Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care

1. 8C
Skills workshop:
Recording
observations on
the partogram
B. Recording the urinary data
Objectives 1. Volume is recorded in ml.
2. Protein is recorded as 0 to 4+.
When you have completed this skills 3. Ketones are recorded as 0 to 4+.
workshop you should be able to:
• Record and assess the condition of the
RECORDING THE
mother.
• Record and assess the condition of the CONDITION OF THE FETUS
fetus.
• Record and assess the progress of labour. C. Recording the fetal heart rate pattern
The following two observations must be
recorded on the partogram:
THE PARTOGRAM
1. The baseline heart rate.
The condition of the mother, the condition 2. The presence or absence of decelerations. If
of the fetus, and the progress of labour are decelerations are present, you must record
recorded on the partogram. whether they are early or late decelerations
(see figure 8C-3).
RECORDING THE D. Recording the liquor findings
CONDITION OF Three symbols are used:
THE MOTHER I = Intact membranes.
C = Clear liquor draining.
A. Recording the blood pressure, M = Meconium-stained liquor draining (see
pulse and temperature figure 8C-3).
The maternal blood pressure, pulse and tem-
perature should be recorded on the partogram.

2. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 179
Figure 8C-1: An example of a partogram

3. 180 MATERNAL CARE
Time: 06:00 10:00
Blood pressure: 110/70 130/80
Pulse: 70/min 90/min
Temp: 37 °C 37.1 °C
Volume: 175 ml 150 ml
Protein: None None
Ketones: None +
Glucose: None None
Blood: None ++
Figure 8C-2: Recording blood pressure, pulse, temperature and urine results on the partogram
LIQUOR:
C = Clear liquor
M = Meconium-stained liqour
Figure 8C-3: Recording the fetal heart rate pattern and the liquor findings on the partogram
E. How often should you record chart that is used for the cervical dilatation. The
the liquor findings? length of the line drawn indicates the length
of the endocervical canal in cm. It is drawn
The recordings should be made:
on the chart whenever the cervical dilatation
1. At each vaginal examination. is recorded. Alternatively, the length of the
2. Whenever a change in the liquor is noted, endocervical canal, measured in cm or mm,
e.g. when the membranes rupture or if the can be noted in the space provided.
patient starts to drain meconium-stained
liquor after having had clear liquor before. H. Recording the amount of the
head palpable above the brim of the
pelvis (descent and engagement)
RECORDING THE The findings are recorded by marking an ‘O’
PROGRESS OF LABOUR on the partogram (see figure 8C-4).
I. Recording the position of the fetal head
F. Recording the cervical dilatation
The position of the fetal head is recorded
Cervical dilatation is measured in cm and then by marking the ‘O’ with fontanelles and the
recorded by marking an ‘X’ on the partogram. sagittal suture. Alternatively, the position can
be noted (e.g. ROA) in the space provided (see
G. Recording the length of figure 8C-4). This is recorded at every vaginal
the cervix (effacement) examination.
The length of the cervix is recorded by drawing
a thick, vertical line on the same part of the

4. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 181
Time: 06:00 10:00 14:00
Dilatation: 2 cm 4 cm 6 cm
Length: 2 cm 5 mm 2 mm
Head above brim: 4/5 3/5 2/5
Position: ROP ROP ROP
Moulding: no no +
Note: Transfer of recordings on
chart from latent to active phase
at 10:00.
Figure 8C-4: Recording the cervical dilatation, cervical length, the amount of fetal head above the brim,
position of the head, and moulding on the partogram
06:00: One weak contraction in ten minutes
08:00: Two moderate contractions in ten minutes
10:00: Three strong contractions in ten minutes
An infusion of one unit of oxytocin in one litre
at 15 drops per minute is being administered
from 9:00 and at 30 drops per minute
from 10:00.
Figure 8C-5: Recording the duration and frequency of contractions on the partogram
J. Recording moulding of the fetal head contractions in ten minutes, and five blocks if
five or more contractions in ten minutes (see
The degree of moulding (i.e. 0 to 3+) is also
figure 8C-5).
recorded on the partogram.
M. Recording drugs and intravenous
K. Recording the duration of contractions
fluid given during labour
The duration of contractions is also recorded
In the space provided on the partogram you
on the partogram. The block is stippled if the
should record:
contractions last less than 20 seconds (i.e.
weak contractions), the block is striped if the 1. The name of the drug.
contractions last between 20 and 40 seconds 2. The dose of the drug given.
(i.e. moderate contractions) and the block is 3. The time the drug was given.
coloured-in completely if the contractions 4. The type of intravenous fluid.
last more than 40 seconds each (i.e. strong 5. The time the intravenous fluid was started.
contractions). 6. The rate of administration.
7. The amount of intravenous fluid given
L. Recording the frequency of contractions (after completion).
The number of contractions occurring within
N. Assessment and management
ten minutes is recorded by marking off one
block for each contraction, e.g. two blocks After each examination an assessment must
marked off equals two contractions in ten be made and recorded on the partogram. All
minutes, four blocks marked off equals four

