Partogram
Dr. Areen Alnasan
Definition
Graphical record of the progress of labor and the condition of the mother and
the fetus against time .
It provides an accurate record of the progress in labour, so that any delay or
deviation from normal may be detected quickly and treated accordingly.
Components
Patient’s profile
Contains: patient’s name, gravidity and parity, hospital number, time of ruptured membranes and the time of admission.
Fetal wellbeing
Fetal Heart Rate: Count fetal heart rate every 30 minutes ,Count for one full minute,
immediately following a uterine contraction
Status of the liquor; expressed as the following:
I :Intact membranes
C :Clear liquor
M :Mecomium stained liquor
B :Bloody stained liquor
Degree of moulding
0 no moulding
+1 sutures approximate each other (but not overlapping)
+2 bones overlap each other but reducible
+3 bones overlap each other and irreducible
Progress of labor
It consists of 3 parts:
1. A chart for Cervical Dilatation and Descent of Head.
- Plot Cervical Dilatation as X
- Plot Descent of head as O
Alert line
A line drawn from the point of cervical dilatation noted at the first vaginal
examination in active labour. This line denotes a dilatation rate of 1cm/hour.
If the line connecting between X & O doesn’t cross the alert line it means
everything is going well. Only re-evaluation (every 4 h [primiparous], 2 h
[multiparous])
If the line connecting between X & O crosses the alert line it means something
is wrong; check her vital signs, contractions, if she need oxytocin, IV fluid or
analgesia; then re-evaluate. (1st stage every 1-2 h, 2nd stage every ½ h )
Action line
A line parallel and 4 hours to the right of the alert line .
If it crosses the action line → you should take an action; which means
you should deliver the baby.
If she is not fully dilated then by C/S .
If she is fully dilated then:
if the head is engaged → by instrumental delivery
if the head is still high → by C/S
2. Number of Contractions per 10 minutes (taken every 30 minutes)
Count how many contractions the patient has in 10 minutes
Each square represents a contraction.
Oxytocin and Drugs: record half hourly.
Oxytocin: How many U/L and how many drops/min
Drugs: used during labor (analgesics, antihypertensive,
insulin…) & IV fluids
Maternal vital signs recording :
Blood Pressure – every 4 hours/more frequent if indicated.
Vertical line with 2 horizontal endings representing the systolic (the upper end) and diastolic (the lower end).
Pulse – every 30 minutes (a dot)
Maternal temperature (every 2 hours)
Urine
- Urine volume
- Urine analysis – dipstick: protein/acetone Nil or +
