Partograph: A Tool for Safe Delivery

SWARAJ HOSPITAL & RESEARCH INSTITUTE

BOLANGIR, ODISHA  •  OBSTETRICS & GYNAECOLOGY CLINICAL PATHWAY SERIES

Clinician Reference Infographic

The Partograph — Monitoring Labour Progress

A partograph is a single graphical chart that plots the progress of labour — cervical dilatation and fetal descent — alongside contractions and maternal/fetal vital signs, all against time. Its purpose is simple: to turn "labour is taking a while" into an objective, visual signal that prompts action before labour becomes obstructed, not after.

🎯 AT A GLANCE — WHEN TO START PLOTTING

Plotting begins in the active phase of labour — cervix ≥4 cm dilated, with regular, painful contractions

Starting the plot too early, during the latent phase, creates a false impression of slow progress and can prompt unnecessary intervention

GREEN: the dilatation plot sits on or to the left of the Alert Line — labour is progressing normally

AMBER: the plot has crossed the Alert Line — increase surveillance, and consider referral if at a lower-resource facility

RED: the plot has crossed the Action Line — active reassessment and intervention are needed now

📋 WHAT GETS RECORDED, AND HOW OFTEN

Fetal heart rateEvery 30 minutes

Contractions (frequency & duration)Every 30 minutes

Maternal pulseEvery 30 minutes

Cervical dilatationEach vaginal exam (~4-hourly)

Descent of the headEach vaginal exam

Liquor & mouldingEach vaginal exam

Blood pressure & temperatureEvery 4 hours

Urine (protein/acetone/volume)At each void

Moulding is graded 0 to +++ ; +++ (overlapping, not reducible) is a real warning sign of disproportion — don't record it as a routine box-tick.

📈 THE ALERT LINE & ACTION LINE

The Alert Line starts at 4 cm and rises at 1 cm per hour — the expected minimum rate of progress in active labour

The Action Line runs parallel, 4 hours to the right of the Alert Line

Alert Line (1 cm/hr)

Action Line (+4 hrs)

Actual dilatation plot

In this example, the plot falls behind early and drifts into the amber zone between the two lines — exactly the window meant for closer watching and reassessment, before anything crosses into the red action zone.

On/Left of Alert Line

Normal progress

Continue routine observation

Crossed Alert, Before Action

Caution zone — increase monitoring

Consider referral if resources are limited here

Crossed the Action Line

Active intervention required

Full reassessment before augmenting

Plateau (No Change ≥2 hrs)

Secondary arrest — reassess urgently

Applies regardless of alert/action line position

🚨 REASSESS URGENTLY — DON'T JUST KEEP PLOTTING

The plot has crossed the Action Line

No cervical change for 2+ hours despite adequate contractions

Moulding +++ or increasing caput — signs of possible disproportion

Any fetal heart rate abnormality (see our FHR Monitoring guide)

Descent not progressing despite apparently full dilatation

🛠️ WHEN THE ACTION LINE IS CROSSED

1

Full reassessment — contractions, fetal condition, and signs of obstruction (moulding, caput, descent)

2

Rule out cephalopelvic disproportion or malposition before augmenting

3

If contractions are inadequate and no disproportion — consider amniotomy (if membranes intact) and cautious oxytocin augmentation

4

If disproportion is suspected, or progress fails to improve — plan for operative delivery

5

Continuous fetal monitoring throughout; involve a senior obstetrician and document clearly

🌍 WHY THIS SIMPLE TOOL MATTERS

Catches prolonged and obstructed labour before it progresses unnoticed — directly reducing the risk of uterine rupture, obstetric fistula, postpartum haemorrhage, and stillbirth

Low-cost and low-tech — genuinely valuable anywhere continuous electronic monitoring isn't available

Standardizes handover — any clinician picking up the chart can see the whole labour trajectory at a glance, not just the current moment

🧠 COMMON PITFALLS IN PRACTICE

Charting retrospectively: filling it in at the end of labour defeats its entire purpose as an early-warning tool

Infrequent or inaccurate vaginal exams degrade the reliability of the whole plot

A line is crossed, but nothing happens: the same "trigger without response" failure seen in early warning systems generally — a documented action line means nothing without action

Not using it at all in a busy unit — the tool only works when it's actually kept up, for every labouring woman

The Core Rule

1 cm Per Hour

4h

GAP BETWEEN
ALERT & ACTION LINES

The Alert Line assumes at least 1 cm of cervical dilatation per hour is normal progress in active labour. Falling behind that rate doesn't automatically mean intervention — it means watch more closely and reassess the whole picture.

The 4-hour gap between the two lines is deliberate — it gives time to correct reversible causes (inadequate contractions, dehydration, positioning) before committing to intervention

A partograph is only as good as how honestly and promptly it's filled in — real-time charting is the whole point

Every member of the team should be able to look at the chart and understand exactly where labour stands, at a glance

Reminder: the partograph turns a vague sense that "labour is taking a while" into an objective, visual, shared decision point — that's its entire value.

Swaraj Hospital & Research Institute · Department of Obstetrics & Gynaecology, Bolangir, Odisha

Clinician-facing summary for structured teaching and triage; exact chart formats and action-line intervals vary between WHO, national, and institutional versions — follow local protocol.