1. PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK
RECORDING PROGRESS OF LABOUR
PARTOGRAM
PROF DR MN MOHD AZHAR
ROYAL COLLEGE OF MEDICINE PERAK

2. WHY IS IT IMPORTANT TO RECORD THE PROGRESS 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.

3. TOOL FOR RECORDING THE PROGRESS OF LABOUR
PARTOGRAM

4. PARTOGRAM
PARTOGRAM is a graphical information about the progress of labour in which the salient information about the fetal well-being, maternal well-being and the progress of labour are recorded into a chart.

5. PARTOGRAM IT’S SIGNIFICANT:
Is a managerial tool used to record all observations made on a woman and fetus in labour in one chart.
Partogram helps to identify at an early stage those women whose labour is slow.
A managerial tool for prevention of prolonged labour.

6. PARTOGRAM WHO REQUIRE PARTOGRAM RECORDING
For all women who are in labour (i.e. either low or high risk group).

7. PARTOGRAM Friedman's partogram - 1954
2 phases of labour (base on dilatation
of the cervix )
Latent phase (dilatation < 3 cm)
Active phase (>3 cm dilated)
Active phase
Latent phase
Philpott and Castle
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

8. PARTOGRAM Mother information Fetal well-being Labour progress
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

9. PARTOGRAM
WHAT NEED TO BE
RECORDED

10. PARTOGRAM RECORDING 3 4 1 2 Notes should be legible, dated and timed.
Enter the outcome
of delivery
Begin plotting at the “zero” hour on the partogram 2
All entries made in relation to time when the observations are made

11. PARTOGRAM RECORDING Mother information Name Age Parity
Gestational period
Date/time of admission
Time of rupture membrane
Short antenatal history

12. PARTOGRAM RECORDING Fetal information Fetal heart rate
Membrane and amniotic
fluid
Moulding

13. PARTOGRAM RECORDING Fetal information Fetal heart rate monitoring
Safe and reliable way of knowing fetus is well.
Listen after each contraction for one minutes.
Recorded ½ hourly (each square is ½ hour)

14. PARTOGRAM RECORDING Fetal information Character of amniotic fluid
State of liquor can assess in monitoring fetal condition.
Observation to be recorded
- Membrane intact record as “I”
- Membrane rupture:
a) liquor clear record as “C”
b) meconiun stained liquor “M”
c) liquor absent record as “A”

15. PARTOGRAM RECORDING Fetal information Moulding of fetal skull
Provide information about the adequacy of pelvis to accommodate fetal head
Record the degree of moulding
0  bones separated
+  bones touching but can
be separated.
++  bone over lapping
+++  bones over lapping
severely

16. PARTOGRAM RECORDING Labour Progress Cervical dilatation Descent
Uterine contraction

17. Dilatation and Descent
PARTOGRAM RECORDING
Labour progress
Dilatation and Descent
Latent (0-3 cm) and Active (3-10 cm) phase.
Dilatation of cervix plotted as “X” axis and Descent plotted as “O” axis.
First vaginal examination done on admission is recorded.
Subsequent vaginal examination is done every 2-4 hourly.
Transfer from latent to active phase.

18. PARTOGRAM RECORDING + + Labour progress recording in latent phase
Plot dilatation as “X”
Plot descent as “O”
Latent phase + +
At admission:
- Dilatation  2 cm
- Descent  -2
2 hours after admission:
- Dilatation  2 cm
- Descent  -1
As the dilatation is only 2 cm therefore
the labour progress is in the latent
phase

19. PARTOGRAM RECORDING + + + + Labour progress recording in active phase
Plot dilatation as “X”
Plot descent as “O”
Latent phase +
Active phase + +
Latent phase +
0 hours
(admission)
2 hours
4 hours
Dilatation
“O”
2 cm
4 cm
7 cm
Descent
“X” -2 -1 +1

20. PARTOGRAM RECORDING + + + + Cervical dilatation
Latent phase +
If labour progress well plotting of cervical dilatation should always remain to the left of alert line.
If it cross to right of action line this warns that labour may be prolonged. + + +

21. PARTOGRAM RECORDING Labour progress Uterine Contractions
Observation is made ½ hourly
Assess the frequency, duration.
Each square represent 1 contraction felt in 10 minutes.
Frequency – highlight the numbers of square.
Duration – shade the contraction in the square.
< 20 sec Mild
20-40 sec Moderate
> 45 sec Strong

22. Recording the uterine on the
PARTOGRAM RECORDING
Labour progress
Recording the uterine on the
partogram
Nos. of
Contraction
in 10 mins
2 weak contractions
in 10 minutes
5 strong contractions
in 10 minutes
3 moderate contractions
in 10 minutes

23. PARTOGRAM RECORDING Mother condition Vital signs – BP, Pulse, TºC
Urine analysis – acetone,
albumin, glucose
Urine volume
Medications or drug given

24. PARTOGRAM RECORDING Mother condition Vital signs recording
BP – 4 hourly or more
frequent if indicated
Pulse - ½ hourly
TºC – 4 hourly
Urine analysis – dipstick
acetone  Nil or +
albumin  Nil or +
glucose  Nil or +
Urine volume

25. PARTOGRAM RECORDING + + + + +
Analyzing the progress of labour from the partogram
Active phase +
If progress is satisfactory the plotting will remain on or to the left of the alert line.
If labour is not progressing normally the plotting will be to the right of the alert line.
Latent phase + + + +

26. PARTOGRAM RECORDING LABOUR PATTERNS Normal labour
Active phase
Normal labour
Prolonged latent phase
Primary dysfunctional
labour
Secondary arrest
Latent phase

27. PROF DR MN MOHD AZHAR ROYAL COLLEGE OF MEDICINE PERAK
RECORDING PROGRESS OF LABOUR - PARTOGRAM
THANK YOU
PROF DR MN MOHD AZHAR
ROYAL COLLEGE OF MEDICINE PERAK