Partograph

Made Easy
 I. The Partograph

►A tool to help in management of

labor
►Guides birth attendant to identify
women whose labor is delayed and
therefore decide appropriate action
 OBJECTIVES
I. To understand the concept of the WHO
partograph
➢ To explain to mothers the significance of
the graph
II. To record the observations accurately
on the graph
III. To interpret the recorded findings,
recognize deviation from the norm,
and decide on timely referral
Monitor during labor…
► Progress of labor
▪ Cervical dilatation
▪ Contraction pattern
► Maternal well being
▪ Pulse, temperature, blood pressure
▪ Urine voided
► Fetal well being
▪ Fetal heart rate and pattern
▪ Color of amniotic fluid
The parts of the partograph

Progress of labor

Maternal and fetal well-being

D
I
L Alert line
A
T
A
T
I
O
N
D
I
L Alert line Action line
A
T Parallel and
A 4 hours to
T the right
I of alert line
O
N
 Conditions that does not need
the use of partograph

► Antepartum hemorrhage ► Multiple pregnancy

► Severe pre-eclampsia ► Malpresentation
and eclampsia ► Very premature baby
► Fetal distress ► Obvious obstructed
► Previous cesarean labor
section
 II. Recording the findings
in the partograph

►Start by labeling the record with

pertinent patient identifying
information.
Plotting the progress of labor

►Plot only the CERVICAL DILATATION

using the symbol “X”
►Start when woman is in ACTIVE LABOR
(4 cm or more) and is contracting
adequately (3-4 contractions in 10
minutes)
 X

Start plotting on alert line in the

intersection corresponding
cervical dilatation finding
X
X
 X
4pm

Indicate the time the IE was made (and

therefore, the observation was plotted)
▪ Write this in the vertical line itself where you
plot the “X”, NOT the space after it
 X

X
4pm 8pm 10pm

Perform internal examination every 4

hours, or more often if necessary, and
plot findings each time
▪ Also, do not forget to write the time each
observation was made
 X

X
4pm 8pm 10pm

Connect the “X”s to demonstrate

the pattern of labor
EXAMPLE

x
1am

A G1P0 is being monitored by a

midwife at home. Her initial IE at
1 am showed 4 cm dilated cervix.
EXAMPLE

x
1am 5am

At 5 am, another IE showed 8

cm dilated cervix.
EXAMPLE
x
x

x
1am 5am 7am

At 7 am, the patient is 9 cm

dilated, station -1, intact BOW.
 III. Distinguishing normal
from abnormal labor pattern
 X X

X X

X
4pm 6pm 8pm 10pm

Progress of labor is normal if

plotting stays on or to the left
of the alert line (green part)
 X

X
4pm 6pm 8pm 10pm

Note that based on the structure of

the partograph as soon as 4 cm is
reached the cervix should dilate
normally at a rate of ≥ 1 cm/hour.
 X

X
4pm 6pm 8pm 10pm 12am 2am

Plotting that passes the alert line

(yellow part) more so if it reaches
or passes the action line (red part)
indicates abnormal progress of labor
If plotting passes alert line …

► Reassess woman and consider

referral if facilities are not available
to deal with obstetric emergencies,
unless delivery is imminent
► Alert transport services
► Monitor intensively
What to do if partograph
passes alert line
► Reassess woman and consider criteria for referral.
► Alert transport services.
► Empty bladder.
► Ensure adequate hydration but omit solid foods.
► Encourage upright position and walking if woman
wishes.
► Monitor intensively. If referral long, reassess in 2
hours and refer if no progress.

If partograph passes action line, refer urgently to an

EmOC facility unless imminent delivery.
If plotting reaches the action
line…

the patient must be already in an

EmOC facility, a decision made
about the cause of slow progress,
and appropriate action taken
The parts of the partograph

Progress of labor

Maternal and fetal well-being

 IV. Other findings to note
(and record) during IE
►Status of membranes, write
▪ “ I ” if intact
►If ruptured, note color of amniotic
fluid, write
▪ “ C ” if clear
▪ “ M ” if meconium stained
▪ “ A ” if absent
▪ “ B ” if bloody
 Monitor every 4 hours*
and record the findings

►Blood Pressure
►Pulse rate
►Temperature
►Urine voided (yes or no)

* More frequently, if indicated

 Monitor more frequently
and record the findings

►Number of contractions in 10
minute period
►Fetal heart rate in 1 full minute
➢ 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 hours (labor is prolonged),
transfer her to hospital.
 EXERCISES
►Indicate whether the progress of labor
in the following partographs are normal
or abnormal.
 x
Case 1

10pm 2am
Case 2
X X

X
X
8pm 12mn 2am 4am
 X
Case 3
X

x
9pm 1am 3am
 EXERCISES
►Plotthe observations in the following
cases.
Case 4:
A G2P1 was admitted at 2 am, IE showed a
4cm dilated cervix. The patient was still
smiling and she was hesitant to be
admitted.
At 6 am, another IE was done … 8 cm
dilated cervix, 80% effaced, station 0.
At 8 am, fetal head was bulging at the
perineum.
Case 5:
A G4P2 was referred at 5 pm. The
midwife said that the patient is at 4 cm
cervical dilatation. At 9 pm, your IE
showed 6 cm dilated cervix. At 1 am,
another IE done showed 8 cm dilated
cervix, 50% effaced, station -1, intact
BOW.