The conclusion of this study should have been that adequate monitoring of the fetus in labor can prevent early neonatal death, not that adequate monitoring of the fetus in labor with EFM can prevent early neonatal death. Moreover, the authors’ attempt to deflect this issue by referring to the current study as an example of “reality-based medicine” as opposed to “evidence-based medicine” undermines the very foundation of scientific investigation.
More questions than answers
The major conclusion of this study is that EFM protects against early neonatal death. So why is there no information about cause of death? These data should be readily available from a linked birth/death certificate data set. Such information might help to determine whether the excess early neonatal deaths were related to EFM or, more likely, to other variables surrounding or related to the delivery, such as the inability to perform an emergency cesarean, if indicated, or the lack of providers skilled in neonatal resuscitation.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
Not only does this analysis add little to the literature—it muddies the waters even further. In my opinion, the authors missed the boat entirely when it came to interpreting these data—but plaintiff’s attorneys won’t make the same mistake. I anticipate that, in the years ahead, this study will be quoted more by lawyers than by physicians. The study effectively seals the fate of any legal case in which EFM was not used in labor, despite the fact that the best available evidence shows no significant difference in perinatal morbidity and mortality between EFM and other standardized methods of intrapartum fetal monitoring, such as intermittent auscultation.—ERROL R. NORWITZ, MD, PHD
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