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1. The Partogram: Essential Tool for Labor Monitoring Improving Maternal and Neonatal Outcomes Your name/Institution Date

2. What is a Partogram? Definition: A graphical record of maternal and fetal data during labor plotted against time Primary purpose: Monitor labor progress and identify abnormal patterns WHO-endorsed tool for preventing prolonged and obstructed labor Also known as partograph

3. Why Use a Partogram? Early detection of abnormal labor Prevention of prolonged labor Reduction in unnecessary interventions Improved communication among healthcare team Better maternal and neonatal outcomes Cost-effective monitoring tool

4. Historical Background 1 1954 Friedman's graphical labor analysis 2 1972 Philpott and Castle develop alert and action lines 3 1988 WHO introduces simplified partograph 4 2000 Modified WHO partograph (removed latent phase) 5 Present Digital partograms emerging

5. Components Overview The partogram has four main sections: 1. Patient Information (top) 2. Fetal Condition Monitoring 3. Labor Progress Graph (central) 4. Maternal Condition Monitoring (bottom)

6. When to Start the Partogram Start at ACTIVE LABOR (4 cm dilatation) Requirements: Regular painful contractions Progressive cervical dilatation 4 cm or more dilated Do NOT start in latent phase Transfer existing data if started elsewhere

7. Fetal Monitoring Section Fetal Heart Rate (FHR): Normal: 110-160 bpm Record every 30 minutes Plot with dots (•) Membranes & Liquor: I = Intact, R = Ruptured C = Clear, M = Meconium, B = Blood Molding: 0 = None, + = Minimal, ++ = Moderate, +++ = Severe

8. Labor Progress Graph X-axis: Time in hours Y-axis: Cervical dilatation (0-10 cm) Plot cervical dilatation with "X" every 4 hours Plot descent of head with "O" Alert line: Starts at 4 cm Action line: 4 hours right of alert line

9. Understanding Alert & Action Lines Alert Line: Represents expected progress (1 cm/hour) Crossing = need for increased vigilance Time to assess for problems Action Line: Critical decision point Crossing = intervention needed Requires senior review

10. Uterine Contractions Recording Assess every 30 minutes Record number in 10 minutes Document duration: Dots (·) = <20 seconds Diagonal lines (///) = 20-40 seconds Solid shade (■) = >40 seconds Normal pattern: 3-5 contractions/10 min, lasting 40-60 seconds