How to Fill the Partograph

Step 0 - Before You Start

• Only begin a partograph when the woman is confirmed to be in labour (contracting sufficiently).
• Check there are no existing complications requiring immediate action.
• The partograph covers the active phase; it is not started during the latent phase.
• According to the WHO/MSF protocol, start the graph at 5 cm dilation (or 4 cm if labour is induced), with at least 3 contractions every 10 minutes.

SECTION 1 - Patient Identification (Top of the Form)

SECTION 2 - Fetal Condition (Upper Graph)

Fetal Heart Rate (FHR)

• Record every 30 minutes during active labour (every 15 min in second stage).
• Normal range: 110-160 bpm.
• The graph has bold lines at 100 and 180 bpm - values outside these lines indicate fetal distress.
• Plot each reading as a dot and connect with a line.

Amniotic Fluid

• Assessed at each vaginal examination and recorded in the row below FHR.
• Use standard codes:
  • I = Intact membranes
  • C = Clear fluid
  • M = Meconium-stained
  • B = Blood-stained
  • A = Absent (dry)

Moulding (Caput / Skull Overlap)

• Assessed by vaginal examination.
• Record using codes:
  • 0 = No moulding
  • + = Bones just touching
  • ++ = Bones overlapping but reducible
  • +++ = Bones severely overlapping, not reducible (dangerous - suggests cephalopelvic disproportion)

SECTION 3 - Labour Progress (Central Graph - The Most Important Section)

Cervical Dilation (Plot with X)

• Assessed by vaginal examination every 4 hours (or more frequently if clinically indicated).
• Plot on the y-axis (0-10 cm) against time on the x-axis.
• Mark each finding with an "X".
• The first plot in the active phase goes directly onto the Alert Line, regardless of actual hours elapsed.

Descent of Fetal Head (Plot with O)

• Assessed by abdominal examination (rule of fifths above the pelvic brim) - always done immediately BEFORE the vaginal examination.
• Scale: 5/5 = head fully above pelvic brim; 0/5 = head fully engaged.
• Plot with an "O" at the same time as cervical dilation.

The Alert Line and Action Line

Normal labour: the cervical dilation plot stays on or to the left of the Alert Line.

SECTION 4 - Contractions (Below the Cervicograph)

• Record every 30 minutes.
• Count number of contractions in a 10-minute window (y-axis: 1-5 contractions).
• Each box represents one contraction; shade the box to indicate duration:
  • Dotted/outline only = < 20 seconds (mild)
  • Hatched/diagonal lines = 20-40 seconds (moderate)
  • Solid/fully filled = > 40 seconds (strong)

SECTION 5 - Medications and Oxytocin

• Oxytocin (U/L and drops/min): Record dose and rate of infusion.
• Drugs given and IV fluids: Write the drug name, dose, route, and time administered in the free-text boxes.

SECTION 6 - Maternal Condition (Lower Section)

Pulse and Blood Pressure

• Pulse (marked with a dot •): Record every 30 minutes.
• Blood pressure (marked as a vertical line with arrows ↑↓): Record every 4 hours (or every 30 min if hypertensive).
• Both are plotted on the same graph (range 60-180).

Temperature

• Record every 4 hours (or 2-hourly if elevated).
• Normal: 36.5-37.5°C.

Urine

• Record each time the woman passes urine:
  • Protein: None, trace, +, ++, +++
  • Acetone: None, trace, +, ++
  • Volume: Amount in mL

Summary: Recording Frequency

Key Interpretation Rules

1. Latent phase (0-3 cm): Should last no more than 8 hours; the partograph has a heavy line at 8 hours of the latent phase as a warning.
2. Active phase (4-10 cm): Normal rate is at least 1 cm/hour.
3. Plot crossing the Alert Line = monitor closely, consider transfer.
4. Plot crossing the Action Line = intervene immediately (augment, ARM, or caesarean section).
5. Moulding +++ even with adequate contractions strongly suggests cephalopelvic disproportion.

