Partograph
• A graphical record of
labour
• Purpose
– To chart the progress of
labour
– To chart important
events during labour
– To chart maternal &
fetal condition
• WHO developed
Why do we need one?
• For early detection of abnormal progress of labour
• Recognition of CPD
• Can allow time & discussion of further management of
labour
• Make observations & recording of fetomaternal condition
more objective
• Prevention of fetomaternal problems & complications
Components of the partograph
• Can be divided into 3
parts
– Part I : fetal condition
( at top )
– Part II : progress of
labour ( middle )
– Part III : maternal
condition (bottom )
FETAL CONDITION
Overview
Descent
of head
Time
The main feature of this section is the graph of
cervical dilatation against time
Contractions Note the division between latent & active phases
Phases of labour
• Labour is not a continuous process
– Begins slowly & becomes faster with time
• Important to recognize this fact
– Measured objectively from 0-10 cm cervical dilatation
– This is Stage I
• Initial slow part is termed the latent phase
– Coincides with the taking up & effacement of the Cx
– Objectively, from 0 to 4 cm cervical dilatation
• The faster part is active labour
– This is all about cervical dilatation
– From 4 -10 cm dilatation
Cervical dilatation
• One way of assessing
progress of labour
• The firm & long Cx
becomes soft & shorter
towards term
• The important dilatation
is with reference to the
internal os
• Dilatation in concert
with contractions
denotes labour
Charting dilatation
• The vaginal examination will
decide if the patient is in the
active or latent phase
• ,
In the active phase of labour
recording of cervical
dilatation starts on the alert
•
line
Crossing the
action line
diltation of the
cervix is plotted with
No descent Dilatation an X ,
arrested desent of the fetal
head is plotted with an
O
uterine contractions
are plotted with
Note the time differential shading
Uterine contractions
• Uterine contractions should increase progressively
• Effect of the pressure of the head on the upper vagina
(Ferguson reflex)
• The frequency, duration & intensity are recorded
• May be recorded as the no. of contractions/10 min
• Observations of the contractions are made every hour in
the latent phase and every half-hour in the active phase
Charting Uterine contractio ns
• Measured in seconds from the time the
contraction is first felt abdominally , to the ime
the contraction phases off
• Each square represents one contraction
• Correlation with oxytocin use important
Palpate number of
contraction in 10 minutes
& duration of each
contraction in seconds
Drugs e.g.
opiates/oxytocics
Vital signs
Urine monitoring
SOME EXAMPLES
Prolonged latent phase
• A prolonged latent phase may denote problems & require
attention
• A heavy line is drawn on the partograph at the end of 8
hours of the latent phase
Polonged Active phase
• Movement of the
dilatation charting beyond
the alert line may denote
obstruction
• Do not just focus on the
dilatation alone
• Other aspects such as
descent, fetal heart rate,
liquor character &
moulding must be taken
together
Secondary arrest of cervical diltation
• Another example
Important points
• It is important to realize that the partograph is a tool for
managing labor progress only
• It does not help to identify other risk factors that may have
been present before labor started
• Charting is only done when the pt is in labour
Diagnosis of labour
+/- show
+/- rupture of membranes