PARTOGRAPH

GENERAL LEARNING OUTCOMES

 Participants acquire appropriate
knowledge and skills in using partograph
in practice to assess and interpret
maternal and fetal conditions and the
progress of labor.
SPECIFIC LEARNING OBJECTIVES
 At the end of the session, the participants are able to:

 Explain the principles of the partograph as a tool for

prevention of fetal and maternal complications during
labor
 Record clinical observations accurately on the
partograph
 Interpret and recognize any deviations from normal

 Describe specific course of action at the appropriate

time
 F.Y.I.
 Greek word: “labor curve”
 The Partograph was originally designed and used by Prof
R.H. Philpott of Zimbabwe in 1972.

 Later modified and simplified by WHO

 DEFINITION
 Partograph or Partogram is a simple, inexpensive
graphical record which gives continuous pictorial
overview of the progress of all observations made of a
woman in labor
 FUNCTION
 The Partograph is a vital tool for care providers who
need to be able to identify complications in childbirth in
a timely manner and refer woman to an appropriate
facility or treatment.
REASONS FOR USING THE PARTOGRAPH
 1. It is an assessment tool that is east to use. It enables
nurses to see progress of labor at a glance on one sheet
of paper. It replaces lengthy descriptions.

 2. Various studies have indicated the disadvantages of

using the Partograph: reduction in number of prolonged
labor, labors requiring oxytocin augmentation and CS.

 Assist in early decision on transfer, augmentation, and

termination of labor
 4. Increases quality and regularity of all observations on
the fetus and mother during labor and aids in early
recognition of problems with either of them.

 5. Recognize maternal or fetal problems as early as

possible.
 - There is decrease in maternal mortality and morbidity
owing to obstructed labor. (Third report on confidential
inquiries into Maternal deaths in South Africa 2002-
2004, 2006:7)
COMPONENTS OF A PARTOGRAPH
 PART 1= progress of labor

 Part 2= assessment of maternal condition

 Part 3= assessment of fetal condition

 Part 4= outcome of labor

PART 1: PROGRESS OF LABOR
 GRAPH OF CERVICAL DILATATION AGAINST TIME

 Cervicogram area
 Graph of cervical dilatation

 Each square is 1cm cervical dilatation

 Active phase:

 Multipara = 1.5 cm/hr.

 Primipara = 1 cm/hr.
 THE ALERT LINE
 Drawn from 4 cm to 10 cm

 Represents rate of dilatation

 Slow rate of dilatation indicates delay in labor
THE ACTION LINE
 Drawn 4 hrs. to the right of the alert line and parallel to
it
 Referred to as critical line

 If cervical dilatation crosses this line:

 - critical assessment of the cause of the delay

 - decide on appropriate management should be

undertaken
PLOTTING THE PROGRESS OF LABOR
 Plot only the cervical dilatation using the symbol “X”

 Start when the woman is in ACTIVE LABOR (4CM or

more) and is contracting adequately (3-4 contractions in
10 minutes)
IF PLOTTING PASSES ALERT LINE…
 Reassess woman and consider crtiteria for referral
 Alert transport services

 Encourage woman to empty bladder

 Encourage upright position and walking if woman wishes

 Monitor intensively

 If referral takes a long time, refer immediately. DO NOT

WAIT TO CROSS ACTION LINE.
IF PLOTTING REACHES THE ACTION LINE…
 Refer urgently to hospital unless birth is imminent

 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 hrs (labor is

prolonged), transfer her to hospital.