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.
Obstet Gynecol. 2010 Dec;116(6):1397-1400. doi: 10.1097/AOG.0b013e3181fae39f.
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.
电子胎儿监护未能成为一项公共卫生筛查项目。尽管如此，每年在美国分娩的 400 万低风险女性中，大多数人仍在接受这种筛查。如果在引入该项目之前考虑了已被接受的筛查原则，那么本可以预料到该项目的失败并避免这种情况发生。在寻找罕见情况（如分娩时胎儿死亡或脑瘫）时，所有筛查试验的阳性预测值都很差。当筛查试验的有效性不佳时，例如电子胎儿监护，这个问题就更加严重了。由于低患病率的目标情况和中等有效性，电子胎儿监护对分娩时胎儿死亡或脑瘫的阳性预测值接近于零。换句话说，几乎每个阳性测试结果都是错误的。为了避免将来出现这种代价高昂的错误，在开始任何筛查项目之前，都必须满足该项目的前提条件。
