Simple Partograph

A Tool to monitor Progress of Labour?

Dr.Prakash Deo

Partograph: A. Foetal Condition

• The Top most squares - record of FHR.

• Each square on the horizontal axis represents half an hour.

• Each square on the vertical axis represents foetal heart rate. • 120-140/min is the normal FHR

• Foetal Heart above 160/min and below 120/min – Alert signal – Foetal distress.

Partograph

Membranes and Amniotic Fluid: Indicated in the row of squares just below FHR. Each square - half-an-hour.

Intact membrane – Write “I” in the corresponding square

If membranes ruptured and amniotic fluid was clear – This will be marked as “C” in the corresponding square.

If membranes ruptured and amniotic fluid was meconium stained, this will be marked as “M”

Conditions of foetus and conditions of membranes and liquor should be observed every half an hour (Type of discharge from vagina and on the pad) – Pelvic examination every time is not required.

Moulding:

This is plotted in the row of squares below amniotic fluid.

Moulding is identified only in cephalic presentations (overlapping of skull bones on one another)

There may be some moulding in normal labour. However, if labour is prolonged and pelvis is tight, moulding is accompanied by oedema over the presenting part – Caput.

Moulding indicates slow progress of labour.

Write “O” in the corresponding square if No moulding

Write “+” in the corresponding square if Moulding presentRecord of Moulding along with FHR and condition of amniotic fluid indicates that the baby is in stress.

B) Labour

• 10 Rows of the squares are meant to plot cervical dilatation.

• Markings of cervical dilatation are from 0-10 cms.

• Each square represents half an hour

• After two small squares there is a longer line going down to indicate the hours.

• Row below the hours indicate the time of observations after the women goes in to active labour.

B) Labour

• In normal labour, the plotting of cervical dilatation should always be on to the left of or on the alert line.

• If it comes between “Alert” and “Action” Lines, it indicates slow progress, prolonged/obstructed labour.

• Such a women should be referred to CHC/FRU to save life of mother and baby.

• There is a gap of four hours between “Alert” line and “Action” line.

• Allowance of four hours from “Action” line to actual

initiation of specific interventions to save the life.

• Pelvic examination should be done four hourly, when the woman is in active labour, unless specifically indicated/decided by the gynecologist.

Uterine Contractions • For Good Progress Of Labour, it is essential that the uterine

contractions are good.

• Normally, as the labour progresses, the contractions become frequent and longer in duration.

• In the initial stages of labour, uterine contractions are assessed for 10 minutes every hour.

• Two important points to be noted for uterine contractions

Frequency – How many contractions occur in 10 minutes.

Duration – How long does a uterine contraction last.

Uterine Contractions --- To know the duration –

• Place the flat of palm on the abdomen over the uterus. Note the time in seconds from the time a contraction starts until it is over.

• Five squares in each vertical column. Each square represents one contraction. If there are two contractions in 10 minutes, then two squares will be marked in the column.

• Mild contractions – Less than 20 seconds – with dots.

• Moderate - 20—40 seconds – marked as diagonal lines

• Strong – > 40 seconds – marked with dark colour.

To monitor labour, cervical dilatation and uterine contractions should be considered together

C. Interventions

• Drugs & IV Fluids given – Each square represents one hour – mention important drugs/IV fluids given

• Pulse & Blood Presure - Each square represents half an hour duration..

• B.P. is recorded with a verticle line from systolic to the diastolic reading

• Pulse is recorded by dots on verticle line

Reading a Partograph: A scan on progress of labour.

Read all parameters: Foetal Heart Sounds, amniotic fluid, moulding, cervical dilatation, uterine contractions, Drugs/IV fluid given, pulse & Blood pressure

Interpreting Partograph Records:

Question Yes/NO InterpretationAction

1. H/Os Latent Phase of 8 hours or less than 8 hours?

2. H/O Latent Phase more than 8 hours?

3. Active phase of labour - findings of cervical dilatation on Alert line or to the left of Alert Line

4. Findings of cervical dilatation are to the Right side of Alert Line

5. FHS plotting above 160 or below 120 per minute?

6. Maternal pulse rate > 120 or < 60 pm or with temperature?

7. Amniotic fluid dark green or yellowish?

8. Is there beginning of moulding of foetal head?

• Utility of partograph Vs Time consumed in plotting? Very busy – We don’t have time?

• Why we should do this additional job?

• Can it help to make complications less severe?

• Can it help to take right decision at right time?

• Can it help to save lives of women?

• Are we not supposed to maintain record of progress of labour on case sheets?

Yes – We will start maintaining partographs.