The relation of electronic fetal monitoring patterns to infant outcome measures in a random sample of term size infants born to high risk mothers.

In the rush to use a new medical technology the fact that relative risk is not a measure of the predictive validity of a variable is sometimes forgotten. In the present paper both the relative risk and predictive value of electronic fetal monitoring patterns are examined to see whether they are associated with problematic neonatal outcomes. It is shown that nonreassuring or ominous patterns are not good predictors of problematic neonatal outcomes. This suggests either that there is no risk associated with these patterns or if in fact there is such a risk, it is moderated by some as yet unknown variables between the time that the pattern is seen and the actual birth of the infant. This fact has implication for the management of labor and delivery using electronic monitoring equipment, since it appears that the use of such equipment will lead to a significant increase in the cesarean section rate. If this increase in the cesarean section rate comes about because of the assumed predictive value of a nonreassuring or ominous pattern, it may represent an unnecessary increase in cost and risk of delivery.