Modified WHO Partograph
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Direct answer
The modified WHO partograph is a graphic record of labour that plots cervical dilatation against time, alongside fetal and maternal parameters. Its alert line starts at 4 cm dilatation and its action line lies four hours to the right of it, so crossing the action line prompts obstetric review and a decision on intervention. Used properly it catches prolonged labour early, and it remains widely used in Indian labour rooms.
What you must remember
- Alert line: starts at 4 cm dilatation and runs to full dilatation at a slope of about 1 cm per hour, so crossing it prompts closer observation.
- Action line: drawn four hours to the right of the alert line, and reaching or crossing it means labour is not progressing and needs intervention.
- Fetal heart rate: plotted every 30 minutes in the active phase, with a normal baseline of about 120 to 160 bpm (some sources use 110 to 160), and persistent values outside the normal range needing reassessment.
- Liquor and moulding: membrane status and liquor colour (clear, meconium or blood) are recorded, and moulding is graded from 0 to 3.
- Descent and contractions: descent is charted as fifths of the head palpable per abdomen, and contractions are recorded as frequency in 10 minutes and duration.
- Maternal parameters: pulse and blood pressure, temperature, urine volume with protein and ketones, and drugs given are all charted.
A worked chart from the first examination
A woman admitted in active labour at 4 cm is the usual test scenario, and the chart is only as good as the order in which entries are made. The steps below show how the partograph is set up and read as labour runs.
- Start at 4 cm. The first cervical reading in the active phase is plotted at 4 cm, and the time of that examination is recorded at the same point.
- Draw the alert line. A straight line runs from 4 cm at the starting time to 10 cm six hours later, which gives a slope of about 1 cm per hour.
- Draw the action line. The action line is drawn four hours to the right of the alert line and runs parallel to it.
- Chart fetal and maternal data. Heart rate, liquor, moulding, contractions, pulse, blood pressure and urine are entered at their set intervals.
- Read the trend, not single points. The cervical curve is interpreted against both lines, and a slow curve that drifts toward the action line calls for close review.
- Act at the action line. Crossing the action line prompts urgent review, a reassessment of progress and a decision about augmentation or delivery.
Where the exam tries to catch you
The partograph questions usually test where the lines start, what each line means and what the chart asks you to do next.
- Trap: treating the alert line as an emergency Correct: crossing the alert line means watchful observation, while the action line is the threshold for intervention.
- Trap: starting the alert line from the first examination at 1 cm Correct: plotting begins at 4 cm in the active phase, so earlier readings do not start the alert line.
- Trap: judging progress from a single cervical reading Correct: progress is judged on the trend along the curve together with the fetal parameters.
Frequently asked questions
Where is the alert line drawn on the modified WHO partograph?
The alert line on the modified WHO partograph starts at 4 cm cervical dilatation and runs to 10 cm at a slope of about 1 cm per hour. Crossing it means labour is slower than expected and needs closer observation. The action line lies four hours to its right.
What is the action line of the modified WHO partograph?
The action line is drawn four hours to the right of the alert line on the modified WHO partograph. Reaching or crossing it means labour is not progressing adequately and requires prompt obstetric review. The decision may be augmentation or delivery, depending on the findings.
Which fetal parameters are recorded on the partograph?
Fetal heart rate, membrane status and liquor colour, and moulding of the fetal skull are recorded on the modified WHO partograph. The heart rate is plotted at regular intervals, and values outside the zone prompt reassessment. Descent of the head is charted as well.
Which maternal parameters are charted on the partograph?
Maternal pulse, blood pressure, temperature, urine output with protein and ketones, and drugs given are charted on the partograph. Uterine contractions are recorded as frequency per 10 minutes and their duration. These entries let the team judge the mother's condition alongside labour progress.
Has the WHO partograph been replaced by a newer tool?
WHO has introduced a Labour Care Guide as an alternative to the partograph in some settings, but the partograph remains widely used. Exam questions still expect the logic of the alert and action lines. The principle of reading trends and acting when the action line is crossed stays the same.