Name: ___Julianne B. dela Cruz_______________________________________________ Date: _Jan.

5, 2021_

Evaluator/Signature: ___Ms. Johanna Jiel S. Padogdog MN, RN_____________________ Grade: _____________

PARTOGRAPH USE

Definition: A partograph is a graphical record of a woman in labor and of fetal and maternal condition during labor on a labor record (partograph) on which, vital signs, fetal heart
rate, cervical dilation, descent of the fetal head, urine tests, and any drug administration can be recorded

Purposes:

1. To detect abnormal progress of labor as early as possible

2. To prevent prolonged labor
3. To recognize CPD long before obstructed labor
4. To assist in early decision on transfer, augmentation/ termination of labor
5. To increase the quality and regularity of all observations of mother and fetus
6. To recognize maternal or fetal problems as early as possible

Considerations:

1. A partograph should be started when a woman is in active labor (cervix dilated at 4cm/ more)
2. If there are any complications that require immediate attention, take appropriate actions before starting the partographh
3. All the recordings on the partograph should be done
4. Each rectangle of the time represents one hour
5. Record the number of hours passed since the partograph was started in the upper row
6. Record the actual time in the lower row

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41


ACTION
1. Assess the woman in labor for any possible
complications that require immediate nursing
action.
2. Perform careful vaginal examination to determine
cervical dilatation and stage of labor. Succeeding
vaginal examinations should then be done every 4
hours.
I. Assessing Fetal Condition
3. Assessing the fetal condition involves assessing the
Fetal Heart Rate (FHR), Amniotic Fluid, and Degree
of Moulding.
4. The first graph represents the FHR. Each vertical side
of the rectangle represents the beats per minute in 10
increments, while each horizontal side represents the
time by 30 minutes.
5. Monitor the heart rate for beats of less than 100 or
PERFORMED
YES NO
RATIONALE REMARKS
For continuity of care
The vaginal examination reveals whether the woman is in true labor
and enables the examiner to determine whether the membranes have
ruptured. Because this examination is often stressful and uncomfortable
for the woman, it should be performed only when indicated by the
status of the woman and her fetus. Also, the only certain objective sign
that the second stage of labor has begun is the inability to feel the
cervix during the vaginal examination, indicating that the cervix is fully
dilated or effaced
Because labor is a period of physiologic stress for the fetus, frequent
monitoring of fetal status is part of the nursing care during labor
Fetal well-being during labor can be measured by the response of the
fetal heart rate to uterine contractions
A baseline FHR is 110 to 160 and must be checked. If the baseline rate
MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41
 beats of more than 180 beats per minute. This begins to slow or if deceleration patterns develop, prompt treatment
requires immediate attention. must be initiated

6. The next set of graph pertains to the status of Labor is initiated at term by SROM in approximately 25% of pregnant
amniotic fluid and membranes. If the membranes women. Membranes (the BOW) also can rupture spontaneously any
have not yet ruptured, write I on the box. time during labor, but most commonly in the transition phase of the
first stage of labor

PERFORMED
ACTION RATIONALE REMARKS
YES NO
7. If the membranes have ruptured, record the Amniotic fluid should be clear as water. Yellow- stained fluid suggests
characteristics of the amniotic fluid. Write C if Clear, a blood incompatibility between the mother and fetus (the amniotic
write B if bloody or red, write M if the fluid is green fluid is bilirubin stained from the breakdown of red blood cells). Green
or meconium stained, and write A if amniotic fluid is fluid suggests meconium staining
absent even after membranes ruptured.

8. If the amniotic fluid is absent after rupture of Because this may cause fetal distress. Assess FHR immediately to be
membranes, increase frequency of assessing the certain the umbilical cord hasn’t prolapsed and is now being
fetal heart rate. compressed against the cervix by the fetal head.

9. The last portion of fetal assessment is the moulding. Ensure normal, spontaneous vaginal delivery or if the mother needs CS
Moulding is an important indicator of how well the
pelvis can accommodate the fetal head.
10. Note and record moulding at each vaginal To monitor progress of labor

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 examination.

11. Normally, in the early stage of labor, the fetal

sutures are separate and bones do not touch each To monitor progress of labor
other. This is recorded on the moulding graph as
(zero) 0.
12. On the later stage of labor, moulding will become If the presenting part is below the ischial spines, the distance is stated
prominent as the head fits on the pelvic inlet. If the as plus stations (+1 to +4 cm). at a +3 or +4 station, the presenting part
fetal bones are touching each other, record +, if they is at the perineum and can be seen if the vulva is separated
are overlapping moderately, record ++, and if the
bones are overlapping severely, record +++.

13. Watch out for severely overlapping skull bones To prevent head decapitation
which are non-reducible while the head is still
above the ischial spines. It is an ominous sign of
labor.
PERFORMED
ACTION RATIONALE REMARKS
YES NO
II. Assessing the Progress of Labor
14. This portion of the partograph assesses the degree of Dilation occurs first because uterine contractions gradually increase the
cervical dilatation against time. Cervical dilatation diameter of the cervical canal lumen by pulling the cervix upover the
is measured in cm. Time refers to the hours starting presenting part of the fetus
from the time the mother has entered the active
stage of labor (4cm) and has started using the
partograph. This is recorded as x on the graph.

