Midwife Licensure Exam Independent Delivery & Emergency Obstetric Care — Partograph Use & Referral Decision-MakingExam Answer Templates

Marks

1

Topic

Amniotic Fluid Codes on the Partograph

Difficulty

easy

Template Id

T1

Examiner Tip

This is a pure memory item. Examiners accept 'meconium-stained liquor' as equivalent. All five fluid codes (I, C, M, B, A) appear regularly — memorize all five.

Model Answer

M stands for meconium-stained amniotic fluid.

Question Type

very_short_answer

Answer Structure

• State the letter and its exact meaning in one clear phrase [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'meconium' without specifying it refers to amniotic fluid
• Confusing M with 'membrane' or 'moulding'
• Leaving the answer blank because the code was not memorized

Key Phrases To Include

• M
• meconium-stained
• amniotic fluid

Marks

1

Topic

Fetal Condition Monitoring on the Partograph

Difficulty

easy

Template Id

T2

Examiner Tip

Both numbers must appear. '110 to 160 bpm' — commit these two digits to memory. A FHR below 110 or above 160 is the trigger for fetal distress detection and referral.

Model Answer

The normal fetal heart rate in labor is 110–160 beats per minute (bpm).

Question Type

very_short_answer

Answer Structure

• State the lower limit, upper limit, and unit in one sentence [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing only one boundary (e.g., 'above 110') — both limits required
• Omitting the unit 'bpm'
• Writing 100–160 or 120–160 (wrong lower limit)

Key Phrases To Include

• 110
• 160
• beats per minute
• bpm

Marks

1

Topic

Alert and Action Lines — Active Phase Threshold

Difficulty

easy

Template Id

T3

Examiner Tip

The MLE uses the classic WHO/BEmONC standard of 4 cm. Note this in your answer to show awareness of the PH context. The newer 2018 WHO guideline (5 cm) may appear as a distractor — choose 4 cm for board exam purposes.

Model Answer

The active phase of labor begins at 4 centimeters (cm) cervical dilatation.

Question Type

very_short_answer

Answer Structure

• State the exact cervical dilatation in centimeters [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 3 cm or 5 cm instead of 4 cm
• Writing '4 fingers' without the centimeter equivalent
• Not specifying 'active phase' — the context matters

Key Phrases To Include

• 4 cm
• active phase
• cervical dilatation

Marks

2

Topic

Alert and Action Lines — Decision Engine of the Partograph

Difficulty

medium

Template Id

T4

Examiner Tip

Examiners award marks for the clinical action linked to each line, not just the geometric description. Always add: alert = 'arrange referral' and action = 'must be in CEmONC'. The clinical response is the second mark.

Model Answer

The alert line is a diagonal line starting at 4 cm and sloping upward at a rate of 1 cm per hour, representing the slowest acceptable rate of normal cervical dilatation. If the plotted dilatation crosses to the right of the alert line, labor is slower than normal and the midwife should arrange referral. The action line is drawn 4 hours to the right of and parallel to the alert line. If cervical dilatation reaches the action line, decisive action is mandatory — the mother must already be in a Comprehensive EmONC (CEmONC) facility for definitive management.

Question Type

short_answer

Answer Structure

• Sentence 1: Define the alert line — position, slope, rate, and meaning [1 mark]
• Sentence 2: Define the action line — position relative to alert line and required action [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing which line is 'alert' vs. 'action'
• Omitting the 4-hour distance between the lines
• Describing only one line and ignoring the other
• Not linking each line to its required clinical action

Key Phrases To Include

• alert line
• action line
• 4 cm
• 1 cm per hour
• 4 hours to the right
• arrange referral
• CEmONC
• mandatory action

Marks

2

Topic

Labor Progress Section of the Partograph

Difficulty

easy

Template Id

T5

Examiner Tip

The Philippine MLE uses the WHO system of fifths above the brim, not the station (-3 to +3) system. 'X' and 'O' are classic exam targets — an item may show a graph and ask which symbol is which. Always specify 'palpable above the pelvic brim' for the descent measurement.

