Affordable Access

Access to the full text

Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate

Authors
  • Balayla, Jacques1
  • Lasry, Ariane1
  • Gil, Yaron1
  • Volodarsky-Perel, Alexander1
  • 1 Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
Type
Published Article
Journal
AJP Reports
Publisher
Thieme Medical Publishers
Publication Date
Jul 01, 2020
Volume
10
Issue
3
Identifiers
DOI: 10.1055/s-0040-1713786
PMID: 33094026
PMCID: PMC7571557
Source
PubMed Central
Keywords
License
Green

Abstract

Over the last 30 years, the caesarean section rate has reached global epidemic proportions. This trend is driven by multiple factors, an important one of which is the use and inconsistent interpretation of the electronic fetal monitoring (EFM) system. Despite its introduction in the 1960s, the EFM has not definitively improved neonatal outcomes, yet it has since significantly contributed to a seven-fold increase in the caesarean section rate. As we attempt to reduce the caesarean rates in the developed world, we should consider focusing on areas that have garnered little attention in the literature, such as physician sensitization to the poor predictive power of the EFM and the research method biases that are involved in studying the abnormal heart rate patterns—umbilical cord pH relationship. Herein, we apply Bayes theorem to different clinical scenarios to illustrate the poor predictive power of the EFM, as well as shed light on the principle of protopathic bias, which affects the classification of research outcomes among studies addressing the effects of the EFM on caesarean rates. We propose and discuss potential solutions to the aforementioned considerations, which include the re-examination of guidelines with which we interpret fetal heart rate patterns and the development of noninvasive technologies that evaluate fetal pH in real time.

Report this publication

Statistics

Seen <100 times