Cervical dilatation over time is a poor predictor of severe adverse birth outcomes: a diagnostic accuracy study

Objective To assess the accuracy of the WHO partograph alert line and other candidate predictors in the identification of women at risk of developing severe adverse birth outcomes Design a facility-based, multicentre, prospective cohort study. Setting 13 maternity hospitals located in Nigeria and Uganda. Population 9,995 women with spontaneous onset of labour presenting at cervical dilatation of ≤6 cm or undergoing induction of labour. Methods Research assistants collected data on socio-demographic, anthropometric, obstetric and medical characteristics of study participants at hospital admission, multiple assessments during labour, and interventions during labour and childbirth. The alert line and action line, intrapartum monitoring parameters, and customized labour curves were assessed using the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio and J statistic. Outcomes Severe adverse birth outcomes. Results 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% (3,506 women) and the caesarean section rate was 13.2% (1,323 women). 49% of women in labour crossed the alert line (4,163/8,489). All reference labour curves had a diagnostic odds ratio ranging from 1.29 to 1.60. The J statistic was less than 10% for all reference curves. Conclusions Our findings suggest that labour is an extremely variable phenomenon and the assessment of cervical dilatation over time is a poor predictor of severe adverse birth outcomes. The validity of a partograph alert line based on the “one-centimetre per hour” rule should be re-evaluated. Funding Bill & Melinda Gates Foundation, United States Agency for International Development (USAID), UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and WHO (A65879). This article is protected by copyright. All rights reserved.