P A RT O G R A P H
JILLIAN A. BEJOC, MSN, RN
ADPCN-EINC TRAINER
General Learning Outcomes
Participants acquire appropriate
knowledge and skills in using partograph
in practice to assess and interpret
maternal and fetal conditions and the
progress of labor
Specific Learning Outcomes
At the end of the session, the participants
are able to:
Explain the principles of the partograph as a
tool for prevention of fetal and maternal
complications during labor
Record clinical observations accurately on
the partograph
Specific Learning Outcomes
Interpret and recognize any deviations
from normal
Describe specific course of action at the
appropriate time
F. Y. I.
Gk. Word: “labor curve”
The partograph was originally designed
and used by Prof. R.H. Philpott of
Zimbabwe in 1972.
Later modified and simplified by WHO
Definition:
Partograph or partogram is a simple,
inexpensive graphical record which gives
continuous pictorial overview of the
progress of all observations made of a
woman in labor
FUNCTION:
The partograph is a vital tool for
care providers who need to be
able to identify complications in
childbirth in a timely manner and
refer women to an appropriate
facility for treatment.
REASONS FOR USING THE PARTOGRAPH
1. It is an assessment tool that is
easy to use.
- enables nurses to see progress
of labor at a glance on one
sheet of paper.
*replaces lengthy descriptions
REASONS FOR USING THE PARTOGRAPH
2. Various studies have indicated the
advantages of using the partograph:
> reduction in number of prolonged
labor, labors requiring oxytocin
augmentation and CS.
* Fahdly & Chongsuvivavatwong,
2005:301;
* WHO, 1994:1;
* Odberg, Petterson et al, 2000:83
REASONS FOR USING THE PARTOGRAPH
3. Assists in early decision on transfer,
augmentation or termination of
labor.
* Partograph can be used by
peripheral personnel in their
referral decisions (WHO, 1994:1)
REASONS FOR USING THE PARTOGRAPH
4. Increases quality and regularity of
all observations on the fetus and
mother during labor and aids in
early recognition of problems
with either of them.
REASONS FOR USING THE PARTOGRAPH
5. Recognize maternal or fetal
problems as early as possible
* There is decrease in maternal
mortality and morbidity
owing to obstructed labor.
(Third Report on Confidential Inquiries
into Maternal Deaths in South Africa
2002-2004, 2006:7)
Components of the PARTOGRAPH
Part 1 = progress of labor
Part 2 = assessment of maternal
condition
Part 3 = assessment of fetal condition
Part 4 = outcome of labor
Graph of Cervical Dilatation
against time
Cervicogram area
◦ Graph of cervical dilatation
◦ Each square is 1 cm cervical dilatation
◦ Active phase:
Multipara = 1.5 cm/hr
Primipara = 1 cm/hr
Alert line
The Alert Line
Drawn from 4 cm to 10 cm
Represents rate of dilatation
◦ Slow rate of dilatation indicates delay in labor
Action line
The Action Line
Drawn 4 hrs to the right of the alert line
and parallel to it
Referred to as critical line
◦ If cervical dilatation crosses this line:
Critical assessment of the cause of delay
Decide on appropriate management should be
undertaken
Learning Activity 1
Mrs.A. S. was admitted at
9:00 a.m. and the cervix was
4 cm dilated.
At 1:00 pm the cervix was
10 cm dilated
X
X
9am 1pm
Learning Activity 2
Mrs. V.Z. was admitted at 12:00
noon and the cervix was 5 cm dilated
At 5:00 pm, the cervix was 9 cm
dilated
X
12nn 5pm
PART 2:
Assessment of
Maternal Condition
Monitoring q4h:
Drugs
Pulse
Blood pressure
Temperature
Urine volume (yes/no)
Regular monitoring of the ff:
FHR
Membranes and amniotic fluid
◦ plotted as follows:
“ I ”= Intact membranes
◦ If ruptured, note color of amniotic fluid
“ C ” = Clear
“ A ” = Absent
“ M ” = Meconium-stained
“ B ” = Blood-stained
• Based on
observations
Part 4: of part 1, 2
Outcome and 3 and
of Labor after
delivery
Learning Activity 3
At 8:00 a.m., Mrs. V, a 39 years old nulliparous, married from
Cebu City, came in with chief complaints of labor pains and
blood-stained discharge starting at around 3:00 am. Initial
assessment findings are as follows:
> Intact BOW
> 5 cm cervical dilatation, 50% effaced cervix
> Voided freely 5 times; in moderate amount since onset
of uterine contractions
> Frequency of contractions: average of 2-3 x in
10 minutes
> FHR: 134 bpm
> T= 37.20C; PR= 88 bpm;
> BP=120/70 mmHg
Learning Activity 3
At 12:00 noon, subsequent assessment was
conducted which revealed the following
observations:
> leakage of clear, watery discharge noted
> 9 cm cervical dilatation;100% effaced cervix
> Voided freely once, in moderate amount
> Frequency of contractions: 3-4x in 10 minutes
> No changes in maternal vital signs
> FHR: 140 bpm
Learning Activity 3
At 1:00 pm., cervix was fully dilated. Mrs. V was
ushered to the DR and positioned comfortably in
the delivery bed, perineal prep done and draped
aseptically. At 1:30 p.m., Mrs. V delivered
spontaneously a healthy baby girl, with APGAR
score = 9,10. Oxytocin 10 “IU” given IM at right
deltoid at 1:32pm. After five minutes, placenta was
completely delivered, Schultze presentation, with
intact perineum. Uterine massage done, uterus is
firm and well-contracted.
X
8am
8am 12nn 1pm 3pm
