Partograph

Topics: Obstetrics, Cervical dilation, Childbirth Pages: 46 (968 words) Published: August 6, 2015
GOOD DAY!!!

  PARTOGRAPH
Made Easy

I. The Partograph
A

tool to help in management of labor

 Guides

birth attendant to identify
women whose labor is delayed and
therefore decide appropriate action

OBJECTIVES
To understand the concept of the WHO
partograph

I.


To explain to mothers the significance of the
graph

II.

To record the observations accurately on the
graph

III.

To interpret the recorded findings, recognize
deviation from the norm, and decide on
timely referral

Monitor during labor…
 Progress



Cervical dilatation
Contraction pattern

 Maternal





well being

Pulse, temperature, blood pressure
Urine voided

 Fetal


of labor

well being

Fetal heart rate and pattern
Color of amniotic fluid

The parts of the
partograph
Progress of labor

Maternal and fetal well-being

D
I
L
A
T
A
T
I
O
N

Alert line

I
L
A
T
A
T
I
O
N

Alert line

Action

Par
Pa
4h
the
th
ale

Conditions that does not need
the use of partograph


Antepartum hemorrhage Multiple pregnancy



Severe pre-eclampsia and
 Malpresentation
eclampsia



Fetal distress



Previous cesarean section
 Obvious obstructed labor



Very premature baby

II. Recording the findings
in the partograph
Start

by labeling the record
with pertinent patient
identifying information.

Plotting the progress of labor
Plot

only the CERVICAL DILATATION
using the symbol “X”

Start

when woman is in ACTIVE LABOR
(4 cm or more) and is contracting
adequately (3-4 contractions in 10
minutes)

X

Start plotting on alert line
in the intersection
corresponding cervical
dilatation finding

X

X

X

4pm

Indicate the time the IE
was made (and therefore,
the observation was
plotted)Write this in the
Vertical line itself where
you plot the “X”, NOT the
Space after it

X
X

X

4pm

8pm

10pm

Perform internal
examination every 4 hours,
or more often if necessary,
and plot findings each time
 Also, do not forget to write the
time each observation was made

X
X

X

4pm

8pm

10pm

Connect the “X”s to
demonstrate the
pattern of labor

EXAMPLE

x

1am

A G1P0 is being monitored by a
midwife at home. Her initial IE
at 1 am showed 4 cm dilated
cervix.

EXAMPLE
x

x
1am

5am

At 5 am, another IE
showed 8 cm dilated cervix.

EXAMPLE
x

x

x
1am

5am

7am

At 7 am, the patient is 9
cm dilated, station -1,
intact BOW.

III. Distinguishing normal from
abnormal labor pattern

X
X

X

4pm

6pm

X

X

8pm

10pm

Progress of labor is normal if
plotting stays on or to the
left of the alert line (green
part)

X
X

X

4pm

6pm

8pm

10pm

Note that based on the structure of the
partograph as soon as 4 cm is reached
the cervix should dilate normally at a
rate of ≥ 1 cm/hour.

X
X
X

4pm

6pm

8pm

10pm 12am

2am

Plotting that passes the alert line (yellow
part) more so if it reaches or passes the
action line (red part) indicates abnormal
progress of labor

If plotting passes alert line …
 Reassess

woman and consider referral if
facilities are not available to deal with
obstetric emergencies, unless delivery is
imminent
 Alert transport services
 Monitor intensively

What to do if partograph passes
alert
line
 Reassess woman and consider criteria for






referral.
Alert transport services.
Empty bladder.
Ensure adequate hydration but omit solid foods.
Encourage upright position and walking if
woman wishes.
Monitor intensively. If referral long, reassess in
2 hours and refer if no progress.

If partograph passes action line, refer urgently to
an EmOC facility unless imminent delivery.

If plotting reaches the action
line…
the patient must be already in an
EmOC facility, a decision made
about the...
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