ for clear and ‘M’ for meconium
stained liquor;
 Cervical dilatation and descent of the head
 Uterine contractions — the squares in the vertical
columns are shaded according to duration and intensity
 Drugs and fluids;
 Blood pressure (recorded in vertical line) at
every 2 hours and pulse at every 30 minutes
 Oxytocin — concentration in the upper box
and dose (m IU/min) in the lower box;
 Urine analysis;
 Temperature record.
ADVANTAGES OF A PARTOGRAPH

 A single sheet of paper can provide details of necessary

information at a glance;
 No need to record labor events repeatedly;
 It can predict deviation from normal progress of labor
early. So, appropriate steps could be taken in time.
 It facilitates handover procedure
 Introduction of partograph in the management of labor
(WHO 1994) has reduced the incidence of prolonged
labor and cesarean section rate. There is improvement in
maternal morbidity, perinatal morbidity and mortality.
 Educational value of staff .