Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate
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 h...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical Publishers, Inc.
2020-07-01
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| Series: | American Journal of Perinatology Reports |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1713786 |
| _version_ | 1818130757705531392 |
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| author | Jacques Balayla Ariane Lasry Yaron Gil Alexander Volodarsky-Perel |
| author_facet | Jacques Balayla Ariane Lasry Yaron Gil Alexander Volodarsky-Perel |
| author_sort | Jacques Balayla |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T08:10:07Z |
| format | Article |
| id | doaj.art-b994acb555ad44a9bb88f96e8df794ba |
| institution | Directory Open Access Journal |
| issn | 2157-6998 2157-7005 |
| language | English |
| last_indexed | 2024-12-11T08:10:07Z |
| publishDate | 2020-07-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | American Journal of Perinatology Reports |
| spelling | doaj.art-b994acb555ad44a9bb88f96e8df794ba2022-12-22T01:14:54ZengThieme Medical Publishers, Inc.American Journal of Perinatology Reports2157-69982157-70052020-07-011003e342e34510.1055/s-0040-1713786Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section RateJacques Balayla0Ariane Lasry1Yaron Gil2Alexander Volodarsky-Perel3Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, CanadaDepartment of Obstetrics and Gynecology, McGill University, Montreal, Quebec, CanadaDepartment of Obstetrics and Gynecology, McGill University, Montreal, Quebec, CanadaDepartment of Obstetrics and Gynecology, McGill University, Montreal, Quebec, CanadaOver 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1713786fetal phcaesarean sectionbayes theoremprotopathic bias |
| spellingShingle | Jacques Balayla Ariane Lasry Yaron Gil Alexander Volodarsky-Perel Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate American Journal of Perinatology Reports fetal ph caesarean section bayes theorem protopathic bias |
| title | Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate |
| title_full | Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate |
| title_fullStr | Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate |
| title_full_unstemmed | Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate |
| title_short | Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate |
| title_sort | bayes theorem and protopathic bias methodological concerns when addressing the impact of fetal heart rate patterns on the cesarean section rate |
| topic | fetal ph caesarean section bayes theorem protopathic bias |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1713786 |
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