A 28-year-old primigravida at term is admitted in active labor. The partograph is being maintained. All of the following are components of the partograph EXCEPT:

Explanation

## Partograph: Essential Components **Key Point:** The partograph is a simple graphical tool used to monitor progress of labor and detect complications early. It integrates maternal, fetal, and labor progress parameters on a single sheet. ### Standard Components of the Partograph | Component | Details | Frequency | |-----------|---------|----------| | **Cervical dilation** | Plotted against time with alert and action lines | Every 2–4 hours | | **Descent of fetal head** | Fifths palpable above symphysis pubis | Every 2–4 hours | | **Uterine contractions** | Frequency, duration, intensity | Continuous/every 30 min | | **Fetal condition** | Heart rate, molding, caput succedaneum | Every 30 min | | **Maternal vital signs** | BP, pulse, temperature, urine output | Every 2–4 hours | | **Vaginal bleeding** | Amount and character | Continuous observation | | **Analgesics/drugs given** | Record of medications | As given | ### What Is NOT Part of the Partograph **High-Yield:** Estimated fetal weight (EFW) and amniotic fluid volume (AFV) are **antenatal ultrasound parameters**, not intrapartum monitoring tools. They are determined before labor and do not change the partograph plotting during active labor. - **EFW** is assessed in the third trimester (typically at 36 weeks) and is not re-estimated during labor. - **AFV** is a marker of fetal well-being in pregnancy but is not routinely assessed during labor on the partograph. ### Why the Other Options Are Correct 1. **Cervical dilation with alert/action lines** — Core partograph element; guides decision-making for intervention. 2. **Fetal heart rate and molding** — Essential for assessing fetal well-being and cephalopelvic disproportion. 3. **Maternal BP and urine output** — Vital for detecting maternal complications (preeclampsia, oliguria, shock). **Clinical Pearl:** The partograph is WHO-endorsed and reduces unnecessary interventions while improving maternal and fetal outcomes. Its strength lies in integrating simple, bedside observations—not complex imaging data. **Mnemonic: PARTOGRAPH components = "CVD-FUM"** - **C**ervical dilation (with alert/action lines) - **V**aginal bleeding and descent - **D**rugs and vital signs - **F**etal condition (HR, molding) - **U**terine contractions - **M**aternal status (BP, pulse, urine)