THE LABOUR CHART

(PARTOGRAPH)

PATRICK R. CHIPUNGU
Malawi College of Health Sciences
Blantyre Campus
 Definition:
• a labour chart is a tool used to record all the
information and observations made on a
woman in labour. The central feature of it is
the graphical recording of the dilatation of
the cervix as assessed by vaginal
examination.
 Admission Details
• a) Patient information including name,
gravidity, para, registration/hospital
number, date and time of admission, time of
rupture of membranes, LMP, EDD,
gestation. Whether she had food, sleep,
home made medicine, any vaginal bleeding,
pre-eclampsia and abnormal symptoms.
 Admission Details
• b) Details of physical examination include:
General condition, height, anaemia,
oedema, fundal height, presentation,
position, status of the bladder, foetal heart
rate and referral details.
 Admission Details
1. c) Details of the first vaginal examination
and pelvic assessment
– Condition of the soft tissues, cervix,
membranes and presenting part.
– Details of the pelvis are also explored and the
conclusion is drawn.
 Admission Details
• d) Details of the first second, third and
fourth stages of labour.
• e) Details of the pueperium for both
mother and baby.
 Important Landmarks and
Indicators on the Partograph
Alert Line: It is a line that indicates how labour is
progressing in cervical dilatation during the active
phase of the first stage of labour.
– Normally cervical dilatation should remain on or to the
left side of the alert line
– When dilatation crosses to the right it is a warning that
labour becomes high risk (CPD) is likely.
– Normal cervical dilatation is 1cm in primigravidas and
1.5cm in multiparas.
– Subsequaint vaginal examinations are done 3 to 4 hourly
interval for multigravidas and primigravidas respectively.
 Important Landmarks and
Indicators on the Partograph
Action Line: An oblique line which is 4 hours to the
right of the alert line in primigravidas and 3 hours
to the right of the alert line in multiparas. If a
woman’s labour reaches this line, a decision is
must be made about the cause of slow progress and
action to be taken.
 Composite partograph
• This part consists of the actual graph where three
main categories of data are recorded. This is on:
a) Foetal condition
• The condition of the foetaus is assessed by pattern
of Heart rate Listen to the heartbeat half
hourly Normal foetal heart rate is 120 - 160 beat
per minute. If the foetal heart is below 120, above
160 or irregular manage the mother as foetal
distress according to the cause.
 Composite partograph
• Colour of amniotic fluid- Colour of liquor should
be monitored hourly. Meconium stained liquor in
a cephalic presentation is a sign of foetal distress.
• C = clear,
• M = meconium stained
• B = blood stained liquor
• R = membranes ruptured but no liquor
draining
• I = membranes intact
 Composite partograph
• Moulding Overlapping of the foetal skull. Is an important factor in
progress of labour because moulding decreases the circumference of the
head and makes descend and rotation easier.. Assess the degree of
moulding as follows:
 0 = Bones are separated and sutures can be felt easily
 + = Bones are just touching each other
 ++ = Bones are overlapping but can be separated easily with digital
pressure.
 +++ = Bones are overlapping but cannot be separated with digital pressure.
• Moulding should be a gradual process to avoid damage to the foetal
brain. bones excessive moulding is a sign of CPD as well as a
predisposing factor to cerebral injury.
 Composite partograph
• Caput succedaneum Formation of cuput on the
presenting part is a normal process and is due to
the tight cervical ring pressing on foetal skull
during a contraction, and causing and effusion of
fluid to collect under foetal scalp. However, this
swelling can become excessive if labour is
prolonged.
•
 Information on progress of
Labour
• b) Contractions: Uterine contractions are necessary
for progress of labour. Contarctions should be felt
for every hour. Feel for frquency, duration and
intensity for a period of ten minutes. As labour
progresses, contractions must increase in frequency,
duration and intensity. Contractions should be
coordinated. Note any deviations from this. They are
recorded on the partograph below the time line.
Squares are numbered from 1-5. Each square
represents one contraction so that if 2 contraction are
felt in 10 minutes, two squares will be shaded.
