Electronic fetal monitoring as a public health screening program: the arithmetic of failure

Obstetrics and Gynecology
David A Grimes, Jeffrey F Peipert

Abstract

Electronic fetal monitoring has failed as a public health screening program. Nevertheless, most of the four million low-risk women giving birth in the United States each year continue to undergo this screening. The failure of this program should have been anticipated and thus avoided had the accepted principles of screening been considered before its introduction. All screening tests have poor positive predictive value when searching for rare conditions such as fetal death in labor or cerebral palsy. This problem is aggravated when the screening test does not have good validity as is the case with electronic fetal monitoring. Because of low-prevalence target conditions and mediocre validity, the positive predictive value of electronic fetal monitoring for fetal death in labor or cerebral palsy is near zero. Stated alternatively, almost every positive test result is wrong. To avoid such costly errors in the future, the prerequisites for any screening program must be fulfilled before the program is begun.

References

Mar 19, 2002·Lancet·David A Grimes, Kenneth F Schulz
Apr 6, 2002·BMJ : British Medical Journal·Johann SteurerGerben ter Riet
Feb 7, 2004·BMJ : British Medical Journal·Malcolm Law
Jan 31, 2007·Neurology·D HirtzR Zalutsky
Sep 11, 2007·American Journal of Obstetrics and Gynecology·Joel D LarmaErnest M Graham
Oct 2, 2007·American Journal of Obstetrics and Gynecology·Colin A WalshMichael P Geary
Jun 24, 2009·Obstetrics and Gynecology·American College of Obstetricians and Gynecologists

Citations

Jul 19, 2013·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Dawn Chin-QueeKavita Nanda
Oct 26, 2013·Journal of Perinatology : Official Journal of the California Perinatal Association·Calla M HolmgrenMichael W Varner
Nov 19, 2011·Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN·Tekoa L King, Julian T Parer
Mar 7, 2012·Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN·Patrick Thornton
Mar 18, 2011·Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN·Nancy K Lowe
Jul 21, 2011·Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN·Michelle L MurrayGayle M Huelsmann
Mar 28, 2016·Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health·Theresa MorrisChristine H Morton
Sep 29, 2011·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·William T SchnettlerMichele R Hacker
Apr 4, 2017·Acta Obstetricia Et Gynecologica Scandinavica·Antoniya GeorgievaAris T Papageorghiou
Apr 25, 2014·Journal of Midwifery & Women's Health·Sally HershCathy Emeis
Jul 22, 2011·Obstetrics and Gynecology·James R Scott
Jan 1, 2013·Nursing Ethics·Robin Narruhn, Ingra R Schellenberg
Aug 28, 2014·Obstetrics and Gynecology·Ernest M GrahamFrank R Witter
Sep 22, 2012·Obstetrics and Gynecology·David A GrimesErika E Levi
Nov 4, 2017·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Eran AshwalLiran Hiersch
Jun 9, 2018·Journal of Midwifery & Women's Health·Ellen L Tilden, Jonathan M Snowden
May 2, 2014·The Journal of Perinatal & Neonatal Nursing·Lisa Hanson, Leona VandeVusse
May 2, 2014·The Journal of Perinatal & Neonatal Nursing·Jennifer TorresLisa Kane Low
Mar 24, 2016·Obstetrics & Gynecology Science·Ji Young Kwon, In Yang Park
Mar 23, 2011·Obstetrics and Gynecology·Julian T Parer, Tekoa L King
Sep 8, 2011·Obstetrics and Gynecology·Marc JacksonMichael W Varner
Dec 12, 2017·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·L N BlighS Kumar
Feb 16, 2018·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Mark I EvansBarry S Schifrin
May 21, 2013·Theoretical Medicine and Bioethics·Toby Schonfeld
Nov 20, 2014·Physiological Measurement·Martin G FraschEnrico Ferrazzi
Jul 30, 2019·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Margo S HarrisonA Metin Gülmezoglu
Jan 11, 2020·Obstetrics and Gynecology·William W Andrews, Alan Thevenet N Tita
Aug 28, 2016·Birth·Mary T PaternoMary Regan
Dec 5, 2017·Maternal Health, Neonatology and Perinatology·Thomas P SartwelleBerna Arda
Oct 16, 2012·BJOG : an International Journal of Obstetrics and Gynaecology·S UccellaF Ghezzi
Oct 2, 2018·The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians·Robert D EdenBarry S Schifrin
Dec 3, 2020·Birth·W Spencer McClelland

Related Concepts

Cerebral Palsy, Spastic
False Positive Reactions
Fetal Mummification
Fetal Monitoring
Cardiotocogram
Neonatal Screening
Birth
Fetal Death
Fetal Monitoring
Woman

Related Feeds

Birth Defects

Birth defects encompass structural and functional alterations that occur during embryonic or fetal development and are present since birth. The cause may be genetic, environmental or unknown and can result in physical and/or mental impairment. Here is the latest research on birth defects.