King Edward Memorial Hospital

Obstetrics & Gynaecology

CLINICAL PRACTICE GUIDELINE

Labour: Partogram
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Contents

Key points .............................................................................................2

Documentation ........................................................................................................ 2
Procedure ..............................................................................................2
Admission & assessment findings plus medical/obstetric history ............................ 2
Maternal assessment............................................................................3
Fetal assessment ..................................................................................3
Labour assessment ..............................................................................4
Oxytocin administration .......................................................................5
Investigations........................................................................................5
Staff initials ...........................................................................................5
Vaginal examination (VE) .....................................................................5
Instrument/ pack count ........................................................................7
Recording of staff .................................................................................7

References ............................................................................................8

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 Labour: Partogram

Key points
1. Alert and Action lines are drawn when the women is in the active phase of
labour.
2. The Alert line separates women into two groups, women with cervical dilatation:
 equal to / greater than 1cm/hour.
 slower than 1 cm/hour who are more likely to require an intervention.
3. The WHO partogram does not differentiate between nulliparous or multiparous
women.4

Documentation
The partogram is a record of care, which constitutes a legal document but is also an
avenue for identifying accountability in clinical practice. Therefore, accurate, legible
and comprehensive entries should be made in accordance with guidelines and in
black ink. Such entries should be made contemporaneously and authenticated with
a full and legible signature.

Procedure
Admission & assessment findings plus medical/obstetric history
 Place the woman’s identification label in the top left-hand corner.
 The admission details should be recorded as soon as practicable following
arrival.
 Enter all details in the appropriate sections on the front of the partogram.

Date
 Record the commencement date at the top of the partogram. When the date
changes at midnight write the new date above the times.

Time
 The numbered (0 1 2 3 etc) full vertical lines are hour lines.
 Note the exact time (e.g. 1450) of the first observation that you wish to record
(e.g. fetal heart, vaginal examination, etc). Go back to the nearest whole hour
– 1400 in this example.
 Fill in the time scale along the top of the partogram: 1400, 1500, 1600 etc
(1400 is 0 hour line) and record the observation on the partogram (in this
example just to the left of the 1500 line).
 Times must be written along the top of the partogram and may be written
along the mid-section of the page.

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 Labour: Partogram

Maternal assessment
 Record maternal blood pressure, pulse, temperature, respirations, and other
observations (e.g. reflexes, blood sugar levels) on the graph at the top of the
partogram
 Using the measurements down the left side of the graph record:
 Systolic blood pressure with a Λ
 Diastolic blood pressure with a V
 Pulse with a 

For example: 1400 1500 1600 1700 1800

Observations at 1500
and 1630hrs respectively

BLOOD 130

PRESSURE 120 


110 

100
PULSE
90 


80
Temperature
70 37.1 37.9
Respiration 22 20
60
Reflexes
Other (BSL/ 3.1
SaO2)

Fetal assessment
Record the FHR with a dot as follows:
 The vertical lines are half-hourly so that the quarter-hourly recordings can be
made
 During the second stage of labour the FHR is recorded 5 minutely in the
boxes provided (if the fetus is not being continuously monitored). The time is
written in the top left and the fetal heart rate is written below
 Second stage fetal heart rate recordings must also be documented half hourly
on the graph as in the first stage

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 Labour: Partogram

Amniotic fluid
 In the box that correlates with the correct time according to the vertical lines
record half hourly absence or presence, and colour of fluid as follows:
 I - membranes intact
 C - amniotic fluid is clear
 B - amniotic fluid is blood stained
 M - amniotic fluid has meconium staining

Labour assessment
Contractions
 These are recorded graphically below the fetal assessment information. An
area of 5 blank vertical squares goes across the width of the graph and record
contractions as ‘frequency in 10 minutes’.
 Each square represents 1 contraction. Therefore if 2 contractions occur in 10
minutes, 2 squares will be shaded.
 Use the key for shading to demonstrate the strength of contraction.
Weak and/or 20-40 seconds duration
Moderate and 20-40 seconds duration
Strong and 40 seconds duration

Abdominal palpation
 Record in position abdominal palpation box.

Cervicograph
 The cervicograph is that section of the partogram which depicts cervical
dilatation and descent of the presenting part in relation to time. Use of the
cervicograph enables the progress of labour to be ascertained and delay in to
progress readily recognised
Dilatation
 Record X for the cervical dilatation on the appropriate line and at the time the
examination is carried out
Descent
 Descent of the head is measured by abdominal palpation and is expressed in
terms of fifths above the pelvic brim. Record O for the level of descent at each
vaginal examination
Alert line
 A line drawn from the point of cervical dilatation noted at the first vaginal
examination in active labour. This line denotes a dilatation rate of 1cm/hour.

