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Partogram

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

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