A 28-year-old primigravida at term is admitted in active labor. The partograph is being maintained as per WHO guidelines. Which of the following is NOT a component of the partograph?

Explanation

## Partograph Components The partograph is a graphical tool recommended by WHO to monitor labor progress and detect complications early. It integrates multiple parameters into a single chart. ### Standard Partograph Elements **Key Point:** According to WHO partograph guidelines, maternal blood pressure is recorded every **4 hours** (not hourly), and urine output is recorded every **2–4 hours** (not hourly). Recording these parameters "hourly" is therefore NOT consistent with standard partograph guidelines. | Component | Recording Interval | Purpose | |-----------|-------------------|---------| | Cervical dilation | Every 2 hours (per vaginal exam) | Assess progress of labor | | Descent of fetal head | Every 2 hours | Monitor engagement and descent | | Uterine contractions | Every 30 minutes | Assess labor strength and frequency | | Fetal heart rate | Every 30 minutes | Detect fetal distress | | Maternal pulse | Every 30 minutes | Monitor maternal status | | Maternal BP and temperature | Every **4 hours** | Monitor maternal status | | Urine output, protein, ketones | Every **2–4 hours** | Assess hydration and metabolic state | ### Why Option A is NOT Correct **High-Yield:** Option A states that maternal blood pressure and urine output are recorded **hourly** on the partograph. This is factually incorrect per WHO guidelines: - Blood pressure is recorded every **4 hours** - Urine output is recorded every **2–4 hours**, not every hour ### Why FHR IS a Component of the Partograph **Clinical Pearl:** Fetal heart rate IS a documented component of the WHO partograph — it is recorded every **30 minutes** in the designated section of the partograph form. Options B, C, and D are all genuine, correctly described components of the partograph. ### Partograph Alert and Action Lines 1. **Alert line** — marks expected normal progress of cervical dilation (1 cm/hour) 2. **Action line** — 4 hours to the right of the alert line; crossing this mandates intervention or referral [cite: WHO Partograph Guidelines; Dutta DC, Textbook of Obstetrics, 9th edition] ## Correct Answer Justification Option A is the correct answer to "which is NOT a component of the partograph" because it incorrectly states that maternal BP and urine output are recorded **hourly**. Per WHO guidelines, BP is recorded every 4 hours and urine output every 2–4 hours. All other options (B, C, D) accurately describe standard partograph components and their recording intervals.