Week 9 Partograph

Bachelor of Science in Nursing: NCMA 217 RLE
RLE MODULE RLE UNIT WEEK

CM2 CU3 10
Partograph
✔ Read course and laboratory unit objectives

✔ Read study guide prior to class attendance
✔ Read required learning resources; refer to course unit terminologies for jargons
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks
At the end of this unit, the students are expected to:

1. Describe the significance of EINC protocols.
2. Demonstrate competent Nursing care in rendering newborn.
3. Describe the essential elements of routine for EINC.
Partograph
The partograph is a graphical presentation of the progress of labor, and of fetal and maternal
condition during labor. It is the best tool to help you detect whether labor is progressing normally or
abnormally, and to warn you as soon as possible if there are signs of fetal distress or if the mother’s
vital signs deviate from the normal range. Research studies have shown that maternal and fetal
complications due to prolonged labor were less common when the progress of labor was monitored
by the birth attendant using a partograph. It was developed and extensively tested by the world
health organization WHO
Overview
• The partograph can be used by health workers with adequate training in midwifery who are able
to:
– observe and conduct normal labor and delivery.
– Perform vaginal examination in labor and assess cervical dilation accurately
– plot cervical dilation accurately on a graph against time
• There is no place for partograph in deliveries at home conducted by attendants other than those
trained in midwifery
• Whether used in health centers or in hospitals, the partograph must be accompanied by a program
of training in its use and by appropriate supervision and follow up
Objectives
• early detection of abnormal progress of a labor
• prevention of prolonged labor
• assist in early decision on transfer, augmentation, or termination or labor
• increase the quality and regularity of all observations of mother and fetus
• early recognition of maternal or fetal problems
• the partograph can be highly effective in reducing complications from prolonged labor for the mother
(postpartum hemorrhage, sepsis, uterine rupture and its sequelae) and for the newborn(death,
anoxia, infections, etc.)
❖ The partograph is actually your record chart for the laboring mother. It has an identification
section at the top where you write the name and age of the mother, her ‘gravida’ and ‘para’
status, her Health Post or hospital registration number, the date and time when you first
attended her for the delivery, and the time the fetal membranes ruptured (her ‘waters broke’).
Components of the partograph

I. Progress of labor
o Cervical dilatation
- Vaginal examinations are carried out approximately every 4 hours from this point until the
baby is born. The active phase of the first stage of labor starts when the cervix is 4 cm dilated
and it is completed at full dilatation, i.e. 10 cm. Progress in cervical dilatation during the active
phase is at least 1 cm per hour (often quicker in multigravida mothers).
- The dilatation of the cervix is estimated by vaginal examination and recorded on the
partograph with an X mark every 4 hours. Cervical dilatation in multipara women may need
to be checked more frequently than every 4 hours in advanced labor, because their progress
is likely to be faster than that of women who are giving birth for the first time.
o Contraction pattern
- Good uterine contractions are necessary for good progress of labor. Contractions are
recorded every 30 minutes on the partograph in their own section.
II. Maternal well being

o Pulse, temperature, blood pressure
- Blood pressure is measured every four hours. Pulse is recorded every 30 minutes.
Temperature is recorded every 2 hours.
o Urine voided
- Urine output is recorded every time urine is passed.
III. Fetal well being

o Fetal heart rate and pattern
-The normal fetal heart rate at term (37 weeks and more) is in the range of 120–160
beats/minute. If the fetal heart rate counted at any time in labour is either below 120
beats/minute or above 160 beats/minute, it is a warning for you to count it more frequently
until it has stabilised within the normal range.
o Color of amniotic fluid

- Another indicator of fetal distress which has already been mentioned is meconium-stained
amniotic fluid (greenish or blackish liquor). Lightly stained amniotic fluid may not necessarily
indicate fetal distress, unless it is accompanied by persistent fetal heart rate deviations
outside the normal range.
- The following observations are made at each vaginal examination and recorded on the
partograph:
o If the fetal membranes are intact, write the letter ‘I’ (for ‘intact’).
o If the membranes are ruptured write:
“ C ” if clear
“ M ” if meconium stained
“ A ” if absent
“ B ” if bloody
Conditions that do not need the use of partograph