Model Answer

Cervical dilatation is plotted using the symbol 'X' on the graph, measured in centimeters (0–10 cm) along the vertical axis against time in hours on the horizontal axis. Descent of the fetal head is plotted using the symbol 'O', measured in fifths (5/5 to 0/5) palpable above the pelvic brim by abdominal examination. As the head descends, the number of fifths above the brim decreases from 5/5 (fully above) toward 0/5 (fully engaged/descended).

Question Type

short_answer

Answer Structure

• Part 1: State symbol 'X', unit (cm), and axes for cervical dilatation [1 mark]
• Part 2: State symbol 'O', unit (fifths above brim), and direction of descent [1 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing symbols — writing O for dilatation and X for descent
• Saying descent is measured in 'stations' (that is the American system, not the WHO/BEmONC fifths system)
• Not specifying that the count is 'palpable above the brim' (abdominal assessment)

Key Phrases To Include

• X
• O
• cervical dilatation
• descent
• fifths
• palpable above the pelvic brim
• 5/5 to 0/5

Marks

3

Topic

Detecting Prolonged Labor and Referral Decision-Making

Difficulty

medium

Template Id

T6

Examiner Tip

Case-study answers earn marks in three layers: detect (what the finding is), interpret (what it means), and act (what the midwife does). Never skip the middle layer — 'crossing the alert line' alone without explaining it means 'prolonged active phase / slow progress' loses the interpretation mark.

Model Answer

Finding: The cervical dilatation has progressed only 1 cm in 4 hours (from 4 cm to 5 cm), which is much slower than the expected minimum rate of 1 cm per hour. On the partograph, the plotted 'X' has crossed to the right of the alert line, indicating prolonged active phase (slow progress/protraction of labor). Significance: This pattern warns that labor is not progressing normally. It may indicate inadequate uterine contractions, malposition, or early cephalopelvic disproportion. It is a danger sign that must not be ignored. Action: The midwife at the BEmONC/RHU level should reassess the mother immediately (check contractions, maternal vital signs, fetal heart rate, bladder, and position), then arrange and initiate referral to a Comprehensive EmONC (CEmONC) facility — a hospital capable of performing cesarean section — while the mother is still stable. The completed partograph and a referral form must accompany the mother during transport.

Question Type

case_study

Answer Structure

• Part 1: Identify the partograph finding — cervical progress vs. expected rate, name the line crossed [1 mark]
• Part 2: Interpret the clinical significance — prolonged active phase / possible cause [1 mark]
• Part 3: State the correct midwife action — reassess + arrange referral to CEmONC + send records [1 mark]

Scoring Breakdown

Common Mark Deductions

• Only saying 'refer' without specifying CEmONC or the reason
• Not calculating or comparing the actual rate (1 cm in 4 hours) to the expected rate (1 cm/hour)
• Not mentioning that the partograph should accompany the mother
• Saying the midwife should 'augment' or 'give oxytocin' — this is a CEmONC action, not a BEmONC/RHU midwife action

Key Phrases To Include

• alert line
• 1 cm per hour
• prolonged active phase
• protraction
• crossed to the right
• reassess
• refer to CEmONC
• partograph and referral form
• while mother is stable

Marks

3

Topic

Fetal Condition — Amniotic Fluid Monitoring

Difficulty

easy

Template Id

T7

Examiner Tip

Use a numbered list, not a paragraph. This type of enumeration question rewards complete, organized lists. A mnemonic: 'I Can Make Blood Absent' — Intact, Clear, Meconium, Blood, Absent.

Model Answer

The five amniotic fluid codes on the partograph are: 1. I – Membranes Intact (membranes have not ruptured) 2. C – Clear fluid (membranes ruptured; fluid is clear and normal) 3. M – Meconium-stained fluid (greenish or brownish; sign of possible fetal compromise) 4. B – Blood-stained fluid (fresh or old blood; possible placental abruption or fetal vessel involvement) 5. A – Absent fluid (dry; no fluid draining after membrane rupture; possible cord compression risk)

Question Type

short_answer

Answer Structure

• Items 1–5 listed in a numbered column [1 mark per 2 correct codes, with full marks for all 5 correct; examiner typically awards 3 marks for getting all 5 correct]