5. 182 MATERNAL CARE
Figure 8C-6: Documenting medication, assessment, management and time on the partogram
management in labour must also be recorded CASE STUDY 1
on the partogram.
A primigravida at term is admitted to a
O. Recording the time on the partogram primary-care perinatal clinic at 06:00 with
The time, to the nearest half hour, should also a history of painful contractions for several
be entered on the partogram whenever an hours. She received antenatal care and is
observation is recorded, medication is given, an known to be HIV negative. The maternal
assessment is made or management is altered. and fetal conditions are satisfactory. On
abdominal examination a single fetus with a
longitudinal lie is found. The presenting part
EXERCISES ON THE is the fetal head, and 4/5 is palpable above the
brim of the pelvis. Two contractions in ten
CORRECT USE OF minutes, each lasting 15 seconds are noted.
THE PARTOGRAM On vaginal examination the cervix is 1 cm
long and 2 cm dilated. The fetal head is in the
right occipito-lateral position.
Only the information given in the cases will
be shown on the partogram. In practice, all
the appropriate spaces on the partogram 1. Is the patient in active labour?
must be filled in. No. The cervix is less than 3 cm dilated. The
patient is, therefore, still in the latent phase
of labour.

6. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 183
2. How should you enter your 5. Where should you enter the
findings on the partogram? findings obtained at 10:00?
As the patient is still in the latent phase of The findings must be entered on the latent
labour, the descent and amount of fetal head phase part of the partogram, four hours to
palpable above the brim, the presenting part the right of the findings at 06:00. However, as
and the position of the head, and the length and the patient is now in active labour, the data
dilatation of the cervix, must be recorded on must then be transferred to the active phase
the vertical line forming the left-hand margin part of the partogram. This must be indicated
of the latent phase part of the partogram. The with an arrow.
correct way of entering the above data on the
partogram is shown in figure 8C-7. 6. How should you transfer the findings
at 10:00 from the latent to the active
3. How should you manage phase part of the partogram?
this patient further?
The X (cervical dilatation) must be moved
The patient must have the routine horizontally to the right until it lies on the
observations (such as pulse rate, blood alert line. This will again be at 5 cm dilatation.
pressure and fetal heart) performed at the The O (number of fifths of the head above the
usual intervals. She must be offered analgesia pelvic brim) is similarly transferred to lie on
and sedation. Adequate analgesia, e.g. the same vertical line opposite the two lines on
pethidine 100 mg and hydroxyzine 100 mg the vertical axis. The new position of the head
or promethazine 25 mg, should be given (ROA) must be indicated on the O. The length
by intramuscular injection as soon as the of the cervix is recorded by a 5 mm thick black
patient asks for pain relief. A second complete column on the base line vertically below the
examination should be done at 10:00, i.e. four X and O. The fact that the membranes have
hours after the first complete examination. been ruptured is entered in the block provided
The patient must be encouraged to walk about for medication/ I.V. fluids/management. A
as this will help the progress towards the ‘C’ in the block provided for liquor indicates
active phase of the first stage of labour. that the liquor is clear. The correct method of
transferring the above findings from the latent
At the second complete examination the
to the active part of the partogram is shown in
maternal and fetal conditions are satisfactory.
figure 8C-7. (The length of the cervix and the
On abdominal examination 2/5 of the fetal
position of the fetal head may also be entered
head is palpable above the brim of the pelvis.
in the appropriate blocks provided elsewhere
Three contractions in ten minutes, lasting
on the partogram).
between 30 seconds each, are noted. On
vaginal examination the cervix is 2 mm long
and 5 cm dilated. The head is in the right
occipito-anterior position. The membranes CASE STUDY 2
are artificially ruptured and the liquor is
found to be clear. A multigravida is admitted to the labour
ward at 08:00 in labour at term. She received
4. Is the patient still in the antenatal care and is known to be HIV
latent phase of labour? negative. The maternal and fetal conditions
are satisfactory. On abdominal examination
No. The cervix is more than 3 cm dilated. The the head is 5/5 palpable above the brim
patient is, therefore, in the active phase of of the pelvis. Three contractions in ten
labour. minutes, each lasting 25 seconds are noted.
On vaginal examination the cervix is 1 mm
long (i.e. fully effaced) and 4 cm dilated.

