Partogram

1. PARTOGRAMPARTOGRAM
PROF DR MN MOHD AZHAR
ROYAL COLLEGE OF MEDICINE PERAK
RECORDING PROGRESS OF LABOUR

2. WHY IS IT IMPORTANT TO RECORD THE WHY IS IT IMPORTANT TO RECORD THE
PROGRESS OF LABOURPROGRESS OF LABOUR
To provide continuity of care.
To provide a basis of decision making.
To facilitate research.
To allow audit and review.
To defend one’s actions – no documentation – no
defense.
Documentation is important

3. TOOL FOR RECORDING THE TOOL FOR RECORDING THE
PROGRESS OF LABOURPROGRESS OF LABOUR
PARTOGRAMPARTOGRAM

4. PARTOGRAMPARTOGRAM
PARTOGRAM is a graphical information about
the progress of labour in which the salient
information about the fetal well-being, maternal
well-being and the progress of labour are
recorded into a chart.

5. PARTOGRAMPARTOGRAM
Is a managerial tool used to record all
observations made on a woman and fetus in
labour in one chart.
Partogram helps to identify at an early stage
those women whose labour is slow.
A managerial tool for prevention of prolonged
labour.
IT’S SIGNIFICANT:

6. PARTOGRAMPARTOGRAM
For all women who are in labour (i.e. either low or
high risk group).
WHO REQUIRE PARTOGRAM RECORDING

7. PARTOGRAMPARTOGRAM
Friedman's partogram - 1954
2 phases of labour (base on dilatation
of the cervix )
Latent phase (dilatation < 3 cm)
Active phase (>3 cm dilated)
Latent phase
Active phase
Philpott and Castle - 1972
Introduced the concept of “ALERT”
and “ACTION” lines.
ALERT LINE – represent the mean rate
of slowest progress of labour
ACTION LINE – appropriate action should
be taken.
Normal labour is plotted to the left alert line

8. PARTOGRAMPARTOGRAM
Mother information
Fetal well-being
• Fetal heart rate
• Character of liquor
• Moulding
Labour progress
• Dilatation
• Descent
• Uterine contraction
Medications
• Oxytocin
• Pain relief (e.g. pethidine)
Maternal well-being
• BP, Pulse, Temperature
• Urine – albumin, glucose, acetone
• Urine output

9. PARTOGRAMPARTOGRAM
WHAT NEED TO BE WHAT NEED TO BE
RECORDEDRECORDED

10. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Begin plotting at the
“zero” hour on the
partogram
Enter the outcome
of delivery
11
22
All entries made in
relation to time when
the observations are
made
33
Notes should be
legible, dated and
timed.
44

11. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Mother information
 Name
 Age
 Parity
 Gestational period
 Date/time of admission
 Time of rupture membrane
 Short antenatal history

12. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Fetal information
 Fetal heart rate

 Membrane and amniotic
fluid

 Moulding

13. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Fetal information
Fetal heart rate monitoring

Safe and reliable way of knowing
fetus is well.
Listen after each contraction for
one minutes.
Recorded ½ hourly (each square
is ½ hour)

14. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Fetal information
Character of amniotic fluid

4.State of liquor can assess in
monitoring fetal condition.
6.Observation to be recorded
- Membrane intact record as “I”
- Membrane rupture:
a) liquor clear record as “C”
b) meconiun stained liquor “M”
c) liquor absent record as “A”

15. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Fetal information
Moulding of fetal skull

4.Provide information about the
adequacy of pelvis to
accommodate fetal head
6.Record the degree of moulding
0 ® bones separated
+ ® bones touching but can
be separated.
++ ® bone over lapping
+++ ® bones over lapping
severely

16. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Labour Progress
 Cervical dilatation

 Descent

 Uterine contraction

17. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Labour progress
Dilatation and Descent

Latent (0-3 cm) and Active (3-10
cm) phase.
Dilatation of cervix plotted as “X”
axis and Descent plotted as “O”
axis.
First vaginal examination done
on admission is recorded.
Subsequent vaginal examination
is done every 2-4 hourly.
Transfer from latent to active
phase.

18. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
Labour progress recording
in latent phase
At admission:
- Dilatation ® 2 cm
- Descent ® -2
2 hours after admission:
- Dilatation ® 2 cm
- Descent ® -1
Plot dilatation as “X”
Plot descent as “O”
++
As the dilatation is only 2 cm therefore
the labour progress is in the latent
phase

19. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
Labour progress recording
in active phase
Plot dilatation as “X”
Plot descent as “O”
+
+1-1-2
Descent
“X”
7 cm4 cm2 cm
Dilatation
“O”
4 hours2 hours0 hours
(admission)
+
+
+ Latent phase
Active phase

20. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
Cervical dilatation
+
+
+
+ If labour progress well plotting of
cervical dilatation should always
remain to the left of alert line.
If it cross to right of action line
this warns that labour may be
prolonged.

21. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Labour progress
Uterine Contractions

3.Observation is made ½ hourly
4.Assess the frequency, duration.
5.Each square represent 1
contraction felt in 10 minutes.
6.Frequency – highlight the
numbers of square.
7.Duration – shade the contraction
in the square.
< 20 sec - Mild
20-40 sec - Moderate
> 45 sec - Strong

22. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Labour progress
Recording the uterine on the
partogram
5 strong contractions
in 10 minutes
2 weak contractions
in 10 minutes
3 moderate contractions
in 10 minutes
Nos. of
Contraction
in 10 mins

23. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Mother condition
 Vital signs – BP, Pulse, TºC

 Urine analysis – acetone,
albumin, glucose
 Urine volume
 Medications or drug given

24. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Mother condition
 Vital signs recording
BP – 4 hourly or more
frequent if indicated
Pulse - ½ hourly
TºC – 4 hourly
 Urine analysis – dipstick
acetone ® Nil or +
albumin ® Nil or +
glucose ® Nil or +

 Urine volume

25. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
Analyzing the progress of
labour from the partogram
+
+
+
+
+ If progress is satisfactory the
plotting will remain on or to the left
of the alert line.
If labour is not progressing
normally the plotting will be to the
right of the alert line.
Active phase

26. PARTOGRAM RECORDINGPARTOGRAM RECORDING
Latent phase
LABOUR PATTERNS
Normal labour
Prolonged latent phase
Primary dysfunctional
labour
Secondary arrest
Active phase

27. THANK YOUTHANK YOU
PROF DR MN MOHD AZHAR
ROYAL COLLEGE OF MEDICINE PERAK
RECORDING PROGRESS OF LABOUR - PARTOGRAM