A record of the progress of labour and relevant details of the mother
and fetus Partograph Components of partogram • Mother information • Fetal well-being - Fetal heart rate, Liquor, Moulding • Labour progress - Dilatation, Descent, Uterine contractions • Medications - Oxytocin, Analgesics • Maternal well-being - Blood Pressure, Pulse, Temperature, Urine Mother information • Name • Age • Parity • Gestation • Date & time of admission • Time of membrane rupture • Brief antenatal history Fetal well-being • Fetal heart rate - 1 minute every 30 minutes (after a contraction) • Liquor: • Membrane intact = I • Membrane ruptured - Clear liquor = C - Meconium stained liquor = M - Absent liquor = A • Moulding: • 0 = bones are separated and sutures can be easily felt • + 1 = bones are just touching each other • + 2 = bones are overlapping but can be reduced • + 3 = bones are severely overlapping and irreducible. Labour progress • Dilatation = X • Latent - less than 4 cm • Active - 4 cm and above • Descent = O • refers to the part of the head palpable above the symphysis pubis • +5, +4, +3, +2, +1, 0, -1, -2, -3, -4, -5 • Uterine contractions • number of contractions in 10 minutes, duration in seconds • < 20 seconds, 20–40 seconds, > 40 seconds Medications • Oxytocin: record the amount (in units) of oxytocin per volume of IV fluids, and the number of drops per minute, every 30 minutes when used. • Drugs given: record any additional drugs given. Maternal well-being • Record pulse rate - every 30 minutes • Blood pressure and temperature - every 4 hours • Urine output and dipstick testing for protein, ketones (if available) and glucose - every time passing urine • Record all fluids (Input/Output) Analysis of labor progress • Satisfactory progress – plotting remain left of alert line • Abnornal progress – plotting cross to right of alert line • Types of progress • Normal labour • Prolonged latent phase • Primary dysfunctional labour • Secondary arrest Abnormal progress • Prolonged latent phase (>8hrs – nullip, >6hrs – multip) • Risk of maternal exhaustion • Increased risk of uterine infection (chorioamnionitis) • Primary dysfunctional labour • Cervical dilatation > 4cm (active phase) • Dilatation < 1cm / hour • Secondary arrest (in active phase) • Cephalopelvic disproportion (CPD) • Absolute – Anatomical • Relative – Malposition