How to Fill This WHO Simplified Partograph

SECTION 1 - Header (Patient Details)

SECTION 2 - Fetal Condition (Upper Panel)

Fetal Heart Rate

• Y-axis: 100 to 180 bpm, in increments of 10.
• Record every 30 minutes (every 15 minutes in the second stage).
• Plot each reading as a dot, then connect dots with a line.
• Normal range: 110-160 bpm.
• The form has bold/thick lines at 100 and 180 - values outside these are danger signs.

Liquor (Amniotic Fluid)

• Record in the Liquor row at every vaginal examination.
• Use standard codes:
  • I = Intact membranes (not yet ruptured)
  • C = Clear fluid
  • M = Meconium-stained (green/brown)
  • B = Blood-stained
  • A = Absent / dry

Moulding

• Record in the Moulding row at every vaginal examination.
• Codes:
  • 0 = No moulding
  • + = Bones just touching
  • ++ = Bones overlapping but reducible
  • +++ = Severe overlap, not reducible (serious - suggests cephalopelvic disproportion)

SECTION 3 - Progress of Labour (Central Graph - Most Important)

Understanding the Pre-printed Lines on This Form

• Alert Line: Diagonal line from 4 cm at Hour 8 to 10 cm at Hour 14 - represents 1 cm/hour dilation.
• Action Line: Diagonal line from 4 cm at Hour 12 to 10 cm at Hour 18 - drawn 4 hours to the right of the alert line.

How to Plot Cervical Dilation (use X)

1. During the latent phase (0-3 cm), plot dilatation in the latent phase area against actual hours elapsed.
2. When the woman enters the active phase (4 cm+), plot the first active-phase reading directly on the Alert Line at 4 cm - do NOT plot it at the actual hour spent so far.
3. All subsequent readings are plotted every 4 hours (or as needed) moving to the right.
4. Mark each reading with an "X".

How to Plot Descent of Fetal Head (use O)

• Assessed by abdominal examination (fifths of head palpable above pelvic brim) - done just BEFORE each vaginal exam.
• Scale: 5/5 = head fully above brim; 0/5 = fully engaged/delivered.
• Mark with an "O" at the same time column as the cervical dilation reading.

Time Row

• In the Hours row: write 1, 2, 3... sequentially from left.
• In the Time row: write the actual clock time (e.g., 08:00, 08:30, 09:00...) under each column.

Interpreting the Graph

SECTION 4 - Contractions (Below the Main Graph)

• Y-axis: 1 to 5 contractions per 10 minutes.
• Record every 30 minutes.
• Count the number of contractions felt in a 10-minute window and shade that many boxes in the column.
• Shade the box differently to indicate strength/duration:
  • Outline only (dotted) = < 20 seconds (mild)
  • Hatched = 20-40 seconds (moderate)
  • Solid/fully shaded = > 40 seconds (strong)

SECTION 5 - Oxytocin & Medications

Oxytocin U/L / drops per min

• Two rows: write the concentration (U/L) in the top row and the infusion rate (drops/min) in the bottom row.
• Update whenever the rate changes.

Drugs given and IV fluids

• In the open section below oxytocin, write:
  • Drug name, dose, route, and time given
  • Type and volume of IV fluids running

SECTION 6 - Maternal Condition (Lower Panel)

Pulse and Blood Pressure

• Y-axis: 60 to 180 (same scale for both).
• Pulse (dot •): Record every 30 minutes.
• Blood Pressure (vertical arrow ↑↓ with top = systolic, bottom = diastolic): Record every 4 hours (or every 30 min if hypertensive - as noted "4 hourly" on this form).
• Plot both on the same grid and connect pulse dots with a line.

Temperature (Temp °C)

• Record in the Temp °C row every 4 hours (or 2-hourly if raised).
• Write the numeric value in the box (e.g., 37.2).

Urine

• Protein: Nil / Trace / + / ++ / +++
• Acetone: Nil / Trace / + / ++
• Volume: Amount in mL (e.g., 200)

Quick Reference Summary

Key rule for this form: The Active Phase plotting always starts at the Alert Line (4 cm). If the woman is admitted already at 6 cm, that 6 cm reading goes on the Alert Line at the 6 cm mark - not at whatever hour she spent in labour before admission. All subsequent plots move rightward in real time from that starting point.