Understanding the Partograph in Labor Management

What is a Partograph?

• A simple and affordable chart used during labor to track the progress of labor, the condition of both the mother and baby, and the outcome of labor.
• Helps detect problems like slow labor or fetal distress early on, allowing for timely intervention.
• Recommended by the WHO for routine use in labor management to prevent complications.

Why is the Partograph Important?

• Provides a comprehensive overview of labor progress, enabling the identification of potential issues early.
• Studies show that utilizing partographs during labor can reduce the occurrence of prolonged labor and associated complications.

Four Components of a Partograph

• Progress of Labor: Tracks cervical dilation against time, utilizing an Alert Line and Action Line to indicate normal or delayed labor.
  • Alert Line: Indicates slow labor progression.
  • Action Line: Signifies significant delay, requiring immediate intervention.
• Maternal Condition: Records maternal vital signs (blood pressure, pulse, temperature), as well as contractions, urine output, and any bleeding.
• Fetal Condition: Monitors fetal heart rate (FHR) and records the condition of the amniotic fluid (clear, meconium-stained, etc.).
• Outcome of Labor: Documents details such as the time of placental delivery, if oxytocin was administered to aid contractions, and any complications.

How to Use the Partograph

• Begin using the partograph at the onset of active labor (cervical dilation of 4 cm and regular contractions).
• Plot cervical dilation every time an internal examination is performed (usually every 4 hours).
• If the plot crosses the Alert Line, evaluate the reason for slow labor.
• If the plot crosses the Action Line, take immediate action or refer to a hospital, particularly if birth is not imminent.

What to Do if Labor is Abnormal

• Crossing the Alert Line: Reassess the mother and fetus more frequently. Encourage the mother to move, empty her bladder, or change position.
• Crossing the Action Line: Take urgent action, such as administering medications or performing procedures, or refer to a hospital, especially if birth is not imminent.

Additional Tips

• Plot cervical dilation only from active labor (4 cm or more).
• Do not wait for the plot to cross into critical zones before acting.
• In early labor (less than 4 cm dilation), the mother can be sent home to wait for active labor to begin.