Scoring Breakdown

Common Mark Deductions

• Writing 'ruptured' for I — I means intact (NOT ruptured)
• Confusing B (blood-stained) with B for something else
• Listing only 3–4 codes and omitting one
• Writing codes as a paragraph instead of a numbered list — harder for examiner to check

Key Phrases To Include

• I
• C
• M
• B
• A
• intact
• clear
• meconium-stained
• blood-stained
• absent

Marks

3

Topic

Fetal Condition — Moulding Assessment

Difficulty

medium

Template Id

T8

Examiner Tip

Examiners test whether you know the specific dangerous grade. '+++ with slow progress' is the critical phrase. Pair it with 'CPD' and 'refer urgently' for full marks on the third point.

Model Answer

Moulding refers to the overlapping of the fetal skull bones at the suture lines as the head adapts to the shape of the birth canal during labor. It is a normal response to compression but becomes a danger sign when excessive. On the partograph, moulding is graded as follows: 0 – Bones are separated (sutures are open; normal) + – Bones are touching at the sutures ++ – Bones are overlapping but the overlap is reducible (can be separated with finger pressure) +++ – Bones are overlapping and the overlap is NOT reducible (fixed overlap) Grade +++ (fixed, non-reducible overlapping) — especially when accompanied by slow cervical progress — signals cephalopelvic disproportion (CPD) and/or obstructed labor. This is an urgent indication for referral to a CEmONC facility.

Question Type

short_answer

Answer Structure

• Sentence 1: Define moulding [0.5–1 mark]
• Grades 0, +, ++, +++ listed with descriptions [1 mark]
• Statement identifying +++ as the danger grade and linking it to CPD/obstructed labor + referral [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing only 2–3 grades instead of all four
• Saying ++ (not +++) is the danger grade
• Not linking the danger grade to CPD or obstructed labor
• Failing to mention that the action is referral (not 'manage' or 'observe')

Key Phrases To Include

• moulding
• skull bones
• sutures
• 0, +, ++, +++
• reducible
• not reducible
• cephalopelvic disproportion
• CPD
• obstructed labor
• urgent referral

Marks

2

Topic

Labor Progress — Uterine Contraction Assessment

Difficulty

easy

Template Id

T9

Examiner Tip

Two numbers anchor this answer: '3–5 per 10 minutes' and '40+ seconds each'. Board items often give a stem with 2 contractions in 10 minutes lasting 20 seconds and ask if labor is progressing adequately — the answer is NO, because neither criterion is met.

Model Answer

Good, adequate uterine contractions in active labor are defined as 3 to 5 contractions per 10 minutes, each lasting 40 seconds or more (strong intensity). On the partograph, this is represented by solid shading of the contraction boxes, indicating contractions lasting more than 40 seconds.

Question Type

short_answer

Answer Structure

• State the frequency: 3–5 contractions per 10 minutes [1 mark]
• State the duration: each lasting 40 seconds or more / strong (solid shading) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying '3 per hour' instead of '3–5 per 10 minutes'
• Omitting the duration criterion (40 seconds)
• Writing only 'regular contractions' without the specific numbers

Key Phrases To Include

• 3 to 5
• per 10 minutes
• 40 seconds
• solid shading
• strong

Marks

2

Topic

Introduction to the Partograph

Difficulty

easy

Template Id

T10

Examiner Tip

Examiners reward answers that connect the tool to the setting. 'BEmONC level' and 'timely referral to CEmONC' show awareness of the Philippine midwife's scope. Always frame the partograph as a referral decision tool, not just a recording tool.

Model Answer

The partograph (partogram) is a graphic, real-time record of labor progress that plots fetal condition, progress of labor, and maternal condition against time on a single page. Its purpose at the BEmONC/RHU level is to provide an at-a-glance picture of whether labor is progressing normally or dangerously slowly. By comparing the plotted cervical dilatation against the alert and action lines, the midwife can detect prolonged or obstructed labor early and make a timely, defensible decision to refer the mother to a Comprehensive EmONC facility before a life-threatening emergency develops.

