RECORDING PROGRESS OF LABOUR

PARTOGRAM
TOOL FOR RECORDING THE
PROGRESS OF LABOUR

PARTOGRAM
PARTOGRAM
PARTOGRAM is a graphical
information about the progress of
labour in which the salient
information about the fetal well-
being, maternal well-being and
the progress of labour are
recorded into a chart.
WHY IS IT IMPORTANT TO RECORD THE
PROGRESS OF LABOUR

Documentation is important


To provide continuity of care.

To provide a basis of decision making.

To facilitate research.

To allow
 audit and review.
To defend one’s actions – no documentation – no
defense.
 The intrapartum period is probably the most
dangerous and traumatic period – a time associated
with a high mortality and morbidity for both mother
and child.
 Maternal and fetal monitoring are essential to pick up
problems early and thus institute timely intervention.
 Eternal alertness for abnormalities essential –
“A Labour Is Only Said To Be Normal After It
Is Over”
PARTOGRAM
IT’S SIGNIFICANCE

Is a managerial tool used to record all

observations made on a woman and fetus in
labour in one chart.

Partogram helps to identify at an early stage

those women whose labour is slow.

A managerial tool for prevention of prolonged

labour.
PARTOGRAM
WHO REQUIRE PARTOGRAM RECORDING

For all women who are in labour (i.e. either low or

high risk group).
 PARTOGRAM
Friedman's partogram - 1954
2 phases of labour (base on dilatation
of the cervix )
Active phase
Latent phase (dilatation < 3 cm)
Active phase (>3 cm dilated)

Latent phase
Philpott and Castle - 1972
Introduced the concept of “ALERT”
and “ACTION” lines.
ALERT LINE – represent the mean rate
of slowest progress of labour

ACTION LINE – appropriate action should

be taken.

Normal labour is plotted to the left alert line

PARTOGRAM
Mother information

Fetal well-being
• Fetal heart rate
• Character of liquor
• Moulding

Labour progress
• Dilatation
• Descent
• Uterine contraction

Medications
• Oxytocin
• Pain relief (e.g. pethidine)

Maternal well-being
• BP, Pulse, Temperature
• Urine – albumin, glucose, acetone
• Urine output
PARTOGRAM

WHAT NEED TO BE
RECORDED
 PARTOGRAM RECORDING
3
Notes should be
legible, dated and
timed.

4
1 Enter the outcome
of delivery
Begin plotting at the
“zero” hour on the
partogram

2
All entries made in
relation to time when
the observations are
made
PARTOGRAM RECORDING
Mother information

 Name
 Age
 Parity
 Gestational period
 Date/time of admission
 Time of rupture membranes
 Short antenatal history
PARTOGRAM RECORDING

Fetal information

 Fetal heart rate

 Membrane and amniotic

fluid

 Moulding
PARTOGRAM RECORDING

Fetal information

Fetal heart rate monitoring

1. Safe and reliable way of knowing

fetus is well.

2. Listen after each contraction for

one minutes.

3. Recorded ½ hourly (each square

is ½ hour)
PARTOGRAM RECORDING

Fetal information

Character of amniotic fluid

1. State of liquor can assess in

monitoring fetal condition.

2. Observation to be recorded

- Membrane intact record as “I”

- Membrane rupture:
a) liquor clear record as “C”
b) meconiun stained liquor “M”
c) liquor absent record as “A”
d) Liquor with blood as “B”
PARTOGRAM RECORDING

Fetal information

Moulding of fetal skull

1. Provide information about the

adequacy of pelvis to
accommodate fetal head

2. Record the degree of moulding

0  bones separated
+  bones touching but can
be separated.
++  bone over lapping
+++  bones over lapping
severely
PARTOGRAM RECORDING

Labour Progress

 Cervical dilatation

 Descent

 Uterine contraction
PARTOGRAM RECORDING

Labour progress
Dilatation and Descent

1. Latent (0-3 cm) and Active (3-10

cm) phase.

2. Dilatation of cervix plotted as “X”

axis and Descent plotted as “O”
axis.

3. First vaginal examination done

on admission is recorded.

4. Subsequent vaginal examination

is done every 2-4 hourly.

5. Transfer from latent to active

phase.
 PARTOGRAM RECORDING
Labour progress recording
in latent phase

Plot dilatation as “X”

Latent phase Plot descent as “O”

At admission:
- Dilatation  2 cm
- Descent  -3

2 hours after admission:

- Dilatation  2 cm
- Descent  -1

As the dilatation is only 2 cm therefore

the labour progress is in the latent
phase
 PARTOGRAM RECORDING
Labour progress recording
in active phase
Plot dilatation as “X”
Latent phase
Plot descent as “O”
Active phase
Latent phase

0 hours 2 hours 4 hours

(admission)

Dilatation
“O” 2 cm 4 cm 7 cm

Descent
“X” -2 -1 +1
 PARTOGRAM RECORDING

Cervical dilatation

Latent phase

If labour progress well plotting

of cervical dilatation should
always remain to the left of alert
line.

If it cross to right of action line

this warns that labour may be
prolonged.
PARTOGRAM RECORDING

Labour progress
Uterine Contractions

1. Observation is made ½ hourly

2. Assess the frequency, duration.
3. Each square represent 1
contraction felt in 10 minutes.
4. Frequency – highlight the
numbers of square.
5. Duration – shade the contraction
in the square.

< 20 sec - Mild

20-40 sec - Moderate

> 45 sec - Strong

PARTOGRAM RECORDING
Labour progress
Recording the uterine contractions
on the partogram

Nos. of
Contraction
in 10 mins

2 weak contractions
in 10 minutes 5 strong contractions
in 10 minutes

3 moderate contractions
in 10 minutes
PARTOGRAM RECORDING

Mother condition

 Vital signs – BP, Pulse, TºC

 Urine analysis – acetone,

albumin, glucose
 Urine volume
 Medications or drug given
PARTOGRAM RECORDING

Mother condition

 Vital signs recording

BP – 4 hourly or more
frequent if indicated
Pulse - ½ hourly

TºC – 4 hourly

 Urine analysis – dipstick

acetone  Nil or +
albumin  Nil or +
glucose  Nil or +

 Urine volume
 PARTOGRAM RECORDING
Analyzing the progress of
labour from the partogram
Active phase
If progress is satisfactory the
Latent phase
plotting will remain on or to the left
of the alert line.

If labour is not progressing

normally the plotting will be to the
right of the alert line.
 PARTOGRAM RECORDING

LABOUR PATTERNS

Active phase
Latent phase Normal labour

Prolonged latent phase

Primary dysfunctional
labour

Secondary arrest
 Advantages
 Inexpensive technology which does not
malfunction.
 A picture is worth a thousand words.
 Helps in continuity of care and providing
information.
 Easy Handover Procedure.
 No major capital investment other than skilled
attendant.
 Documented evidence for Medico Legal purpose.
 Educational value for all grades of staff.
 Disadvantages
 Assumes that all women progress at same rate
– May influence intervention rate.
 Clinical findings have subjective variations.
 Loss of clinical autonomy.
 Lack of knowledge.
 Non availability of printed partographs.
 Duplication of recording.
RECORDING PROGRESS OF LABOUR - PARTOGRAM

THANK YOU