How the cases are made
Each six-character code runs one invented labour forward in half-hour steps: dilatation at a steady rate for its pattern (normal, slow, prolonged, weak contractions, obstructed or fetal distress), descent that follows it, contractions that strengthen, and the fetal heart and maternal observations. Only then are the notes written, so the chart, the notes and the key always agree.
The chart is the modified WHO partograph: plotting starts at 4 cm on the alert line, the alert line rises 1 cm per hour, and the action line runs 4 hours to its right. Examinations are 4 hours apart unless there is a reason, such as an urge to push.
Example: plotting a slow labour
In case PGR9HX, Mrs B, a first-time mother, is admitted at 13:30 with the cervix at 4 cm. That X goes on the alert line at hour 0, with 13:30 in the time row. At 17:30 the cervix is 7 cm. That is hour 4, where the alert line is already at 8 cm, so the X sits to the right of the alert line: 3 cm in 4 hours, 0.75 cm per hour. The action line is only at 4 cm at hour 4, so she is well clear of it. At 21:00 she has an urge to push and is fully dilated at hour 7.5, still left of the action line. Open this case.
Levels and classes
Plot only gives the notes and a blank chart. Interpret only gives a completed chart and questions. Full case gives both. Share with class copies a link to the same case; set Cases to a number before printing and each student gets a different labour, with the keys at the end.
Questions people ask
How do you plot a partograph step by step?
Fill in the details at the top. At the first examination of 4 cm or more, put an X on the alert line at that dilatation and write the clock time below. Plot the fetal heart and contractions every half hour, and liquor, moulding and descent at each examination, then the maternal observations.
Where do you plot the first X on a partograph?
On the modified WHO partograph a woman admitted in the active phase is plotted on the alert line, at her dilatation: 6 cm goes at hour 2. Findings below 4 cm are latent phase and are written in the notes, not plotted. Later examinations go to the right, one square per hour.
What do the alert line and action line mean?
The alert line is dilatation at 1 cm per hour. A plot to its right warns that labour may be prolonged: the WHO guide says to transfer from a health centre to hospital, or observe more often in hospital. The action line, 4 hours further right, calls for a critical assessment of the cause and a decision on management.
How do you shade contractions on a partograph?
Count the contractions in 10 minutes and shade that many boxes in the half-hour column, starting from the time of the count. Use dots when they last under 20 seconds, diagonal lines for 20 to 40 seconds, and fill the boxes in solid when they last more than 40 seconds.
What do I, C, M and B and the moulding signs mean?
Liquor: I membranes intact, C ruptured with clear fluid, M meconium-stained, B blood-stained. Moulding: 0 bones apart, + sutures apposed, ++ overlapped but reducible, +++ overlapped and not reducible. Both are recorded at every vaginal examination.
How is the WHO Labour Care Guide different from the partograph?
The Labour Care Guide (2020) starts at 5 cm, not 4, and has no alert or action line. Each observation has a threshold in an Alert column, and the cervix has a time limit for each centimetre, from 6 hours at 5 cm to 2 hours at 9 cm. It also records supportive care such as a companion and posture.
Sources: WHO, Preventing prolonged labour: a practical guide. The partograph (WHO/FHE/MSM/93.8 to 93.11, 1994); WHO, Managing complications in pregnancy and childbirth, 2nd edition 2017 (the modified partograph, pages C-89 to C-97 and S-73 to S-80). Our chart is drawn from these rules, not copied. Checked 25 October 2026.