Peripartum hysterectomy has increased significantly during the last 20 years. Optimizing treatment of PPH may decrease the incidence of peripartum hysterectomy in the future.

The diagnostic value of a test depends on the variabilityof thetest resultsand theaccuracyofthe test. Theobject of this investigation was to estimate the observer variability and the accuracy, when intrapartum CTGs were assessed by experienced obstetricians. Fifty CTGs were evaluated twice by four obstetricians. They were asked to identify the CTGs belonging to the compromised infants. They were told the criteria for a compromised infant and the incidence (one-third).Eleven (22%) of the CTGs were assessed in the same way of all the Obstetricians in both evaluations. Between the obstetricians, thc accuracy ranged from 50 to 66%. We conclude that the considerable observer variability found in this and other invcstigations must severely impair the clinical value of electronic fetal monitoring (EFM). The variability must be reduced before the "true" predictive value and thecost/benefit of EFM can be estimated. Key worclr: Fetal monitoring, delivery, asphyxia neonatorumT h e value of electronic fetal monitoring (EFM) during delivery has been assessed in several investigations designed with random allocation and controls. Also the latest and largest (1) has only been able t o show a marginal effect of intrapartum EFM.Peter Vest Nielsen, M.D. Akanderhaven 118 DK -2965 Smerum Denmark Acco Obstet Gynecd S a n d 66 11987)