Question Type

short_answer

Answer Structure

• Sentence 1: Define the partograph — what it is and what it records [1 mark]
• Sentence 2: State its purpose — early detection of slow/obstructed labor and timely referral decision at BEmONC level [1 mark]

Scoring Breakdown

Common Mark Deductions

• Defining it as only a 'chart for cervical dilatation' — missing the three-family structure
• Not linking it to the BEmONC/referral context
• Writing about its purpose without mentioning alert/action lines

Key Phrases To Include

• partograph
• graphic record
• labor progress
• fetal condition
• maternal condition
• alert and action lines
• detect early
• refer to CEmONC

Marks

3

Topic

Recording Frequency on the Partograph

Difficulty

medium

Template Id

T11

Examiner Tip

The number '30 minutes' anchors FHR, contractions, and pulse — all three are checked together. The different intervals (4 hours for BP, 2–4 hours for temperature) are the ones that test attention to detail. A table format helps organize these intervals clearly in your answer.

Model Answer

During the active first stage of labor, monitoring and recording frequency is as follows: 1. Fetal Heart Rate (FHR): Every 30 minutes — assessed immediately after a contraction to detect late decelerations. (Increased to every 5–15 minutes in the second stage.) 2. Uterine Contractions: Every 30 minutes — counting the number of contractions per 10 minutes and estimating their duration (strong/moderate/weak based on length in seconds). 3. Maternal Pulse: Every 30 minutes. Maternal blood pressure is checked every 4 hours (more frequently if elevated); temperature every 2–4 hours; urine output is recorded each time the mother voids.

Question Type

short_answer

Answer Structure

• Item 1: FHR — every 30 minutes [1 mark]
• Item 2: Contractions — every 30 minutes [1 mark]
• Item 3: Maternal pulse — every 30 minutes; BP every 4 hours; temperature every 2–4 hours [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying FHR is checked every hour — it is every 30 minutes in active labor
• Not specifying that contractions are counted per 10 minutes
• Confusing BP frequency (4 hours) with pulse frequency (30 minutes)

Key Phrases To Include

• every 30 minutes
• fetal heart rate
• contractions
• maternal pulse
• blood pressure every 4 hours
• temperature every 2–4 hours

Marks

5

Topic

Referral Decision-Making — Indications and Process

Difficulty

hard

Template Id

T12

Examiner Tip

For a 5-mark enumeration-plus-explanation question, write at least 7–8 numbered items. The last paragraph (referral principle with records) is a bonus point that distinguishes an outstanding answer. Always use the BEmONC-to-CEmONC language — not just 'refer to hospital'.

Model Answer

The following are indications for referral of a laboring woman from the BEmONC/RHU level to a CEmONC facility: 1. Cervical dilatation crossing the ALERT LINE — labor is progressing slower than 1 cm/hour in the active phase; arrange early transfer while the mother is still stable. 2. Cervical dilatation reaching the ACTION LINE — definitive action is mandatory; the mother must already be in a CEmONC facility. 3. Fetal distress — fetal heart rate below 110 bpm or above 160 bpm, especially if persistent; meconium-stained (M) or blood-stained (B) amniotic fluid. 4. Prolonged or obstructed labor — prolonged latent phase (>8 hours without active-phase progression), arrest of cervical dilatation (no change for 2 hours in active phase), arrest of descent (head not descending despite good contractions), or increasing moulding (+++ grade). 5. Malpresentation or malposition — breech, transverse lie, face or brow presentation detected; these cannot be delivered safely at the primary-care level. 6. Antepartum or intrapartum hemorrhage — any vaginal bleeding beyond normal show; possible placenta previa or abruptio placentae. 7. Hypertension / Pre-eclampsia signs — blood pressure ≥140/90 mmHg with proteinuria; symptoms such as severe headache, epigastric pain, or visual disturbances. 8. Maternal fever or signs of chorioamnionitis — temperature ≥38°C, foul-smelling liquor, uterine tenderness, or tachycardia with prolonged ruptured membranes. Referral Principle: The midwife DETECTS the problem early using the partograph and clinical findings, then REFERS promptly — sending the partograph record and a completed referral form — while the mother is still stable. The transfer zone between alert and action lines exists precisely to ensure safe, timely transport.

