Souza JP, et al. - Researchers evaluated the accuracy of the World Health Organization (WHO) partograph alert line and other candidate predictors in the identification of women at risk of developing severe adverse birth outcomes. Labour was acknowledged as an extremely variable phenomenon. severe adverse birth outcomes were poorly predicted by the assessment of cervical dilatation over time. Re-assessment of the validity of a partograph alert line based on the ‘one-centimetre per hour’ rule was recommended.

Methods

• Using a facility-based, multicentre, prospective cohort study design, this investigation was carried out at 13 maternity hospitals located in Nigeria and Uganda, including a total of 9995 women with spontaneous onset of labour presenting at cervical dilatation of ≤6 cm or undergoing induction of labour.
• Data collection was done by research assistants in order to gain information on sociodemographic, anthropometric, obstetric, and medical characteristics of study participants at hospital admission, multiple assessments during labour, and interventions during labour and childbirth.
• Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and the Jstatistic were used to assess the alert line and action line, intrapartum monitoring parameters, and customised labour curves.
• Study outcomes included severe adverse birth outcomes.

Results

• Researchers found that the rate of severe adverse birth outcomes was 2.2% (223 women with severe adverse birth outcomes), the rate of augmentation of labour was 35.1% (3506 women), and the caesarean section rate was 13.2% (1323 women).
• The alert line (4163/8489) was crossed by 9 % of women in labour.
• Findings demonstrated that all reference labour curves had a diagnostic odds ratio ranging from 1.29 to 1.60.
• For all reference curves, the J statistic was shown to be less than 10%.