MDLinxThe ‘Worst Test in Medicine’? Doctors Know It Doesn’t Work—So Why Are We Still Using It?

Continuous electronic fetal monitoring—used in virtually every US labor—doesn’t reduce brain damage or death despite 50 years as standard practice. The test drives unnecessary C-sections through false alarms while Canada and UK have abandoned routine use in healthy pregnancies, yet US obstetricians remain “stuck with it” due to lawsuit fears.

⚖️ PROFESSIONAL IMPACT

• High false-positive rate triggers emergency C-sections with documented surgical risks—infection, hemorrhage, future pregnancy complications—without evidence of fetal outcome improvement.
• Legal liability outweighs clinical evidence: OB/GYNs face highest malpractice rates among specialties, making monitor presence “protective shield” in litigation regardless of actual efficacy.
• International practice diverges sharply—Canada and UK recommend against routine continuous monitoring in healthy pregnancies while US maintains universal adoption.
• Practice driven by “habit or fear” rather than outcomes, with Chicago obstetrician labeling it “worst test in medicine” for variability misinterpreted as distress.

🎯 ACTION ITEMS

• Document informed consent discussions explaining monitoring limitations and false-alarm rates before labor
• Establish protocols distinguishing high-risk from low-risk pregnancies to guide monitoring intensity decisions
• Train staff on physiologic heart rate variability versus pathologic patterns to reduce intervention overreaction
• Review institutional C-section rates tied to monitoring interpretations against evidence-based benchmarks

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