Question Type

long_answer

Answer Structure

• Introduction: State that these are referral indications from BEmONC to CEmONC [0.5 mark]
• Items 1–2: Alert line and action line crossings [1 mark]
• Item 3: Fetal distress (FHR abnormal, meconium/blood-stained fluid) [1 mark]
• Items 4–5: Prolonged/obstructed labor (including moulding +++) and malpresentation [1 mark]
• Items 6–7: Hemorrhage and pre-eclampsia/hypertension [1 mark]
• Closing statement on referral principle — detect and refer, send records [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Listing fewer than 6 indications — always aim for 7–8 to secure full marks
• Only listing 'prolonged labor' without specifying the partograph finding (e.g., crossing the alert line)
• Saying 'manage hypertension' instead of 'refer for hypertension' — midwife scope is detect and refer
• Not mentioning that the partograph should accompany the mother
• Writing a paragraph instead of a numbered list — examiner cannot award individual marks easily

Key Phrases To Include

• alert line
• action line
• fetal distress
• 110 bpm
• 160 bpm
• meconium
• prolonged active phase
• arrest of dilatation
• moulding +++
• malpresentation
• hemorrhage
• BP ≥140/90
• proteinuria
• refer to CEmONC
• partograph and referral form

Marks

5

Topic

Structure and Components of the Partograph

Difficulty

hard

Template Id

T13

Examiner Tip

Use clear section headings (bold or underlined in actual exam) and sub-labels. A 5-mark question on the partograph's three sections is a gift if you have memorized the key numbers — every number you write correctly is a potential mark-earner. Examiners appreciate organized, easy-to-read answers.

Model Answer

The partograph is organized into three main sections, each recording a different category of information: SECTION 1 — FETAL CONDITION (Top Section) This section monitors the well-being of the baby and includes: a. Fetal Heart Rate (FHR) — plotted every 30 minutes; normal range is 110–160 bpm. A rate below 110 or above 160 bpm indicates fetal distress and the need for referral. b. Amniotic Fluid Status — coded as: I (intact membranes), C (clear fluid), M (meconium-stained), B (blood-stained), A (absent). c. Moulding — graded 0 (bones separated), + (bones touching), ++ (overlapping, reducible), +++ (overlapping, not reducible). Grade +++ signals possible CPD and obstructed labor. SECTION 2 — PROGRESS OF LABOR (Central Section — Most Important) This is the core of the partograph, containing the alert and action lines. a. Cervical Dilatation — plotted with 'X' in centimeters (0–10 cm). The active phase begins at 4 cm. Progress should be at least 1 cm/hour. Crossing to the right of the alert line = slow progress; reaching the action line = mandatory referral/action. b. Descent of the Fetal Head — plotted with 'O' in fifths palpable above the pelvic brim (5/5 → 0/5). Falling numbers indicate the head is descending into the pelvis. c. Uterine Contractions — recorded per 10-minute period, with shading to show duration: light stippling = <20 seconds (weak), diagonal lines = 20–40 seconds (moderate), solid = >40 seconds (strong). Adequate labor requires 3–5 contractions per 10 minutes, each lasting ≥40 seconds. SECTION 3 — MATERNAL CONDITION (Bottom Section) This section monitors the safety and well-being of the mother. a. Vital Signs — pulse every 30 minutes; blood pressure every 4 hours (more often if elevated); temperature every 2–4 hours. b. Urine — volume, protein (pre-eclampsia indicator), and acetone/ketones (dehydration indicator) recorded each time the mother voids. c. Drugs and Fluids — any oxytocin given, IV fluids, and other medications recorded with time and dose. Conclusion: Together, these three sections provide a complete, real-time picture of labor. The midwife at the BEmONC/RHU level uses all three sections to detect danger signs early and make timely referral decisions.

