Describe partogram — its aetiology, clinical features and management.

Definition

A partogram (partograph) is a graphic record of the progress of labour and of maternal and fetal condition plotted against time on a single sheet. It allows early detection of abnormal labour and is a key tool to reduce obstructed labour and its complications.

Components Recorded

• Fetal condition — fetal heart rate, state of the membranes/liquor (clear, meconium-stained) and moulding of the fetal skull.
• Progress of labour — cervical dilatation (the central feature, the "cervicograph"), descent of the head (in fifths palpable per abdomen) and uterine contractions (frequency and duration per 10 minutes).
• Maternal condition — pulse, blood pressure, temperature, urine output (volume, protein, acetone) and drugs/oxytocin/fluids given.

Phases of Labour on the Partogram

The latent phase (cervix < 4 cm, slow dilatation) and the active phase (from 4 cm, rapid dilatation at ≈ 1 cm/hour) are recorded. The newer WHO modified partograph begins plotting from the active phase and omits the latent phase to avoid premature intervention; recent WHO guidance recognises a slower normal active phase beginning around 5 cm.

Alert and Action Lines

Cervical dilatation in the active phase is plotted against the alert line (expected rate of 1 cm/hour). The action line is drawn 4 hours to the right of the alert line. When the dilatation curve crosses to the right of the alert line, progress is slow and the woman is reviewed/transferred; crossing the action line mandates active intervention (assessment for augmentation, instrumental delivery or caesarean section).

Advantages

• Single-sheet, at-a-glance picture of labour that any health worker can interpret.
• Early visual warning of slow progress, allowing timely augmentation or referral.
• Helps prevent prolonged and obstructed labour and its sequelae (ruptured uterus, fistula, sepsis, asphyxia), reducing maternal and perinatal morbidity and mortality.

A Note on WHY the Partogram Saves Lives

A useful point is understanding why so simple a chart is regarded as one of the great advances in safe motherhood. Its power is that it makes slow progress visible early and objectively. Without it, a failing labour declares itself only when the mother is exhausted, the fetus distressed and the uterus close to rupture — by which time transfer to a surgical facility may be impossible. By plotting cervical dilatation against time, with an alert line and an action line, the partogram converts the abstract judgement 'is she progressing?' into a line on a graph that any midwife can read. Crossing the alert line is the signal to reassess and — crucially in a peripheral setting — to transfer the woman to a facility with emergency obstetric care while there is still time; crossing the action line mandates intervention. It also records, on a single sheet, the fetal heart rate, liquor, moulding, contractions, oxytocin and drugs, and the mother's pulse, blood pressure, temperature and urine — so that deterioration in any of them is seen at a glance. Understanding that the partogram turns time into an early warning of obstruction explains why the WHO promotes it universally, and why it prevents obstructed labour, uterine rupture and obstetric fistula.

Crossing the action line mandates intervention.

• The partogram is a graphic record of labour: cervical dilatation and descent plotted against time, with an alert line and an action line.
• Started in the active phase (≥4 cm); the alert line represents 1 cm/hour, and the action line lies 4 hours to its right.
• It also records fetal heart rate, liquor, moulding, contractions, oxytocin/drugs, and maternal pulse, BP, temperature and urine.
• Crossing the alert line → reassess and transfer to a unit with emergency obstetric care; crossing the action line → intervene.
• It prevents prolonged and obstructed labour, uterine rupture and fistula — recommended by the WHO for every labour.