Introduction to Partograph

What You Will Learn

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Definition

A graphical representation of events in labour measured against time in hours.

History

1954: Friedman prepared the cervicograph.
1972: Philpott and Castle (Rhodesia, now Zimbabwe) developed the first partograph using Friedman’s cervicograph and included the relationship of the presenting part to the maternal pelvis.
1973: Introduced the concepts of "ALERT" and "ACTION" lines.
1987: WHO produced a partograph to improve labour management and reduce maternal and fetal morbidity and mortality.

Helps to Prevent:

Prolonged labour
Cephalopelvic disproportion (CPD), including:
- Dehydration
- Sepsis
- Obstructed labour
- Fistulae
- Ruptured uterus
Inefficient uterine action
Postpartum hemorrhage (PPH)
Maternal mortality
Perinatal mortality
Perinatal sepsis

Appropriate for Health Workers Who Can:

Conduct and observe normal labour
Perform vaginal examinations and assess cervical dilatation
Plot cervical dilatation against time

Not Suitable For:

Home delivery
Untrained health workers

Includes 8 hours of latent phase of labour
Alert line represents minimum progress at 1 cm/hour
Action line is 4 hours parallel to the alert line
Zone between alert and action line is the transfer zone

Composite WHO Partograph

Changes in the Modified Version:

Latent phase removed
To be filled from active phase (cervical dilatation of 4 cm)
Alert and action line controversies exist at tertiary health facilities

Main Components of the Partograph

Includes:

Fetal condition
Progress of labour
Maternal condition

Notes:

A small box represents 30 minutes; a bigger box represents 1 hour
Pelvic examination is done every 4 hours (some centres do it 3-hourly)
Examinations may be more frequent if second stage is anticipated or based on fetomaternal condition
The partograph should be completed for all parturients in the active phase of labour
There is space for additional textual notes

Modified WHO Partograph

Patient Information

Details to Record:

Patient's name
Age
Parity
Hospital number
Date and time of admission
Duration of ruptured membrane

Patient Information

Fetal Condition

Fetal heart rate (FHR) is recorded every 30 minutes in the first stage and every 15 minutes in the second stage of labour
Normal FHR: 110–160 beats per minute

Membranes and Moulding

Membranes and Liquor:
Record at every vaginal examination (4-hourly):

I: Intact membranes
C: Clear liquor
M: Meconium-stained liquor
B: Blood-stained liquor

Moulding:
Record at every vaginal exam (4-hourly):

(–): Sutures apart
(+): Sutures apposed
(++): Sutures overlapped and reducible
(+++): Sutures overlapped and not reducible

Fetal Condition

Progress of Labor

Cervical Dilatation

Assess cervical dilatation at every vaginal examination and plot with an "X"
Place on the pre-drawn alert line at the corresponding cervical dilation
The vertical line at this point is the Zero hour, where all first entries are made
If the partograph has no pre-drawn lines:
- Draw alert line from the first point at 1 cm/hour to 10 cm
- Draw action line 4 hours to the right and parallel to the alert line

Descent of Presenting Part:

Marked with "O" for cephalic presentation
Marked with "W" for breech presentation

Uterine Contractions

Chart every 30 minutes:

Palpate and count contractions in a 10-minute interval
Record duration in seconds using symbols:
- Less than 20 seconds (weak): Dots
- 20–40 seconds (moderate): Lines
- More than 40 seconds (strong): Shading

Progress of Labor

Medications and Maternal Vital Signs

Medications:

Record the amount of oxytocin and volume of IV fluids given (if used)
Record any additional drugs administered

Vital Signs Monitoring:

Pulse: every 30 minutes, marked with a dot (.)
Blood Pressure: every 4 hours, marked with an arrow (↕)
Temperature: every 2 hours
Urine: Measure and record volume, protein, and acetone every time the woman passes urine