Question Type

long_answer

Answer Structure

• Section heading for Fetal Condition + FHR, fluid codes, moulding with key values [1.5 marks]
• Section heading for Labor Progress + cervical dilatation (X, 4 cm, 1 cm/hr, alert/action lines), descent (O, fifths), contractions (3–5 per 10 min, 40 sec) [2 marks]
• Section heading for Maternal Condition + pulse/BP/temp intervals, urine, drugs/fluids [1 mark]
• Concluding statement linking all three sections to referral decisions [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Describing only two sections and omitting the maternal condition section
• Not providing the specific normal values (e.g., 110–160 bpm, 3–5 per 10 min) — descriptions without numbers earn partial marks only
• Not naming the symbols (X and O) for dilatation and descent
• Writing a continuous paragraph instead of organized sections — harder to mark and easier to miss key points

Key Phrases To Include

• fetal heart rate
• 110–160 bpm
• amniotic fluid codes
• moulding
• alert line
• action line
• cervical dilatation X
• descent O
• fifths
• 3–5 contractions per 10 minutes
• 40 seconds
• pulse every 30 minutes
• blood pressure every 4 hours

Marks

2

Topic

Detecting Prolonged Labor — Latent Phase

Difficulty

medium

Template Id

T14

Examiner Tip

'8 hours' is the single most important number for the latent phase — it is the criterion that separates normal from prolonged. Pair it with 'no progression to active phase' and 'refer' for a complete 2-mark answer.

Model Answer

A prolonged latent phase is defined as a latent phase of labor — when the cervix is between 0 and less than 4 cm with irregular contractions — that lasts more than 8 hours without progression into the active phase. The midwife's appropriate action is to reassess the mother (confirm whether she is truly in labor, check fetal well-being, review maternal condition), and if the latent phase has truly exceeded 8 hours with no progress, arrange referral to a Comprehensive EmONC facility for further evaluation and management.

Question Type

short_answer

Answer Structure

• Define prolonged latent phase with the diagnostic criterion (>8 hours without active-phase progression) [1 mark]
• State the midwife's action: reassess and refer to CEmONC [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing '6 hours' or '12 hours' instead of '8 hours'
• Not clarifying that the criterion is 8 hours without progressing to the active phase
• Saying 'observe and wait' without specifying a time limit or referral

Key Phrases To Include

• latent phase
• 0 to 4 cm
• more than 8 hours
• no progression to active phase
• reassess
• refer to CEmONC

Marks

3

Topic

Fetal Distress Detection and Referral

Difficulty

hard

Template Id

T15

Examiner Tip

For any FHR abnormality question, the answer structure is always: (1) identify the abnormality and compare to normal range, (2) name the clinical condition (fetal distress), (3) first-response action (left lateral + fluids), and (4) refer. Never stop at the first-response — referral is mandatory for fetal distress at the BEmONC level.

Model Answer

Interpretation: A fetal heart rate of 95 bpm is below the lower limit of normal (110 bpm). This indicates fetal bradycardia, a sign of fetal distress. When the FHR drops below 110 bpm — especially if it falls after contractions and does not recover — it suggests that the fetus is not receiving adequate oxygen, possibly due to cord compression, uteroplacental insufficiency, or prolonged/obstructed labor. Immediate Actions of the Midwife: 1. Change the maternal position to the left lateral (left side-lying) position to relieve aortocaval compression and improve uteroplacental blood flow. 2. Ensure the mother is well-hydrated (offer oral fluids or maintain IV line if already inserted). 3. Discontinue any oxytocin if it is running (if applicable in a BEmONC setting). 4. Record the abnormal FHR on the partograph and note the time. 5. Arrange immediate referral to a CEmONC facility — fetal distress is an obstetric emergency. Notify the receiving facility in advance and ensure the mother is accompanied by the partograph and referral documents.

Question Type

case_study

Answer Structure

• Part 1: Identify finding — 95 bpm = fetal bradycardia = fetal distress (below 110 bpm) [1 mark]
• Part 2: Immediate first-response actions (position change, fluids) [1 mark]
• Part 3: Referral action — arrange immediate referral to CEmONC with partograph and records [1 mark]

Scoring Breakdown

Common Mark Deductions

• Not stating that 95 bpm is below the lower limit of 110 bpm — the comparison is required
• Saying 'place on right side' — the correct position is the LEFT lateral to relieve pressure on the aorta and inferior vena cava
• Not escalating to referral — 'observe' is not acceptable for a fetal distress finding
• Omitting to mention sending the partograph with the mother

Key Phrases To Include

• 95 bpm
• below 110 bpm
• fetal bradycardia
• fetal distress
• left lateral position
• hydration
• immediate referral
• CEmONC
• partograph and referral form