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Partographh

The partograph is a vital tool for monitoring the progress of labor, maternal, and fetal conditions, helping to identify normal and abnormal labor patterns. It includes sections for recording cervical dilation, fetal heart rate, maternal vital signs, and other key indicators, with alert and action lines to prompt timely interventions. Proper use of the partograph can reduce complications associated with prolonged labor by ensuring consistent monitoring and documentation.

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Crisjia Marie Escoltero
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3 views

Partographh

The partograph is a vital tool for monitoring the progress of labor, maternal, and fetal conditions, helping to identify normal and abnormal labor patterns. It includes sections for recording cervical dilation, fetal heart rate, maternal vital signs, and other key indicators, with alert and action lines to prompt timely interventions. Proper use of the partograph can reduce complications associated with prolonged labor by ensuring consistent monitoring and documentation.

Uploaded by

Crisjia Marie Escoltero
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Partograph

The partograph is a graphical presentation of the progress of labour, and of fetal and
maternal condition during labour. It is the best tool to help detect whether labour is progressing
normally or abnormally, and serve as a warning if there are signs of fetal distress or if the
mother’s vital signs deviate from the normal range.

Research studies have shown that maternal and fetal complications due to prolonged
labour were less common when the progress of labour was monitored using a partograph.

The Graph Sections of the Partograph

The graph sections of the partograph are where you record key features of the fetus or the
mother in different areas of the chart. We will describe each feature, starting from the top of
Figure 4.1 and travelling down the partograph.

• Below ‘Moulding’ there is an area of the partograph labelled Cervix (cm) (Plot
X) for recording cervical dilatation, i.e. the diameter of the mother’s cervix in
centimetres. This area of the partograph is also where you record Descent of
Head (Plot O), which is how far down the birth canal the baby’s head has
progressed. You record these measurements as either X or O, initially and every
4 hours. There are two rows at the bottom of this section of the partograph to
write the number of hours since you began monitoring the labour and the time on
the clock.
• The next section of the partograph is for recording Contractions per 10
mins (minutes) initially and every 30 minutes.
• Below that are two rows for recording administration of Oxytocin during labour
and the amount given. (You are NOT supposed to do this – it is for a doctor to
decide! However, you will be trained to give oxytocin after the baby has been
born if there is a risk of postpartum haemorrhage.)
• The next area is labelled Drugs given and IV fluids given to the mother.
• Near the bottom of the partograph is where you record the mother’s vital signs;
the chart is labelled Pulse and BP (blood pressure) with a possible range from
60 to 180. Below that you record the mother’s Temp °C (temperature).
• At the very bottom you record the characteristics of the mother’s Urine: protein,
acetone, volume. You learned how to use urine dipsticks to test for the
presence of a protein (albumin) during antenatal care.
• The scale for fetal heart rate covers the range from 80 to 200 beats per minute.
• Below the fetal heart rate, there are two rows close together. The first of these is
labelled Liquor – which is the medical term for the amniotic fluid; if the fetal
membranes have ruptured, you should record the color of the fluid initially and
every 4 hours. The row below ‘Liquor’ is labelled Moulding; this is the extent to
which the bones of the fetal skull are overlapping each other as the baby’s head
is forced down the birth canal; you should assess the degree of moulding initially
and every 4 hours.
The Alert and Action lines

In the section for cervical dilatation and fetal head descent, there are two
diagonal lines labelled Alert and Action. The Alert line starts at 4 cm of cervical
dilatation and it travels diagonally upwards to the point of expected full dilatation (10 cm)
at the rate of 1 cm per hour. The Action line is parallel to the Alert line, and 4 hours to
the right of the Alert line. These two lines are designed to warn you to take action
quickly if the labour is not progressing normally.
Recording and interpreting the progress of labour

Another important point is that (unless you detect any maternal or fetal problems), every
30 minutes you will be counting fetal heart beats for one full minute, and uterine
contractions for 10 minutes.

You should do a digital vaginal examination initially to assess:

• The extent of cervical effacement (look back at Figure 1.1) and cervical dilatation
• The presenting part of the fetus
• The status of the fetal membranes (intact or ruptured) and amniotic fluid
• The relative size of the mother’s pelvis to check if the brim is wide enough for the baby to
pass through.
Thereafter, in every 4 hours you should check the change in:

• Cervical dilatation
• Development of cervical oedema (an initially thin cervix may become thicker if the woman
starts to push too early, or if the labour is too prolonged with minimal change in cervical
dilatation)
• Position (of the fetus, if you are able to identify it)
• Fetal head descent
• Development of moulding and caput (Study Session 2 in this Module)
• Amniotic fluid colour (if the fetal membranes have already ruptured).
You should record each of your findings on the partograph at the stated time intervals
as labour, progresses. The graphs you plot will show you whether everything is going
well or one or more of the measurements is a cause for concern. When you record the
findings on the partograph, make sure that:

• You use one partograph form per each labouring mother. (Occasionally, you may make a
diagnosis of true labour and start recording on the partograph, but then you realise later
that it was actually a false labour. You may decide to send the woman home or advise her
to continue her normal daily activities. When true labour is finally established, use a new
partograph and not the previously started one).
• You start recording on the partograph when the labour is in active first stage (cervical
dilation of 4 cm and above).
• Your recordings should be clearly visible so that anybody who knows about the partograph
can understand and interpret the marks you have made.

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