1. The Partograph

3. Partograph Use partograph to monitor progress of labour at all women admitted to labour ward Women should not be admitted for labour ward until in active labour Active labour is when women have regular contractions (3-5 in ten minutes) and cervix is 4 cm. dilated

4. Fetal Heart Rate: Assess after contraction for 60 seconds: Each 30 minutes in first stage (each 15 minutes if risk factors are identified Each 5 minutes when pushing

5. Cervical Dilatation Assessed each 4 hours (or before if a crossed action line is anticipated) Alert Line: Start recording cervical dilatation in the alert line. As long as dilatation is 1 cm or more/hr the alert line is not crossed. If cervical dilatation is < 1 cm/hr the alert is crossed and causes of prolonged labour should be considered: always consider: artificial rupture of membranes and augmentation with oxytocin.

6. Cervical dilatation Action Line: If the action line is crossed the actions should be as follows in mentioned order (if not already performed) ARM and oxytocin augmentation Correction of malposition Cesarean Section or Vacuum (if in second stage and descend is 1/5 or below)

7. Amniotic fluid: I= Intact Membranes C= Clear M= Meconium stained B= Blood stained Remember: the diagnosis “cephalopelvic disproportion” cannot be made with intact membranes!

8. Contractions: Chart every 30 minutes Number/10 minutes and Duration Weak: Lasting 40 seconds Oxytocin: Record oxytocin (amount/volume) and drops / minute