Partograph

What is it?
The Partograph is a tool that can be used by midwifery personnel to assess the progress of labor and to identify when intervention is necessary. Studies have shown that using the partograph can be highly effective in reducing complications from prolonged labor for the mother (postpartum hemorrhage, sepsis, uterine rupture and its sequelae) and for the newborn (death, anoxia, infections, etc.).

Who uses it?

Nurse midwife, medical doctor, nurse.

Why use it?

To assist in making the correct decision about transfer, Caesarean section, or other life-saving interventions.

When to use it?

To monitor all stages of labor of all women arriving at the maternity or health facility.

How to use it?

A partograph must be started only when a women is in labor. In the latent phase (cervix dilatation not more than 2 cm), she should have two or more contractions in 10 minutes, each lasting 20 seconds or more. In the active phase (cervix dilatation more than 3 cm), she should have one or more contractions in 10 minutes, each lasting 20 seconds or more. The partograph is used to plot the following parameters for the progress of labor: cervical dilatation, descent of fetal head, and uterine contractions. It will also be used for monitoring fetal conditions with the following parameters: fetal heart rate, membranes and liquor and moulding of fetal skull. Additionally, the partograph can be used to monitor maternal condition: pulse, blood pressure, temperature, urine, drugs, IV fluids, and oxytocin. In this site, we will only explain how to use the partograph for monitoring labor (cervical dilatation and descent of fetal head). For additional information, please refer to: Preventing Prolonged labor: A Practical Guide. The Partograph, WHO/FHE/MSM/93.8.

1. Cervical dilatation: The rate of dilatation of the cervix changes during labor, this is represented by the bold lines in the graph. Dilatation of the cervix is measured by the diameter in cm. This is recorded with an X in the center of the partograph, at the intersection of vertical and horizontal lines. The vertical scale represents dilatation by 10 squares of 1 cm each. The horizontal scale represents time by 24 squares of one hour each. When labor goes from latent to active phase, the dilatation must be plotted on the alert line. The latent phase should normally not take longer than 8 hours. When admission takes place in the active phase, the dilatation is immediately plotted on the alert line. If progress is satisfactory, the plotting of the cervical dilatation will remain on or to the left of the alert line (see graph).

2. Descent of fetal head: Descent of the fetal head may not take place until the cervix has reached about 7 cm of dilatation. This is measured by abdominal palpation and expressed in number of finger widths (fifths of the head) above the pelvic brim. It is also recorded in the central part of the partograph with an "O".

Example:

Admission time was 13:00, the dilatation of the cervix was 1 cm and the head was 5/5 above the pelvic brim. At 17:00, the dilatation was 5 cm (active phase), and the head was 4/5 above the brim. Labor is now in active phase. Cervical dilatation is immediately transferred to the alert line; descent of the head and time are transferred to the vertical line intersecting the 5 cm line on the alert line. At 20:00, the cervix was fully dilated (10 cm), and the head was only 1/5 above the pelvic brim. The total length of the first stage of labor observed in the unit was 7 hours.