• Partogram is a graphical representation of the progress of labour depicting cervical dilatation and station of head plotted against time
• The concept of partogram was first introduced by Friedman

Data recorded in a partogram are:

• Patient data – Name, Age, Parity, Hospital identification number, Date of admission, Time of admission
• Dilatation of cervix
• Station of fetal head
• Fetal heart rate
• Number of uterine contractions in 10 minutes
• Moulding (+ / ++ )
• Liquor amni
  • Intact membranes – I
  • Clear liquor – C
  • Meconium staining – M
• Oxytocin units, drops/min
• Drugs
• Oral and IV fluids
• Blood pressure, pulse, temperature
• Urine for acetone

How to use a partogram in active management of labour:

• Labour is divided into 2 stages
  • Latent phase – from onset of true labour pains till 3 cm dilatation of cervix
  • Active phase – 3 cm dilation of cervix till complete dilatation (10cm)
• Once labour is in active phase, cervical dilation is expected to progress at the rate of at least 1cm per hour
• This minimum rate is plotted as alert line on the partogram
• Another line – alert line – is plotted 4 hours to the right
• As long as the plotted cervical dilatation curve is to the left of the alert line, it is considered normal
• If the curve crosses the alert line, intervention is necessary – if the patient is in a peripheral hospital, referral to a higher level hospital is necessary

Advantages of using a partogram:

• All the data regarding the progress of labour can be understood at a glance from the partogram
• It is necessary for active management of labour
• Decreases incidence of prolonged labour and caesarean section.
• Reduces maternal mortality and morbidity

1. Artificial rupture of membranes (amniotomy)
2. Modified Bishop’s Score
3. Age pyramid
4. Demographic cycle