Table 3.13Diagnostic test accuracy of using the 1-cm/hour threshold (alert line) to diagnose risk of adverse birth outcomes (ABOs) for 11 included studies

Country reference (year of publication)
[ABO as defined in the study]		Alert line statusABOPercentage crossing alert linePrevalence of ABOSensitivity (95% Cl)Specificity (95% Cl)Positive likelihood ratio (95% Cl)Negative likelihood ratio (95% Cl)Diagnostic Odds Ratio (95% Cl)J statistic (95% Cl)
PresentAbsent
Senegal (1992) (78)
[Fresh stillbirths and neonatal resuscitation at birth]		Crossed19628.4%6.8%28.8%
(19.3-40.6)		93.1%
(91.3-94.6)		4.18
(2.67-6.56)		0.76
(0.66-0.89)		5.47
(3.03-9.89)		21.9%
(10.9-33.0)
Not crossed47839
Indonesia, Malaysia and Thailand (1994) (79)
[Fresh stillbirths and Apgar score ≤ 7 at 1 minute]		Crossed6558516.6%3.8%44.2%
(36.4-52.3)		84.4%
(83.2-85.6)		2.84
(2.34-3.46)		0.66
(0.57-0.76)		4.30
(3.07-6.03)		28.7%
(20.5-36.8)
Not crossed823175
South Africa 2006 (80)
[Fresh stillbirths and Apgar score < 7 at 5 minutes]		Crossed3043375.9%8.0%61.2%
(47.3-73.6)		22.8%
(19.5-26.5)		0.79
(63.2-99.6)		1.70
(1.16-2.49)		0.47
(0.25-0.86)		−16.0%
(−30.0 to −1.9)
Not crossed19128
Ecuador 2008 (81)
[Apgar score < 7 at 5 minutes]		Crossed328958.4%0.6%100.0%
(43.9-100.0)		41.9%
(37.6-46.2)		1.72
(1.60-1.85)		NANA41.9%
(37.6-46.2)
Not crossed0208
Nigeria
(2008) (82)
[Fresh stillbirth and birth asphyxia]		Crossed2718646.0%11.2%51.9%
(38.7-64.9)		54.7%
(49.9-59.5)		1.15
(0.87-1.52)		0.88
(0.65-1.18)		1.31
(0.73-2.33)		6.7%
(−7.7-21.1)
Not crossed25225
Brazil
(2009) (83)
[Apgar score < 7 at 5 minutes]		Crossed44110736.0%90.4%32.0%
(29.64-34.56)		26.7%
(20.2-34.42)		0.44
(0.39-0.50)		2.54
(1.94-3.34)		0.17
(0.12-0.25)		−41.2%
(−48.8 to −33.6)
Not crossed93539
Mali (84)
[Apgar score < 7 at 1 minute]		Crossed29842.9%1.3%66.7%
(20.8-93.9)		57.4%
(50.9-63.6)		1.56
(0.69-3.53)		0.58
(0.12-2.89)		2.69
(0.24-30.13)		24.1%
(−29.7-77.8)
Not crossed1132
India
(2014) (85)
[Apgar score < 7 at 5 minutes]		Crossed435319.2%17.2%50.0%
(39.7-60.3)		87.2%
(83.6-90.0)		3.91
(2.81-5.42)		0.57
(0.46-0.71)		6.81
(4.08-11.36)		37.2%
(26.2-48.2%)
Not crossed43361
Iran
(2006) (86)
(Apgar score < 7 at 1 minute]		Crossed103029.4%9.6%76.9%
(49.7-91.8)		75.6%
(67.3-82.4)		3.15
(2.05-4.85)		0.31
(0.11-0.83)		10.33
(2.67-40.0)		52.5%
(28.4-76.7)
Not crossed393
India
(2016) (87)
[Birth asphyxia]		Crossed710656.5%4.5%77.8%
(45.3-93.7)		44.5%
(37.6-51.6)		1.4
(0.97-2.03)		0.5
(0.15-1.71)		2.8
(0.57-13.86)		22.3%
(−5.8%-50.3%)
Not crossed285
Nigeria and Uganda
(2018) (88)
[Fresh stillbirths and Apgar score < 7 at 5 minutes or neonatal resuscitation during hospital stay]		Crossed152401149.0%3.0%59.8%
(53.7-65.7)		51.3%
(50.2-52.4)		1.23
(1.11-1.36)		0.78
(0.67-0.91)		1.57
(1.22-2.02)		11.1%
(5.0-17.3)
Not crossed1024224
Nigeria and Uganda
(2018) (88)
[Severe ABO]a		Crossed110405349.0%2.3%56.7%
(49.7-63.5)		51.1%
(50.1-52.2)		1.16
(1.02-1.32)		0.85
(0.72-100)		1.37
(1.03-1.83)		7.8%
(0.80-14.9%)
Not crossed844242
a

Severe ABO was defined as the occurrence of any of the following; stillbirth, early neonatal death, neonatal use of anticonvulsant, neonatal cardiopulmonary resuscitation, Apgar score less than 6 at 5 minutes, maternal death or organ dysfunction associated with labour dystocia, or uterine rupture.

Source: Bonet et al., 2018 (74).

From: 3., Evidence and recommendations

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WHO recommendations: Intrapartum care for a positive childbirth experience.
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