 Information on progress of
Labour
• Levels of intensity of the uterine contractions are
recorded differently.
• Dots represents mild contraction of less than 20 seconds
duration
• Diagonal lines indicate moderate contraction of 20-40
seconds duration
• Solid shade represents strong contractions of 40-60
seconds duration
• If contractions are week augument labour accordingly
• If contractions are hypertonic manage according to
protocols
 Information on progress of
Labour
• Cervical Dilatation: most important observation to
monitor progress of labour. Dilatation is plotted
with ‘X’. Dilatation is plotted on the latent phase if
it is less than 3 cm and on active phase on the alert
line from 3 cm to 10 cm. A vaginal examination is
performed every 3 hours in multigravida and every
4 hours in primigravida. The cervix should dilate at
1cm/hour in primigravida and 1.5cm to 2 cm per
hour in multiparas. Remember to use sterile gloves
during the vaginal examination.
 Information on progress of
Labour
• Descent of the presenting part: descent is plotted
with an ‘O’ in cephalic presentation Other
presentations nothing is recorded on descent instead
the type of presentation should be recorded on top
of the partograph in red. Assessment of descent is
done through abdominal palpation. It is measured in
fifths of the foetal head above the brim of the
pelvis. Descent can also be assessed vaginally
whereby station of the presenting part is estimated
in relation to the ischial spines of the maternal
pelvis.
 Information on progress of
Labour
• If descent is static for 3 hours a decision is
must be made about the cause of slow
progress and action to be taken.
•
• Time is recorded using the time of
admission as zero time. The actual time of
the day is recorded below the hours line.
•
 Information on Maternal
Condition
• All the observations fore the mother’s condition are
recorded in the spaces provided at the bottom of the
partograph.
• Pulse:- Pulse rate is recorded hourly, rate above 90
beats per minute could suggest infection, shock or
dehydration.
• Blood Pressure:- Should be checked hourly. Note
degree of elevation and drop. A rise by 15mmHg
and 30mmHg in diastolic respectively suggests pre-
eclampsia. A sudden drop could indicate shock.
 Information on Maternal
Condition
• Respirations to be monitored hourly. Note the
smell of the breathe. Sweet smell is associated with
acetonuria. This may imply that the woman is
exhausted and is using up fats. Respiration rate
should not exceed 40 per minute. If rate is above 40,
the woman may be hypeventilating or in severe
pain.
• Temperature- Check temperature 4 hourly. It
should not rise above 37 degrees celcius. High
temperature is a sign of infection or dehydration.
Temperature below 35 may be a sign of shock.
 Information on Maternal
Condition
• Urine- Ask the mother to empty the bladder 2
hourly. Ensure that the bladder is empty
throughout labour and delivery. A full bladder
delays progress of labour, can cause PPH during
third stage of labour and puperium. A full bladder
can also get injured by the presenting part.
• Measure the volume and examin urine for colour,
concentration and amount. test for albumin and
acetone. If maternal vital signs, and urine output
becomes abnormal act according to protocols.
 Information on Maternal
Condition
• Rehydration All fluids administered during labour should
be record on the chart given. Evaluate fluid balance chart,
and act accordingly
• monitor signs of dehydration. Signs of dehydration include:
 Dry mouth and lips
 Concentrated urine
 Ketones in urine
 A rise in temperature
 A risein pulse rate
 Increased respiration
 Information on Maternal
Condition
• Drugs Record these on the chart give.
• Oxytocine: There is a separate column for
oxytocine. All entries are made on the time
line at which the observations are made.
 Information on Maternal
Condition
• Pain Relief: It is the responsibility of the attending
midwife/doctor to reduce pain. Sometimes pain is
excessive if the woman is anxious or in fear. You
should therefore explain the procedures and
progress of labour to ally fear and anxiety. Reassure
her that she is in safe hands, and employ other pain
relief measures such as back rubbing, and
divertional therapy (i.e. chat with the woman). Give
analgesics if she does not respond to the above
measures. Remember that if pain is not relieved
labour may be prolonged.