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

<bold>Background: </bold>There are questions about the use of the 'one-centimetre per hour rule' as a valid benchmark for assessing the adequacy of labour progress.<bold>Objectives: </bold>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.<bold>Search Strategy: </bold>PubMed, EMBASE, CINAHL, POPLINE, Global Health Library, and reference lists of eligible studies.<bold>Selection Criteria: </bold>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.<bold>Data Collection and Analysis: </bold>Two reviewers at a time independently identified eligible studies and independently abstracted data including population characteristics and maternal and perinatal outcomes.<bold>Main Results: </bold>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.<bold>Conclusions: </bold>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.<bold>Tweetable Abstract: </bold>Alert line of partograph does not identify women at risk of adverse birth outcomes. [ABSTRACT FROM AUTHOR]