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Obstetric litigation in the U.S. has rendered electronic fetal monitoring “efficacious and capable of detecting asphyxia at an early enough stage to avoid neurologic damage.”Court decisions are “directly translatable to one's practice”when randomized controlled trials, apparently, are not.

Nevertheless, hypotheses regarding the benefits of certain paper speeds and the importance of beat-to-beat variability cannot be accepted until they are tested in properly designed randomized controlled trials. Among several difficulties to surmount is the repeated finding that interobserver agreement on fetal heart rate tracings has never exceeded 70 percent.