Modified WHO Partograph

2. WHO PARTOGRAPH
Presented by
Miss. Santosh
M.Sc.1st Year

3. PARTOGRAPH
• First introduced by E.A Friedman
from New York in 1955
• It is the graphic analysis of labour
for clinical evaluation of the
progress of labour.
• It plots the dilatation of cervix in
centimeters against time in hour.

4. • Partograph was further modified by
Philpott and Castle in 1972.
• They added the alert line and action
line.
• They also plotted the descent of
head.
• They emphasized its clinical
application.

5. • Modified
• Begins in the active phase.
• Cervix dilated 4 cm.

6. PARTOGRAPH

7. MOTHER INFORMATION

9. FETAL INFORMATION

10. • Each vertical side of the rectangle
represents 10 beats per minutes.
• Each horizontal side of the
rectangle represents 30 minutes.

11. • Expectite delivery if fetal heart rate
is below 100 or above 180bpm.
• Below 100bpm severe bradycardia
and above 180bpm its severe
tachycardia.

12. AMNIOTIC FLUID
• Record color at every vaginal
examination.
• If thick meconium and absent of
fluid at the time of rupture
membrane.
• Note frequent fetal heart rate
• May be sign of fetal distress.

13. • I – Intact membrane.
• R – Ruptured membrane.
• C – Clear fluid and membrane
ruptured.
• M – Meconium- stained fluid.
• B – Blood stained fluid.

14. MOULDING
• Moulding is an important indicator of
how adequately the pelvis can
accommodate the fetal head.
• Moulding noted every 4 hourly.
• Note and record moulding in each
pelvic examination.
• Palpate the suture and bones of fetal
skull to determine the degree of
moulding.

15. There are four ways to note the moulding
• If the bones are separated and sutures
are felt easily, record as “ 0”.
• If the bones are just touching each other
record as “+1”.
• If the bones are overlapping record as
“+2”.
• If the bones overlapping severely record
as “+3”.

17. LABOUR PROGRESS

18. Cervical Dilatation
• Each vertical side of the rectangle
shows 1 cm of dilation.
• Each horizontal side of the
rectangle (small) shows 30 minutes.
• Alone the bottom of the graphs the
square shows the number of hours.
Each square represent 1 hours.

19. • Cervical dilation noted as per 4
hourly.
• Each square represent 1 hour.
• Two diagonal lines
1. Alert line.
2. Action line.

20. ALERT LINE
• Represents the rates of cervical
dilatation 1cm per hour.
• Considered to be the lowest level of
the norm for both nuliparae and
multipare.
• Labor progress normally the rate of
the dilation on the alert line or to the
left of the alert line.

22. Cervical dilation to the right of the
alert line is shows the slow progress
of labour. Appropriate action should
be taken. E.g. Amniotomy.

23. ACTION LINE
• If the cervical dilation reaches or
cross the action line it means very
slow progress of labour.

24. • The value of dilation at admission
should be immediately plotted on the
alert line. It is plotted by (X).
• During each next vaginal
examination plot the value on the
graph and connect all the finding
with a solid line.

25. HEAD DESCENT
• Descent should not takes place when
the cervical dilation should not reach
to 7cm.
• To plot the fetal head descent use the
space from 5 to 0 in the same area
where you record cervical dilatation.

26. • Each vertical side of the rectangle,
one fifth of the head above the pelvic
brim. For convenience, the width of
the finger is used as a practical guide.
• Each horizontal side of the rectangle
shows 30 minute

27. • Pelvic brim will accommodate the full
width of 5 fingers should record the
head position on the partograph with
“0”.
• The head is engaged when the
position above the brim is represented
by 2 fingers or less.

29. • Plot the values of the fetal head
descent (0 sign) are plotted at the
same vertical lines as the values of
the cervical dilatation (x sign).
• The descent should be taken at the
same time of vaginal examination or
cervical dilatation.

31. e.g.
At admission (10pm)
• Cervical dilation is 5 cm
• Head descent is 5/5 cm.
At 2 am
• Cervical dilation is 9 cm.
• Head descent is 2/5 palpable.

32. 2:00

33. UTERINE CONTRACTION
•

36. Oxytocin
• When inadequate uterine activity is
detected the use of oxytocin should
be considered.
• Always check the membrane are
ruptured before oxytocin infusion is
used in labour.

37. • Note the unit of oxytocin per litter in
upper row. Note the number of drops
per minutes in lower row.
• Note every half hour the oxytocin
infusion

38. DRUG
• Sometimes there is need to
administer drugs and intravenous
fluid.
• Record the name of drug, dosage and
the route of administration, just below
the column of the oxytocin recorded.

40. MOTHER CONDITION

41. PULSE
• Record every 30 minute and mark
with a dot (.)

42. BLOOD PRESSURE
Record every 4 hourly and mark with
arrow

43. TEMPRATURE
Record every 2 hours.
.

44. PROTEIN, ACETONE AND
VOLUME
• Record when urine passed

45. EXAMPLE
Astha admitted in active labor at 10:00 PM.
 Gradiva 1, Para 0.
 FHR- 130bpm
 Fetal descent - 5/5 palpable.
 Cervix dilatation- 5cm.
 3 contraction in 10 minute each lasting for 30
seconds.
 Intact membrane.
 Bones are seperated and suture are felt
easily.
 Pulse-70bpm.
 B.P. – 120/80mm/hg
 Temperature- 36.8c.

46. At 12:00 am
 FHR- 140bpm
 Fetal descent- 4/5 palpable.
 4 contraction in 10 minute each lasting for 30
seconds.
 Pulse-80bpm.
 Temperature- 36.8c

48. AT 2:00 AM
 FHR- 140
 Fetal head 2/5 palpable.
 Cervical dilatation- 9cm
 4 contraction in 10 minutes, each lasting
more than 40 seconds
 Membrane intact
 The bones still separated and sutures can
be felt easily.
• Spontaneous vaginal delivery at 2:25 AM.

49. 2:00

50. SCENERIO
At 9 AM (admitted)
• FHR- 130bpm.
• Amniotic fluid clear.
• Skull bones are just touching each other.
• Fetal head 3/5 palpable.
• Cervix dilated 5 cm.
• Four contractions in 10 minutes, each lasting 35
seconds.
• B.P of mother is 120/80 mm//hg.
• Pulse is 80bpm.
• Temperature of mother is 36.8°c.
• Volume of urine is 200ml.

51. At 11 AM
• Fetal head 2/5 palpable.
• Four contractions in 10 minutes
each lasting 45 seconds.

52. At 1 AM
• FHR- 140bpm.
• Amniotic fluid clear.
• Sutures are overlapped and not seperated easily.
• Fetal head 0/5 palpable.
• Cervical dilation progressed at rate of more than 1
cm per hour and cervix fully dilated.
• Five contraction in 10 minutes each lasting 45
seconds.
• B.P. of mother is 120/80 mm/hg.
• Pulse is 90bpm.
• Spontaneous vaginal delivery at 1:20 PM.