15. The progress of labor graph features the Alert Line The form shows an “alert line”, which marks when 4 hours has passed.
and the Action Line. The goal of monitoring is to Four hours beyond that. An “action line” advises a primary care

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 keep the progress line on the left side of the lines provider that cervical dilation is taking longer than usual and that an
and prevent or manage if the labor progress crosses intervention may be necessary to make the labor safe and effective
the alert or action line.

16. The alert line represents cervical dilatation rate of 1

cm per hour which is considered to the slowest rate To determine the normal progress of labor
of cervical dilatation in normal conditions both for
nullipara and multipara.

17. The normal progress of labor should be along the
Alert Line or to the left of the alert line. If the rate
of dilatation crosses the alert line (but before the
action line) decisions to speed up the dilation such
as amniotomy can be considered.
Maintaining an ongoing record and alerting the care provider that the
alert line or action line is approaching are important nursing
responsibilities

PERFORMED
ACTION RATIONALE REMARKS
YES NO
18. If the rate of dilatation reaches or crosses the Action
Line, it indicates dangerously slow progress of To ensure safety and to have an effective labor
labor. Decision and action must be done to transfer
the mother to a hospital with equipment and
facilities that deal with obstetric emergencies.
19. Cervical dilatation should be accompanied with fetal
head descent. Head descent is plotted on the same
graph representing the cervical dilation on the To monitor the progress of labor
spaces from 0-5cm along the vertical line.

20. The assessment of head descent is done abdominally

and is represented by the examiners fingerbreadth To monitor fetal head descent
with each finger approximating 1cm.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 21. Head descent is plotted as O on the partograph and To demonstrate change along delivery and reflects the amount of
must be assessed and plotted the same time as the resistance that must be overcome
cervical dilatation.

22. It is important to remember that the direction of the To determine what are the resistance that must be overcome
dilatation and the fetal head descent must be in
opposite direction to represent a normal progress of
labor. As the dilatation goes up, the fetal head
simultaneously goes down in normal labor progress.
23. The third portion of labor progress monitoring is the Between contractions, the uterus relaxes. As labor progresses, the
labor contraction. Normally as the labor progresses, relaxation intervals decrease from 10 minutes early in labor to only 2 to
the uterine contractions become more frequent and 3 minutes.
last longer.

PERFORMED
ACTION RATIONALE REMARKS
YES NO
24. Uterine contraction should be assessed every 30 The duration of contractions also changes, increasing from 20 to 30
minutes, and is taken on a 10-minute period. The seconds at the beginning to a range of 60 to 70 seconds by the end of
technique is counting how many contraction within the first stage
10 minutes and recording the duration of each
contraction in seconds.

25. If contraction last for 20 seconds or less fill square To efficiently monitor the progress of labor and to obtain accurate
with dots. If between 20-40 seconds by diagonal results
line and >40 seconds fill the square completely by
shading.
III. Assessment of Maternal Condition
26. Assess maternal condition regularly by monitoring. To make labor safe and effective

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 Drugs, IV fluids, Pulse are monitored every 30
minutes; Temperature and BP every 4 hours; and
urine volume, analysis for protein and acetones
every 2 to 4 hours.
27. When poor progress of labor is due to inadequate When labor contractions are ineffective, several interventions, such as
uterine activity, the use of amniotomy followed by induction and augmentation of labor with oxytocin or amniotomy
oxytocin infusion after may be considered. (artificial rupture of the membranes), may be initiated to strengthen
them

28. When oxytocin is used, record every 30 minutes the Oxytocin is an effective uterine stimulant, but there is a thin line
concentration per liter and the number of drops between adequate stimulation and hyperstimulation, so careful
infused to the patient. Always check the membranes observation during the entire infusion time is an important nursing
are ruptured before oxytocin is used. responsibility

28. Always observe that oxytocin infusion must result to

increased frequency and duration of uterine
contractions.

PERFORMED
ACTION RATIONALE REMARKS
YES NO
29. Drugs on IV infusions given during labor must be To keep track of what is happening
recorded on the portion of the partograph just below
the oxytocin infusion area. Record the name,
dosage, and route of administration. Make sure that
it is parallel on the exact time of the labor progress.
30. Record the mother’s pulse every 30 minutes and A side effect of oxytocin is that it causes peripheral vessel dilation, and
reflect as a dot connected with solid lines on each peripheral dilation can lead to extreme hypotension. To ensure safe
subsequent recordings. BP and temperature are induction, therefore, take the woman’s pulse and blood pressure

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41

 recorded every 4 hours or more frequently if
indicated.
31. If ordered, obtain urine sample every 2 to 4 hours A second effect of oxytocin is that it can result in decreased urine flow,
and check for protein, volume, and acetone. possibly leading to water intoxication

32. Finally, do a written documentation of the outcome

of labor based on the observation obtained on the Ensure continuity of care
previous monitoring.

Learner’s Reflection: (What did you learn most of the activity? What is its impact to Instructor’s Comments:
you?)

I have learned about the importance of partograph and how to monitor the progress of
labor and identify and intervene in cases of abnormal labor.

Reference(s):
Maternal and Child Health Nursing(2014) Adele Pillitteri
Maternal-Neonatal Nursing (2008). Lippincott Williams & Wilkins
Maternal and Child Nursing (2007), Elsevier Inc.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 41