Partogram
A partogram or partograph is a composite graphical record of key data during labour entered against time on a single sheet of paper. Relevant measurements might include statistics such as cervical dilation, fetal heart rate, duration of labour and vital signs.
In, 1954 Friedman prepared the cervicography. In 1972 Philpott and Castle, working in Rhodesia, developed the first partograph, by utilizing Friedman's cervicograph, and adding the relationship of the presenting part to the maternal pelvis.
It is intended to provide an accurate record of the progress in labour, so that any delay or deviation from normal may be detected quickly and treated accordingly. However, a Cochrane review came to the conclusion that there is insufficient evidence to recommend partographs in standard labour management and care.
Components
- Patient identification: Patient Name, Gravida Para, Patient ID Number, Date of Admission, Ruptured Membranes
- Time: It is recorded at an interval of one hour. Zero time for spontaneous labour is time of admission in the labour ward and for induced labour is time of induction.
- Fetal heart rate: It is recorded at an interval of thirty minutes.
- State of membranes and colour of liquor: "I" designates intact membranes, "C" designates clear, "M" designates meconium stained liquor and "B" designates blood stained.
- Cervical dilatation and descent of head
- Uterine contractions: Squares in vertical columns are shaded according to duration and intensity.
- Drugs and fluids
- Blood pressure: It is recorded in vertical lines at an interval of 2 hours.
- Pulse rate: It is also recorded in vertical lines at an interval of 30 minutes.
- Oxytocin: Concentration is noted down in upper box; while dose is noted in lower box.
- Urine analysis
- Temperature record
Advantages
- Provides information on single sheet of paper at a glance
- Early prediction of deviation from normal progress of labour
- Improvement in maternal morbidity, perinatal morbidity and mortality
Limitations
- It requires a skilled healthcare worker who can fill and interpret the partograph.
- Recent studies have shown there is no evidence that partograph use is detrimental to outcomes.
- Often paper-partograph and the equipment required to complete it are unavailable in low resource settings.
- Despite decades of training and investment, implementation rates and capacity to correctly use the partograph are very low.
- According to some 2018 literature, cervical dilatation over time is a poor predictor of severe adverse birth outcomes. This raises questions around the validity of a partograph alert line.
Usage
A partograph is contained in the Perinatal Institute's "Birth notes".Use of a partograph in established labour is recommended by the National Institute for Clinical Excellence in the "Intrapartum Care" guideline.