5.2 Monitoring labour and delivery

5.2.1 Partograph

The partograph is a tool for monitoring maternal and foetal wellbeing during labour, and a decision-making aid when abnormalities are detected. It is designed to be used at any level of care.

The partograph begins with the active phase of labour, starting at 4 cm of dilation, and 3 contractions every 10 minutes. It should be filled in regularly during labour.

Its central feature is a graph used to record the progress of cervical dilation, as determined by vaginal examination.

The partograph also includes other indicators to be entered on the graph each time they are checked:

– Maternal indicators:
• Vital signs (heart rate, blood pressure and temperature)
• Time of spontaneous or artificial rupture of the membranes
• Uterine contractions (number per 10 minutes and duration)
• Urine output
• Administration of any drugs (oxytocin, antibacterial, etc.)

– Foetal indicators:
• Foetal heart rate
• Amniotic fluid (colour, odour and quantity)
• Descent of the foetal head and head moulding

Interpreting the partograph

The WHO partograph (see below) has two diagonal lines: an alert line and an action line.

The alert line goes from 4 to 10 cm and corresponds to an average dilation rate of 1 cm per hour. If the labour curve crosses to the right of this line, this means that the dilation is slow (less than 1 cm/hour).
The action line is located 4 hours to the right of the alert line. If the dilatation curve crosses this line, action must be taken.

If the alert line is crossed, transfer to the hospital must be considered if the woman is at an outpatient clinic or a BEmONC facility. If the woman is at a CEmONC facility, either immediate intervention or, at a minimum, closer monitoring is required.

If the action line is crossed, decisions (augmentation of labour, artificial rupture of membranes, caesarean section, etc.) must be made. See Chapter 7.

The WHO partograph

5.2.2 Postpartum maternal monitoring in the delivery room

– Vital signs (pulse, blood pressure, temperature and respiratory rate), blood loss and uterine retraction:
• Between Hour 0 and Hour 2: every 15 to 30 minutes,
• Between Hour 2 and Hour 4: every hour.

– Verify that the patient drinks and urinates.

– Check if there are other treatment indications, e.g., antibiotic therapy for prolonged rupture of membranes (Chapter 4, Section 4.9.3), treatment of anaemia (Chapter 4, Section 4.1), etc.

– In case of caesarean section, see Chapter 6, Section 6.4.

For monitoring and care following the immediate postpartum, see Chapter 11, Section 11.2 and Section 11.4.