Partograph

1) Definition:
Partograph is the graphical record of all the events of labor in a single sheet of paper.
Progress of labor is assessed from the visual pattern of cervical dilatation and descent of
presenting part in conjunction with the record of fetal and maternal well-being which are
recorded. It was developed and extensively tested by WHO, 1994 later modified in 2000.

2) Components of the Partograph:

Part 1: Patient identification
Fill out name, gravida, para, hospital no., date and time of admission, and time of ruptured
membranes or time elapsed since rupture of membranes is written at the top of the graph.

Part 2: Fetal condition

A) Fetal heart rate: Fetal heart rate indicates the state of the fetus inside the uterus and is
recorded half hourly. Each square in the graph indicates half hour. The average baseline heart
rate should be between 100-180 beats/min. Place on dot (●) in the line at the level of fetal heart
rate.
B) Membranes and amniotic fluid: Observe and record the color of amniotic fluid at every
vaginal examination. Normally the amniotic sac contain whitish water fluid, occasionally with
flakes of vernix caeosa. Following observations are recorded in the graph.
 If the membranes aren’t ruptured i.e if membranes are intact – letter ‘’I’’
 If the membranes are ruptured:
-Liquor is clear - letter ‘’C’’
- Liquor is blood stained - letter ‘’B’’
- Liquor is meconium stained - letter ‘’M’’
- Liquor is absent - letter ‘’A’’
C) Moulding of fetal bones: Record of the moulding of fetal skull at every vaginal examination.
And marked with 0, +1, +2, +3.
No (0) Moulding – parietal bones (sagital suture) are not opposed.
+1 Moulding – parietal bones are touching but not overlapping.
+2 Moulding – parietal bones are overlapped but easily reduced.
+3 Moulding – parietal bones have overlapped and are irreducible.
Part 3: Progress of labor
A) Cervical Dilatation: Begin plotting partograph at 4 cm, assessed at every vaginal examination
and marked with cross (X) in the graph which are joined by a continuous line.
Alert line starts at 4 cm of cervical dilatation. When progress of labour is satisfactory,
cervical dilatation remains on alert line or to the left. When cervical dilatation cross to the alert
line, this is a warning sign that labour may be prolonged and the mother must be transferred to a
tertiary level hospital.
Action line: it is parallel and four hours to the right of alert line. This is the critical line at
which specific management decision must be made about action needed to be taken. At or
beyond this line prepare for delivery by caesarean section if there is fetal distress or obstructed
labour. Augment with oxytocin by IV infusion if not contraindicated.
B) Descent of fetal head: Descent assessed by abdominal palpation before doing vaginal
examination using the rule of fifth to assess engagement. It refers to the part of the head palpable
above the symphysis pubis and recorded as circle (o). Descent of fetal head is measured in no.of
fingers in abdomen palpation.
Hours and time: Refers to the time elapsed since the onset of active phase of labour and actual
time of the day recorded at hourly interval.
C) Uterine contraction: The frequency, duration and intensity of uterine contraction can be
estimated by palpation. The tightening increases to a hard, board like consistency at the peak of
the contraction and then gradually diminishes as the contraction goes down.
•Dot represents mild contraction(feels like touching finger to tip of nose), of less than 20
second duration
•Diagonal lines indicate moderate contraction(feels like touching finger to chin), of between 20
and 40 second duration .
•Solid color represents strong contraction (feels like touching finger to forehead), of more than
40 second duration.

Part 4: Maternal condition

A) Oxytocin: Units per liter and drops per min.
B) Drugs given: Record any additional drugs (sedatives, antibiotics) given.
C) Pulse: Record maternal pulse every 30 min and mark with a dot (.)
D) Blood pressure: Record maternal BP every 4 hourly and mark with vertical arrows ( )
E) Temperature: Record every 2 hourly.
F) Protein, Acetone and Volume: Record when urine is passed.
Record the delivery details to the right of the action line
-Type of delivery
- Date and time of delivery.
- Birth weight of baby.

3) Filling of partograph:
A primi gravida was admitted in active labor at 2pm.On admission
FHR 130/min
On p/v examination, membrane was intact, cervix was 5 cm dilated,
Head was 3 fingers above symphysis pubis.
Uterine contraction of 35-40sec, 3 in 10 minutes
Oxytocin 5U in 500 ml RL at 40 drops/min
Full dilataion of cervix at 6 pm.
Baby delivery at 6:15pm by SVD
Baby- Female, 2.75 kg
Fill the partograph using above mentioned conditions.

Summary:
Partograph is the graphical record of progress of labour. Plotting of partograph begins in the
active phase of labor. Components of Partograph are Part 1: Patient identification, Part 2: Fetal
condition that represent fetal heart rate, condition of amniotic fluid, fetal membrane and
moulding of fetal bones. Part 3 represents Progress of Labour i.e. cervical dilatation and descent
of head and uterine contraction and part 4 represents maternal condition.
Post test:
What is partograph?
Which symbol represents fetal heart rate?

REFERENCES:

1) Subedi, D. (2018) ‘’Textbook of MIDWIFERY NURSING –II Intra-partum care’’(1st

edition), TARA Books and stationary, Chhetrapati, Kathmandu. (Page no. 48-55)
2) Subedi, D.,Bhattrai,S.G. (2016) ‘MIDWIFERY NURSING PART–I’’(3rd
edition),Medhavi Publication, Jamal Kantipath, Kathmandu. (Page no. 143-144,148)
3) Tuitui, R.,( 2010). ‘’Manual of midwifery II (intra partum care )’’ (7 th
edition),Kathmandu, Vidyarthi Pustsak Bhandar, Bhotahity.
4) Retrieved from https://www.contemporaryobgyn.net/view/who-partograph-beginner on
2077/9/3
5) Retrieved from
https://apps.who.int/iris/bitstream/handle/10665/58589/WHO_FHE_MSM_94.4.pdf?
sequence=1&isAllowed=y on 2077/9/3
6) Retrieved from
https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-10-23
7) Retrieved from
http://helid.digicollection.org/en/d/Jwho37e/7.1.html