7. 184 MATERNAL CARE
Figure 8C-7: Information from case study 1 correctly entered onto the partogram

8. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 185
The presenting part is in the left occipito- cause. Intact membranes and inadequate
posterior position. The patient complains that uterine contractions are diagnosed as the
her contractions are painful. causes of the poor progress.
1. Is the patient in the active 4. How should you record these
phase of labour? findings on the partogram?
Yes, as the cervix is more than 3 cm dilated. The X must be recorded on the horizontal line
corresponding to 5 cm cervical dilatation, four
2. How should you record your findings? hours to the right of the record at 08:00. The
O (the position of the fetal head and length of
As the patient is in the active phase of labour, the cervix), are recorded on the same vertical
the findings must be entered on the active line as the X. The correct way of recording
phase part of the partogram. The X (cervical these observations is shown in figure 8C-8.
dilatation) is recorded on the alert line,
opposite the 4 on the vertical axis indicating
5. Is the progress of labour satisfactory?
4 cm dilatation. The O (number of fifths
palpable above the pelvic brim) is recorded No. This is immediately apparent by
above the X opposite the 5 on the vertical line. observing that the second X has crossed
The length of the cervix is recorded by a 1 mm the alert line. For labour to have progressed
column on the base line, vertically below the X satisfactorily, the cervix should have been at
and O. The correct way of recording the above least 8 cm dilated (4 cm initially plus 1 cm
findings is in figure 8C-8. per hour over the past four hours).
3. How should you manage 6. How should you manage
the patient further? this patient further?
The routine observations (e.g. pulse rate, blood The membranes must be ruptured. Rupture
pressure, fetal heart, and urine output) must be of the membranes will result in stronger
performed at the usual intervals. The patient uterine contractions. Because there has
must be offered analgesia. Pethidine 100 mg been inadequate progress of labour, a third
and hydroxyzine 100 mg or promethazine complete examination should be performed
25 mg should be given by intramuscular at 14:00, i.e. two hours after the second
injection as soon as the patient requests pain complete examination.
relief. A second complete examination should
At the third complete examination the maternal
be done at 12:00, i.e. four hours after the first
and fetal conditions are satisfactory. On
complete examination.
abdominal examination the head is 1/5 palpable
At the second complete examination the above the pelvic brim. Four contractions in ten
maternal and fetal conditions are satisfactory. minutes, each lasting 50 seconds are observed.
On abdominal examination the head is 3/5 On vaginal examination the cervix is 1 mm
palpable above the brim of the pelvis. Three long and 9 cm dilated. The presenting part is in
contractions in ten minutes, each lasting 25 the left occipito-anterior position. The findings
seconds, are noted. On vaginal examination are recorded as shown in figure 8C-8.
the cervix is 5 mm long and 5 cm dilated with
bulging membranes. 7. What is your assessment of the
The presenting part is in the left occipito- progress of labour at 14:00?
transverse position. Poor progress is Labour is progressing satisfactorily. This is
diagnosed and a systemic assessment of the shown by the third X having moved closer
patient is made in order to determine the to the alert line. The head, which has rotated

9. 186 MATERNAL CARE
from the left occipito-posterior to the left phase part of the partogram. The X (cervical
occipito-anterior position, is also engaged. A dilatation) is recorded on the alert line
spontaneous vertex delivery may be expected opposite the 5 on the vertical line. The other
within an hour. findings are entered in their appropriate places
as shown in figure 8C-9.
CASE STUDY 3 2. Is the decision to schedule the next
complete examination at 13:00 correct?
A gravida 2 para 1 is admitted to the labour Yes. There are no signs of cephalopelvic
ward at 09:00 in labour at term. She has already disproportion (e.g. 3+ moulding) on
had painful contractions for the past two hours. admission, and the maternal and fetal
Two years before she had a difficult forceps conditions are satisfactory.
delivery for a prolonged second stage of labour.
The infant’s birth weight was 3000 g. The
3. What observations must be done
maternal and fetal conditions are satisfactory.
carefully during the next four hours?
On abdominal examination the head is 4/5
palpable above the brim of the pelvis. The Meconium in the liquor indicates that the
cervix is 2 mm long and 5 cm dilated. There fetus is at an increased risk for fetal distress.
is 1+ of moulding present and the presenting Therefore, the fetal heart rate pattern must be
part is in the right occipito-posterior position. observed carefully for signs of fetal distress
The patient is HIV negative and an artificial (e.g. late decelerations).
rupture of the membranes is performed and a
small amount of meconium-stained liquor is 4. What is likely to happen to this
drained. The patient is given pethidine 100 mg patient’s progress of labour?
and hydroxyzine 100 mg. A second complete
examination is scheduled for 13:00. The most likely outcome is the development
of cephalopelvic disproportion. On abdominal
examination the head will remain 3/5 or
1. How should you record
more palpable above the pelvic brim (i.e.
the above findings?
unengaged) and on vaginal examination there
As the patient is in the active phase of labour, will be 3+ moulding. An urgent Caesarean
the findings must be entered on the active section should then be performed.

10. SK ILLS WORKSHOP : RECORDING OBSER VATIONS ON THE PAR TOGRAM 187
Figure 8C-8: Information from case study 2 correctly entered onto the partogram

11. 188 MATERNAL CARE
Figure 8C-9: Information from case study 3 correctly entered onto the partogram