PROCESS FLOW OF ANTENATAL CARE

Quick Check & RAM

Ask, Check Record

Assess pregnancy status &

prepare Birth & Emergency plan
CHECK for pre-eclampsia, anemia, Sy & HIV

Look, Listen & Feel

Respond to observed S/SX

Identify signs

Give PREVENTIVE MEASURES due

Classify

Treat & Record

Advise & counsel on nutrition, FP,

labor signs, danger signs, follow-up visits

RECORD all findings, birth plan

And treatments given

The Partograph

Basic Emergency Obstetric Care

Dr. Jose Fabella Memorial Hospital

OBJECTIVES
General:
To understand the concept of the WHO
partograph.
Specific:
1.
To be able to record the observations
accurately on the graph.
2.
To be able to interpret the recorded
findings, recognize deviation from the
norm, and decide on timely referral

Module contents
I.

The Partograph

II.

Recording findings in the partograph

III.

Distinguishing normal from abnormal

labor patterns

IV.

Other findings to note (and record)

during IE

I. The Partograph
A

tool to help in management of

labor
Guides birth attendant to
identify women whose labor is
delayed and therefore decide
appropriate action

Monitor during labor

Progress

of labor

Cervical dilatation
Contraction pattern
Maternal

well being

Pulse, temperature, blood

pressure
Urine voided
Fetal

well being

Fetal heart rate and pattern

Color of amniotic fluid

Conditions that do not

need
the use of partograph

Conditions that do not need

the use of partograph
Antepartum

Multiple

pregnancy
hemorrhage
Malpresentation
Severe pre-eclampsia Very premature
and eclampsia
baby
Fetal distress
Obvious obstructed
Previous cesarean
labor
section

The parts of the partograph

Progress of labor

Maternal and fetal well-being

D
I
L
A
T
A
T
I
O
N

Alert line

D
I
L
A
T
A
T
I
O
N

Alert line

Action line

Parallel
and 4
hours to
the right
of alert
line

II. Recording the findings

in the partograph
Start

by labeling the record

with pertinent patient
identifying information.

Plotting the progress of

labor
Plot

only the CERVICAL

DILATATION using the symbol X
Start when woman is in ACTIVE
LABOR (4 cm or more) and is
contracting adequately (3-4
contractions in 10 minutes)

Start plotting on alert line in

the intersection
corresponding cervical
dilatation finding

4pm

Indicate the time the IE was made

(and therefore, the observation was
plotted)
Write this in the vertical line itself
where you plot the X, NOT the space

4pm

8pm

10pm

Perform internal examination

every 4 hours, or more often if
necessary, and plot findings each
time
Also, do not forget to write the time
each observation was made

4pm

8pm

10pm

Connect the Xs to
demonstrate the pattern of
labor

EXAMPLE

x
1am

A G1P0 is being monitored by

a midwife. Her initial IE at 1
am showed 4 cm dilated
cervix.

EXAMPLE
x

x
1am

5a
m

At 5 am, another IE
showed 8 cm dilated cervix.

EXAMPLE
x

x
1am

5a
m

7am

At 7 am, the patient was 9

cm dilated, intact BOW.

III. Distinguishing normal

from abnormal labor
pattern

X
X

4pm

6pm

8pm

10pm

Progress of labor is normal if

plotting stays on or to the
left of the alert line (green
part)

X
X

4pm

6pm

8pm

10pm

Note that based on the structure

of the partograph as soon as 4
cm is reached the cervix should
dilate normally at a rate of 1
cm/hour.

X
X
X

4pm

6pm

8pm

10pm 12am

2am

Plotting that passes the alert

line (yellow part) more so if it
reaches or passes the action
line (red part) indicates
ABNORMAL progress of labor

If plotting passes alert line D9

Reassess

woman and consider criteria

for referral.
Alert transport services
Encourage woman to empty bladder
Encourage upright position and
walking if woman wishes.
Monitor intensively.
If referral takes a long time, refer
immediately. DO NOT WAIT TO CROSS
ACTION LINE.

If plotting reaches the

action line D9
Refer urgently to hospital unless
birth is imminent

The parts of the partograph

Progress of labor

Maternal and fetal well-being

IV. Other findings to note

(and record) during IE
Status

of membranes, write

I if intact
If

ruptured, note color of amniotic

fluid, write

C if clear
M if meconium stained
A if absent
B if bloody

Monitor every 4 hours*

and record the findings
Blood

Pressure
Pulse rate
Temperature
Urine voided (yes or no)
* More frequently, if indicated

Monitor more frequently

and record the findings
Number

of contractions in
10 minute period
Fetal heart rate in 1 full
minute

 If

woman is admitted in LATENT

PHASE of labor (less than 4 cm
dilated) record only other
findings (BP, FHT etc). D8

If

she remains in latent phase for

next 8 hours (labor is prolonged),
transfer her to hospital. D8

EXERCISES
Indicate

whether the progress of

labor in the following partographs
are normal or abnormal.

Case 1

x
10p
m

2am

Case 2
X X

8pm

X
12mn

2am3am

Case 3

9pm
x

1am

3am

Case 4

X
X

9pm
x

1am

3am

EXERCISES
Plot

the observations in the

following cases.

Case 5:
Maria, G2P1 was admitted today at 2 am, IE
showed a 5cm dilated cervix, cephalic,
intact BOW. BP=110/70, PR=88/min,
afebrile. FHT=140/min.
She had moderate contractions (3 in 10
min). At 6 am, the BOW ruptured with
clear amniotic fluid. IE showed 8 cm
dilated cervix. Vital signs were the same.
At 8 am, cervix was 9 cm. She delivered
spontaneously at 8:30 am. 10 u oxytocin
was given IM. Placenta was delivered
complete at 8:35 am.

X
X

Maria,
G1P0
Date Today

X
2am

6am

8am
2

0
I

140

3
140

88
110/70
5

88
110/70

8:3
8:3
5
0

Case 6:
Lourdes, G4P2 was admitted at 1 pm today
due to watery vaginal discharge. The cervix
was 3 cm, cephalic, (-) BOW with clear
amniotic fluid. BP=120/80, PR=80/min, T36.5.
At 5pm, contractions were moderate, 3 in 10
min. IE showed cervix 4 cm dilated. Vital
signs remained the same.
At 9 pm, your IE showed 6 cm dilated cervix.
At 1 am, another IE done showed 8 cm dilated
cervix, meconium stained fluid. BP-110/70,
PR-92/min, T-37.5, FHT-140/min

Lourdes,
G4P2 Date
Today

X
X
X

5p
m
4

9pm
8

1am
12

3
36.5
80
120/80

140
37.5

92
110/70

Case 6:
Marites, G1P0 was admitted at 6 pm.
BP=120/80, PR-84/min, T=36.5.
FHT=150/min, cervix 5 cm dilated, (+) BOW.
She had 2-3 uterine contractions in 10 min.
After 4 hours, IE showed 7 cm dilated cervix.
Vital signs and FHT were the same.
At 12 am, another IE done showed 8 cm dilated
cervix, negative BOW, clear AF. FHT=
140/min.
Another IE after 2 hours was the same.
FHT=144/min, Vital signs same

Marites,
G1P0
Date Today

2am

X
X
6p
m

10p
m

12am

I
2-3
150

I
3
143
0
36.5
84
120/80
7

36.5
84
120/80
5

14
0
8

2
C
144
36.5
120/80
8

RECAP
Significance

and use of the

partograph
Parts of the partograph and
information contained in it
Recording or plotting of clinical
observations
Interpretation of the recorded
findings and decision on referral

Love
You,
I