Partogram

Dr. Areen Alnasan

Definition
 Graphical record of the progress of labor and the condition of the mother and
the fetus against time .

 It provides an accurate record of the progress in labour, so that any delay or

deviation from normal may be detected quickly and treated accordingly.
Components
Patient’s profile

Contains: patient’s name, gravidity and parity, hospital number, time of ruptured membranes and the time of admission.
 Fetal wellbeing
 Fetal Heart Rate: Count fetal heart rate every 30 minutes ,Count for one full minute,
immediately following a uterine contraction

 Status of the liquor; expressed as the following:

I :Intact membranes
C :Clear liquor
M :Mecomium stained liquor
B :Bloody stained liquor

 Degree of moulding
 0 no moulding
 +1 sutures approximate each other (but not overlapping)
 +2 bones overlap each other but reducible
 +3 bones overlap each other and irreducible
Progress of labor
 It consists of 3 parts:

1. A chart for Cervical Dilatation and Descent of Head.

- Plot Cervical Dilatation as X
- Plot Descent of head as O
Alert line

 A line drawn from the point of cervical dilatation noted at the first vaginal
examination in active labour. This line denotes a dilatation rate of 1cm/hour.

 If the line connecting between X & O doesn’t cross the alert line it means
everything is going well. Only re-evaluation (every 4 h [primiparous], 2 h
[multiparous])

 If the line connecting between X & O crosses the alert line it means something
is wrong; check her vital signs, contractions, if she need oxytocin, IV fluid or
analgesia; then re-evaluate. (1st stage every 1-2 h, 2nd stage every ½ h )
 Action line
 A line parallel and 4 hours to the right of the alert line .

 If it crosses the action line → you should take an action; which means
you should deliver the baby.

 If she is not fully dilated then by C/S .

 If she is fully dilated then:
 if the head is engaged → by instrumental delivery
 if the head is still high → by C/S
2. Number of Contractions per 10 minutes (taken every 30 minutes)
 Count how many contractions the patient has in 10 minutes
 Each square represents a contraction.
 Oxytocin and Drugs: record half hourly.
 Oxytocin: How many U/L and how many drops/min
 Drugs: used during labor (analgesics, antihypertensive,
insulin…) & IV fluids
 Maternal vital signs recording :
 Blood Pressure – every 4 hours/more frequent if indicated.
 Vertical line with 2 horizontal endings representing the systolic (the upper end) and diastolic (the lower end).

 Pulse – every 30 minutes (a dot)

 Maternal temperature (every 2 hours)

 Urine
 - Urine volume
 - Urine analysis – dipstick: protein/acetone  Nil or +