A 28-year-old primigravida at 39 weeks gestation presents to the labour ward with spontaneous rupture of membranes 6 hours ago. She is in active labour with contractions every 3 minutes lasting 45 seconds. On examination, cervix is 6 cm dilated, 80% effaced, and the fetal head is at −1 station. Vital signs are stable, and fetal heart rate is 140 bpm with normal variability. A partograph is plotted. Where should the alert line be drawn on the partograph for this patient?

Question

Accepted Answer

D. 2 cm to the left of the action line, representing the expected cervical dilation at 1 cm/hour. ## Partograph Alert and Action Lines

**Key Point:** The alert line on a partograph is positioned 2 cm to the LEFT of the action line. It represents the expected cervical dilation curve assuming a rate of 1 cm/hour of cervical dilation in active labour.

### Alert Line Definition
The alert line:
- Serves as an **early warning system** for slow labour progress
- Is plotted 2 cm to the left of the action line
- Represents the expected cervical dilation trajectory at 1 cm/hour
- Applies to **both primigravidae and multiparae**

### Action Line Definition
The action line:
- Is positioned 2 cm to the RIGHT of the alert line
- Represents the threshold at which **active intervention** (augmentation, operative delivery) is indicated
- If cervical dilation crosses the action line, labour augmentation or operative delivery should be considered

### Clinical Application in This Case
This primigravida is at 6 cm dilation in active labour. Her cervical dilation should be plotted on the partograph:
- If it falls **between alert and action lines** → continue observation, assess for slow progress
- If it crosses the **action line** → consider augmentation with oxytocin or operative delivery

**High-Yield:** The mnemonic "**Alert-Action = 2 cm gap**" helps recall that the alert line is 2 cm to the LEFT of the action line.

**Clinical Pearl:** The partograph is a **single sheet** that combines cervical dilation, descent of head, uterine contractions, vital signs, and fetal condition. It is a WHO-recommended tool for preventing prolonged labour and reducing maternal and fetal morbidity.

[cite:Park 26e Ch 15]

Answer

A. At the same point as the action line, representing the threshold for intervention

Answer

B. 1 cm to the left of the action line, representing accelerated labour in multiparae

Answer

C. 2 cm to the right of the action line, representing the maximum acceptable delay before intervention

Explanation

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