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Effective Perinatal Care (EPC)

PARTOGRAM


Keywords

 Prolonged labour
 Preventing
 WHO

Effective Perinatal Care (EPC)

 Partograph

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Learning objectives

 Know the history and the background of the partograph
 Understand the effectiveness of the partograph for improving perinatal outcomes
 Know how a partograph is used and how to complete one
 Be able to interpret the partograph and use it to make decisions in managing

Effective Perinatal Care (EPC)

 At the end of this module, the participants will:

labour

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What is a Partograph?
The partograph is a means of graphic presentation of labour:
 Progress of labour
• Cervical dilatation
• Foetal head descent

Effective Perinatal Care (EPC)

Definition: A tool to assess & interpret the progress of labour.

• Uterine contractions
 Foetal status
 Maternal status

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Record

Record
Recordfoetal
foetalcondition
conditionincluding:
including:

Foetal
Foetalheart
heartbeat
beatrate
rate
Moulding
Mouldingofofthe
thefoetal
foetalhead
head
Condition
Conditionofofamniotic
amnioticfluid
fluid
Record
Recordmaternal
maternalcondition:
condition:
Pulse
Pulseand
andblood
bloodpressure
pressure
Body
Bodytemperature
temperature
Urine
Urine(quantity,
(quantity,presence
presenceofofprotein

proteinand
andacetone)
acetone)
Drugs
Drugsadministered
administeredincluding
includingOxytocin
OxytocinIV
IVfluids.
fluids.
Record
Recordprogress
progressof
oflabor:
labor:
Cervical
Cervicaldilatation
dilatation
Descent
Descentofofthe
thehead
head
Uterine
Uterinecontractions
contractions


Why it is important to record the progresse of labour?

Documentation is important



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.


Effective Perinatal Care (EPC)

History of the Partograph: Friedman Curve, 1954

Friedman EA, 1954
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Effective Perinatal Care (EPC)

History of the Partograph: First Partograph,
1971

Philpott RH, et al, 1972
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PARTOGRAM
Friedman's partogram - 1954
2 phases of labour (base on dilatation
of the cervix
)
Active phase

Latent phase

Latent phase (dilatation < 3 cm)
Active phase (>3 cm dilated)

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


Partograph:

Effective Perinatal Care (EPC)

History of the

WHO, 1988

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The WHO Partograph, 1988
Benefits
 Provides early detection for the unsatisfactory progress of
labour
 Detection

of

cephalopelvic

disproportion

before

the

obstruction appears

Effective Perinatal Care (EPC)

 Effective standard for observing the progress of labour

 Helps to make quick and logical decisions for managing
labour
 Identifies the necessary interventions
 Simple, low cost, accessible and clear

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The Use of the Partograph

The incidence of prolonged labour

from 6.4% to 3.4%

The proportion of labours requiring augmentation

from 20.7% to 9.1%

The emergency Caesarean section rate

from 9.9% to 8.3%

Intrapartum stillbirth rate

from 0.5% to 0.3%

Effective Perinatal Care (EPC)

Reduced:

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Key Principles for Using the Partograph (1)
 The partograph is used to record mainly the first stage of labour

to record vital information related to the mother and the fetus (foetal
heart rate, uterine contractions, maternal pulse, and blood pressure)
 The partograph is started if there are
– Two or more uterine contractions in 10 min lasting 20 sec or more in

Effective Perinatal Care (EPC)

– However, after full cervical dilatation is reached, you should continue

the latent phase
– One or more uterine contractions in 10 min lasting 20 sec or more in

the active phase
– No complications requiring urgent interventions or delivery

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Key Principles for Using the Partograph (2)

 During labour, the partograph must be kept in the labour

room
 The partograph is filled in and interpreted by trained

personnel (midwife or obstetrician)

Effective Perinatal Care (EPC)

 The partograph is filled out during the labour not after birth

 Filling in the partograph should be stopped when
– Complications requiring urgent delivery arise

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Component of Partogram
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
•


PARTOGRAM
WHAT NEED TO BE
RECORDED


PARTOGRAM RECORDING

3
Notes should be
legible, dated and
timed.

1
Begin plotting at the
“zero” hour on the
partogram

2
All entries made in
relation to time when
the observations are
made

4

Enter the outcome
of delivery


PARTOGRAM RECORDING
Mother information


Name



Age



Parity



Gestational period



Date/time of admission



Time of rupture membrane



Short antenatal history


Boiko I.
12.04.06

3
16:35

2

425
5

Effective Perinatal Care (EPC)

General Information

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PARTOGRAM RECORDING
Fetal information
 Fetal heart rate
 Membrane and am. fluid
 Moulding
Caput


Part 1: Fetal condition


)Fetal Heart (Charting
Basal fetal heart rate
•brady >110-160< tachy
Decelerations?
yes/no
Relation to contractions?
•Early

•Variable
•Late


PARTOGRAM RECORDING
Fetal information
Fetal heart rate monitoring
1.

Safe and reliable way of knowing
fetus is well.

2.

Listen after each contraction for
one minutes.

3.

Recorded ½ hourly (each square
is ½ hour)


PARTOGRAM RECORDING
Fetal information
Character of amniotic fluid
1.

State of liquor can assess in
monitoring fetal condition.

2.

Observation to be recorded
- Membrane intact record as “I”
- Membrane rupture:
a) liquor clear record as “C”
b) meconium stained liquor “M”
c) liquor absent record as “A”
d) bloody “B”


 I – the membranes intact
 C – clear amniotic fluid
 В – blood-stained amniotic fluid

Effective Perinatal Care (EPC)

Amniotic Fluid

 M – meconium-stained amniotic fluid
 A – absent amniotic fluid
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