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 Labour: Partogram

Action line
 A line parallel and 4 hours to the right of the alert line 1

Oxytocin administration
Units: record half hourly in black the number of units per 500mL of intravenous fluid.
mL/h: record in black the mL/h infusion rate.
For example:
0900 1000 1100 1200

Oxytocin units 10 10 10 10 10
mL/h 12 36 36 36 48
24
In this example the infusion commenced at 0930 at 12mL/h, increased to 24mL/h at
0945 and increased to 36mL/h at 1000.

Investigations
 Document any investigations performed since labour admission or those prior
to induction of labour. For example: Full Blood Count, Group and Hold,
vaginal swab.

Urine
 Record each void, measure the volume of urine as required
 Record urinalysis (if required) for protein and ketones in the appropriate time
box

Staff initials
 Staff (including midwifery and medical students) that have performed
observations are to provide their initials in the allocated boxes
 Full name, signature, designation and initial are to be recorded on the reverse
side of the partogram

Vaginal examination (VE)

All VE’s are to be documented on the partogram
Date/time
 Record for each examination
Indication
 Specify the reason for the vaginal examination
Cervical effacement/length
 Estimate length in cm

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 Labour: Partogram

Dilatation
 Measured dilatation in cm
Cervical position
 Stated as either anterior, posterior or midline
Application
0: not applied
L: loosely applied
M: moderately applied
T: tightly applied.
Consistency
F: the cervix is firm to touch
M: the cervix is medium to touch
S: the cervix is soft to touch
Membranes/liquor
 Use ‘I’, ‘C’, ‘B’, ‘M’
Presentation
 Stated as cephalic, breech, shoulder, cord
Position
 Record LOA, LOL, LOP, ROA, ROL, ROP
Caput
0: no caput
+: small caput
++: moderate
+++: large caput
Moulding
0: no moulding
+: sutures are apposed
++: sutures overlapped but reducible
+++: sutures overlapped and not reducible
Station
 This is measured in cms above (-) or below (+) the ischial spines. That is
 Above spines: -5, -4, -3. -2, -1
 0 (at spines)
 Below spines: +1, +2, +3, +4, +5

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 Labour: Partogram

Head above brim (as per abdominal palpation)

5/5: completely above
4/5: sinciput high, occiput easily felt
3/5: sinciput easily felt, occiput felt
2/5: sinciput felt, occiput just felt
1/5: sinciput felt, occiput not felt
0/5: none of head palpable
FHR post-VE/FBS
 Record the fetal heart rate after a vaginal examination and the result of a fetal
blood sample here
Bishops score
 See scoring guide on the partogram. Record if induction of labour is required
Performed by
 Include signature, printed name and designation

Instrument/ pack count

 Two staff members are to check the number of birth instruments and/ or
packs immediately prior to the procedure commencing and confirmed again at
the end of the procedure prior to equipment being cleared away [RCA
recommendation Nov 2019]
 Record the number of birth instruments and/or packs utilised on the
Instrument/Pack Count section of the MR 270 Partogram
 Additionally, if perineal repair is required document the Instrument and Pack
Count on the relevant form:
 Spontaneous vaginal birth: On the MR 270 Partogram: Perineal Repair
– Spontaneous Birth section
 Operative birth: On the MR 275 Operative Vaginal Delivery and
Perineal Repair: Perineal Repair section
 See also WNHS Policy: Count Policy [NEW 2019]

Recording of staff
 Legibly document name, signature, designation and initials

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 Labour: Partogram

References
1. World Health Organisation. WHO recommendation on the use of active phase
partograph with a four hour action line for monitoring the progress of labour. 2014.

Related WNHS policies, procedures and guidelines

WNHS Policy:
 Count Policy
KEMH Clinical Guidelines:
 Labour and Birth: First stage; Second Stage

Useful resources (including related forms)

Forms:
 MR 270: Partogram
 MR 275 Operative Vaginal Delivery and Perineal Repair

Keywords: partogram, cervical dilation, action line, alert line, labour

Document owner: Obstetrics, Gynaecology & Imaging Directorate
Author / Reviewer: CMC Labour & Birth Suite
Nov 2019: Instrument / pack count section updated to include that two staff
members are to check the number of birth instruments and/ or packs prior to and
at the end of the procedure, prior to equipment being cleared away
Date first issued: Nov 2001
Reviewed: ; Feb 2015; Oct 2018; March 2019 (minor Next review date: Nov 2022
amendment to table on page 5); Nov 2019
(amendment to instrument /pack count
section on page 7- RCA recommendation)
Supersedes: ‘Partogram’ - Version dated March 2019
Endorsed by: Obstetrics & Gynaecology Directorate Date: 25/11/2019
Management Committee [OOS approved with
Medical and Midwifery Co directors]
NSQHS Standards 1 Governance, 8 Recognising & Responding to Acute Deterioration
(v2) applicable:
Printed or personally saved electronic copies of this document are considered uncontrolled.
Access the current version from the WNHS website.

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