Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec;126(13):1524-1533.
doi: 10.1111/1471-0528.15884. Epub 2019 Aug 18.

Diagnostic accuracy of the partograph alert and action lines to predict adverse birth outcomes: a systematic review

M Bonet  1 , O T Oladapo  1 , J P Souza  1   2 , A M Gülmezoglu  1
Affiliations

Diagnostic accuracy of the partograph alert and action lines to predict adverse birth outcomes: a systematic review

M Bonet et al. BJOG. 2019 Dec.

Abstract

Background: There are questions about the use of the 'one-centimetre per hour rule' as a valid benchmark for assessing the adequacy of labour progress.

Objectives: To determine the accuracy of the alert (1-cm/hour) and action lines of the cervicograph in the partograph to predict adverse birth outcomes among women in first stage of labour.

Search strategy: PubMed, EMBASE, CINAHL, POPLINE, Global Health Library, and reference lists of eligible studies.

Selection criteria: Observational studies and other study designs reporting data on the correlation between the alert line status of women in labour and the occurrence of adverse birth outcomes.

Data collection and analysis: Two reviewers at a time independently identified eligible studies and independently abstracted data including population characteristics and maternal and perinatal outcomes.

Main results: Thirteen studies in which 20 471 women participated were included in the review. The percentage of women crossing the alert line varied from 8 to 76% for all maternal or perinatal outcomes. No study showed a robust diagnostic test accuracy profile for any of the selected outcomes.

Conclusions: This systematic review does not support the use of the cervical dilatation over time (at a threshold of 1 cm/h during active first stage) to identify women at risk of adverse birth outcomes.

Tweetable abstract: Alert line of partograph does not identify women at risk of adverse birth outcomes.

Keywords: Alert line; childbirth; diagnostic accuracy; partograph.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Sensitivity and specificity of the alert line for adverse fetal and neonatal outcomes. (A) Sensitivity and specificity of the alert line for adverse fetal (fresh stillbirths). (B) Sensitivity and specificity of the alert line for Apgar score <7 at 5 min. (C) Sensitivity and specificity of the alert line for birth asphyxia.
See this image and copyright information in PMC

Comment in

References

    1. National Institute for Health and Clinical Excellence . Intrapartum care for healthy women and babies. 2014 [https://www.nice.org.uk/guidance/cg190]. Accessed 12 February 2019. - PubMed
    1. Danilack V, Nunes A, Phipps M. Unexpected complications of low‐risk pregnancies in the United States. Am J Obstet Gynecol 2015;212:809.e1–6. - PMC - PubMed
    1. Lawn JE, Kinney M, Lee AC, Chopra M, Donnay F, Paul VK, et al. Reducing intrapartum‐related deaths and disability: can the health system deliver? Int J Gynaecol Obstet 2009;107(Suppl. 1):S123–40, s40‐2. - PubMed
    1. Lee AC, Kozuki N, Blencowe H, Vos T, Bahalim A, Darmstadt GL, et al. Intrapartum‐related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990. Pediatr Res 2013;74(Suppl 1):50–72. - PMC - PubMed
    1. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 2014;384:347–70. - PubMed

Publication types