- Antepartum hemorrhage - Multiple pregnancy
- Severe pre-eclampsia and eclampsia - Malpresentation
- Fetal distress - Very premature baby
- Previous cesarean section - Obvious obstructed labor
The parts of the Partograph
● Progress of labor
● The upper colored portion is where you plot the progress of labor.
● The lower portion is where you are supposed to write your other observations particularly the
findings of your monitoring of the maternal and fetal well-being.
● Maternal and fetal well-being
DILATATION
Alert line.
● Each horizontal gridline corresponds to the cervical dilatation in centimeter from 4 to 10.
● While the vertical gridlines indicate the time, in hours, the patient is in active labor.
● The upper portion is also divided into 3 colors – green, yellow, and red.
● The boundary between the green and yellow parts forms a diagonal line which is highlighted
here. This is designated as the alert line which starts at 4 cm. up to 10 cm.
Parallel and 4 hours to the right of alert line

Action line
● Parallel and 4 hours to the right of alert line
● Parallel and 4 hours to the right of the alert line is another line formed by the boundary
between the yellow and red part which is again highlighted here. This is the action line.
● Note that it too starts at 4 cm and ends in 10 cm.
Plotting the progress of labor

Plot only the CERVICAL DILATATION using the symbol “X” Start when woman is in ACTIVE
LABOR (4 cm or more) and is contracting adequately (3-4 contractions in 10 minutes)
If plotting passes alert line …
● Reassess woman and consider referral if facilities are not available to deal with obstetric
emergencies, unless delivery is imminent
● Alert transport services
● Monitor intensively
Make your own Partograph and plot the observations in the given scenario.
SECNARIO:
Mrs. AD, 35-year-old G4P3 multipara was admitted directly to the labor room, cervix 7-8 cm,
50% effaced, FHT 130 beat/minute, in cephalic position based on ultrasound result, V/S taken and
recorded: BP = 110/180, P/R = 70, R/R = 18. Gestational age is 38 weeks. After an hour, the patient
was transferred and placed in lithotomy position on the DR table for continuous monitoring of labor
and FHT. The patient has a history of lower abdominal pain for 2 hours, discharge of mucus with
blood stain for 1 hour. The OB Gyne did internal examination and revealed fully dilated cervix, and
amniotomy was done. The mother was instructed to bear down each contraction. After a few minutes,
a well-baby boy was delivered at 8:00 PM.
Answer the following questions based on EINC protocol:

1. Upon the delivery of the baby, what is your immediate nursing action?
2. What is your baseline assessment prior to do cord clamping?
3. How would you maintain the body temperature of the baby to avoid hypothermia?
4. How often should you measure the vital signs of the mother and record them on the
partograph in a normally progressing labor?
5. What are key indicators that needs immediate referral to the hospital?
Plot this in a Partograph
Time Cervix Membrane Lie Presentation FHR Descent Contraction

(cm)
4:00 3 (3 sec
4cm Intact Longitudinal Cephalic 144 3/5
PM each)
8:00 4 (45 sec
8cm Clear Longitudinal Cephalic 146 2/5
PM each)
Time 4:00 PM 8:00 PM

Pulse Rate 88 90
Blood Pressure 120/70 120/70
Temperature 377 3
Respiratory Rate 25 27
Fetal Development: Stages of Growth. Cleveland Clinic. Accessed October 21, 2020.
https://my.clevelandclinic.org/health/articles/7247-fetal-development-stages-of-growth
Santiago-Munoz P. Boy or girl? The difficulties of early gender prediction. diction. University of Texas
Southwestern. December 20, 2016. Accessed October 21, 2020. https://utswmed.org/medblog/gender-
prediction/
Zargari M, Sadeghi MR, Shahhosseiny MH, et al. Fetal Sex Determination using Non-Invasive Method
of Cell-free Fetal DNA in Maternal Plasma of Pregnant Women During 6(th)- 10(th) Weeks of
Gestation. Avicenna J Med Biotechnol. 2011;3(4):201-206.
https://slideplayer.com/slide/12865316/
https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=272&printable=1

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Bachelor of Science in Nursing: NCMA 217 RLE

RLE MODULE RLE UNIT WEEK

✔ Read course and laboratory unit objectives

At the end of this unit, the students are expected to:

Components of the partograph

II. Maternal well being

III. Fetal well being

o Color of amniotic fluid

Conditions that do not need the use of partograph

Parallel and 4 hours to the right of alert line

Plotting the progress of labor

Answer the following questions based on EINC protocol:

Plot this in a Partograph

Time Cervix Membrane Lie Presentation FHR Descent Contraction

Time 4:00 PM 8:00 PM

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