30/01/2026
THE PARTOGRAPH.
Definition of a Partograph
A partograph is a tool used by the midwife/obstetrician to monitor the progress of labour and be able to detect any deviation from normal as early as possible.
The following information regarding labour is recorded on the partograph.
PERSONAL PARTICULARS
Name
Gravid
Parity
Date of Admission
Time of Admission
Hospital Number
Time membranes ruptured
PROGRESS OF LABOUR
A partograph is opened when cervical dilatation is 4cm or more. It has 2 diagonal lines.
The alert line (alerts us)
This is the 1st line. It represents the active phase of labour. It is drawn at 4cm dilatation to a point at the top of the graph which will represent full dilatation. The cervix dilates to a minimum of 1cm/hour in primi-gravida and 1.5cm in multi-gravida
This line alerts the midwife/Doctor to the fact that progress of labour is abnormal when the readings cross this line.
Action line (action needs to be taken)
This is the 2nd line, drawn parallel to and 4hours to the right of the alert line. It indicates the need for something to be done about poor progress of labour.
Cervical Dilation
This is plotted as O with an upward arrow on top. The 1st V.E is recorded and then the subsequent will be done every after 4hours and recorded.
On admission, cervical dilatation is recorded on the alert line at the place equal to her dilatation and time recorded at the space for time. If labour is progressing well, the plotting of cervical dilatation will remain plotted on the left of the alert line.
Descent of the Head
The cervix dilates as the foetal head descends into the mother’s pelvis. Descent is determined abdominally as the midwife places her hand over the foetal head. If all fingers cover the head, it is said to be 5/5 above the pelvic brim. Plot the descent of the head at every V.E conducted. It is plotted using “Δ” “O”
Uterine Contractions
The midwife is required to note:
The length
The strength
The frequency of uterine contractions
The strength of the contractions is assessed from the reactions of a woman and by laying your hand on the fundus and noting the degree of hardness of the contractions.
The following boxes show the type of contractions as follows.
1. Fill in one horizontal square for each contraction felt in a 10 – minute period
2. Use dots to fill in the squares for mild contractions lasting less than 20 seconds.
3. Use diagonal lines to fill in the squares for moderate contractions lasting 20 to 40 seconds.
4. Use solid color to fill in the squares for strong contractions lasting longer than 40 seconds
In the latent phase, contractions should be 1 or more in 10 minutes, each lasting 20 seconds or more.
In the active phase, contractions should be 2 or more in 10 minutes, each lasting 20 seconds or more.
FETAL WELLBEING
Foetal Heart Rate
Auscultate and listen to the foetal heart rate. It is a safe and reliable way of knowing that the foetus is well. This is done using a Pinards stethoscope or Doppler Ultra Sound apparatus.
Note the following:
Rate
1. Count the fetal heart rate in a full complete minute.
2. It should be within the normal range 120-160beats/min
3. Below 120beats may indicate bradycardia and above 160beats may indicate tachycardia, both extremes would indicate fetal distress.
Rhythm
The normal foetal heart has a coupled beat which remains steady.
The fetal heart rate is recorded on top of the graphs and is plotted every 30minutes (1/2hourly)
LIQUOR AND MEMBRANES
The condition of liquor gives more information to the midwife about the foetal condition especially after they have ruptured.
Normal liquor is clear.
At each V.E, it is important to note the state of the membranes or liquor and plot on the partograph as follows:
C- Clear liquor
B- Blood-stained liquor
M - Meconium stained liquor (fresh/old)
A - Absent liquor
I - Intact membranes
Dark green meconium may indicate foetal distress especially in non-breech presentation.
Absent may indicate ruptured membrane or the baby is post mature and hence reduced liquor volume.
If the above are noted listen to the foetal heart every 15minutes (1/4hourly)
MOULDING OF THE FETAL SKULL BONES
Moulding allows for reduction of the foetal head diameters and easy passage in the pelvic canal.
The recording is as earlier discussed:
0 Nomoulding
+ Bonesin apposition
++ Bones overlapping but reducible on finger pressure
+++ Excessive moulding
In case of excessive moulding, the mother should be referred to the next level of health service delivery.
MATERNAL WELLBEING
All the recordings for the mother’s condition are entered at the bottom of the partograph
Vital Signs
Pulse - recorded every 30minutes, mark with a dot.
Blood Pressure- recorded every 2-4 hours, it is marked with fused arrows.
Temperature- every 2hours
Urinalysis
Each time the woman passes urine or micturites, measure the amount and test for glucose, proteins and acetone.
Drugs
Record all drugs given to the mother during labour in the space provided on the partograph
Fluids
Oral fluids or IV fluids should be recorded in the column provided.
INTERPRETATION OF THE RESULTS
1. The recording of the partograph should be done correctly and adequately in order to have a precise interpretation.
2. The recordings should be clear enough for everyone to read and interpret.
3. The symbols used should be familiar to everyone for easy interpretation.
