PARTOGRAM

Definition A partograph is a composite graphical record of cervical dilatation and descent of head against duration of labour in hours

Principles Active phase of labour commences at 3cm cervical dilatation. Latent phase of labour should not last longer than 8 hours During active labour, the rate of cervical dilatation should not be slower than 1 cm/hour Vaginal examination should be performed as frequenlty as once in 2-4 hours Uterine activity and fetal heart tones are assessed every 15-30 minutes It should be used for all women in established labour.

History Friedman (1954) Hendricks (1969) Philpott (1972) WHO (1987)

Components of a partograph

Identification data

Vitals signs of the mother

Fetal Heart Rate

Membrane and Liquor

Cervical Dilatation Latent to active phase Latent phase upto 3cm Active phase from 3cm to 10cm

Descent of the head

Uterine Contractions

Oxytocin Regime Drugs and IV Fluids Urine volume, output and Proteins

Advantages Useful tool in the labour room Information in a single sheet Easy to maintain Record are straight forward and objective Facilitates easy handing over Has a predictive value Possible to estimate time of delivery Early warning in case of impending problems

Limitations Frequency of examination varies Difficult for a incompetent personnel to maintain and record Chances of copying the previous recordings Deviation from 1cm/hour dilatation rate may be normal