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Electronic Fetal Monitoring as a Public Health Screening Program: The Arithmetic of Failure

Grimes, David A. MD; Peipert, Jeffrey F. MD, PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181fae39f
Current Commentary

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.

In Brief

The positive predictive value of electronic fetal monitoring for intrapartum fetal death and cerebral palsy is near zero.

Author Information

From FHI, Research Triangle Park, North Carolina; the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and the Division of Clinical Research and the Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St. Louis, Missouri.

Corresponding author: David A. Grimes, MD, FHI, PO Box 13950, Research Triangle Park, NC 27709; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.