The Partogram: Alert & Action Lines
The guidelines recommend management of common obstetric conditions at primary and referral level, based on local experience and evidence-based practice. They are not intended as strict protocols nor as standard operating procedures, but rather as a guide to safe effective management of common obstetric problems. The guidelines should be most useful to interns, medical officers and registrars.
Record all findings of maternal & fetal condition, & of progress in labour, on the partogram. Also record all intravenous fluids administered, & the use of oxytocin, where indicated.
As soon as the active phase of labour is diagnosed, draw an alert line at a slope of 1 cm/hour from the first cervical dilatation that is ≥4 cm dilated. Alternatively, if the partogram has a pre-drawn alert line, the first cervical dilatation noted in the active phase of labour is placed on the alert line.
The action line is drawn 2 hours to the right of & parallel to the alert line, & represents poor progress where ‘action’ is indicated (amniotomy or oxytocin infusion or caesarean section). The action line may be used by midwife obstetric units (MOUs) to guide transfer of women with poor labour progress to hospital.