Joy,
You could try to give the descision makers some food for thought by
presenting some pretty convincing statistics.Recruit some help from an
epidemiologist. You need to be able to give the epidemiologist figures for
how many times CTG correctly predicts a negative fetal outcome - best choice
is probably apgar less than 7 at 5 minutes. The epidemiologist also needs to
know approximately how often CTG is used on a given population of labouring
mothers to be.
From this you can calculate the sensitivity and specificity of CTG
monitoring in labour. You can then go on to calculate the PPV (positive
predictive value) and NPV (negative predictive value). The answers you get
can be translated into understandable terms by something like this:"How many
wrong diagnoses of fetal distress does CTG lead to before we get a correct
diagnosis?"
That way we can clearly see the damage we do even when the intention is to
do good.
This isn't simple but as far as I know it's the best way to produce the hard
facts that are needed to get descision makers to sit up. (Unfortunately even
this doesn't always work).
Good luck!
Linda Kvist.
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