Key result
Knowledge of adverse neonatal outcomes increases substandard care judgments by ~100% versus healthy outcomes.
Why the study?
To determine whether obstetricians evaluating management decisions for abnormal FHR patterns are more likely to judge care as below the standard of care when informed of an adverse versus healthy neonatal outcome.
Does knowledge of an adverse neonatal outcome increase the likelihood of obstetricians judging care as below the standard of care?
RCT (n=128)
Randomly assigned
Yes
Does knowledge of an adverse neonatal outcome increase the likelihood of obstetricians judging care as below the standard of care?
Knowledge of adverse outcomes significantly biases obstetricians' retrospective interpretation of fetal heart rate tracings and quality of care judgments.
Hindsight bias may distort obstetricians' retrospective judgments of cesarean timing; leaves open whether blinding improves quality reviews or medicolegal fairness.
Objective: To determine whether obstetricians evaluating management decisions for abnormal fetal heart rate (FHR) patterns are more likely to judge care as below the standard of care when informed of an adverse neonatal outcome rather than a healthy outcome. Study design: Obstetricians from four academic institutions participated in a study involving three clinical scenarios with abnormal intrapartum FHR tracings. Each case included clinical details, FHR tracing segments, and neonatal outcomes. Participants were asked to categorize the FHR tracing, assess the timing of cesarean delivery (CD), and evaluate the quality of care. All participants received identical information for the first two cases. For the third case, participants received identical intrapartum data and FHR tracings but were randomly assigned to 1 of 2 neonatal outcomes (healthy vs adverse). Results: A total of 128 obstetricians participated. There were no differences in assessments for the first 2 cases. For the third case, knowledge of an adverse neonatal outcome was associated with more severe categorization of the FHR tracing (p=0.002), a greater likelihood of perceiving that CD was performed too late (79.3% vs 48.6%; p=0.0001; RR, 1.6 [95% CI, 1.2–2.2]), and a higher likelihood of judging care as below the standard of care (72.4% vs 37.1%; p=0.0001; RR, 2.0 [95% CI, 1.4–2.8]). Conclusion: Knowledge of an adverse neonatal outcome altered the interpretation of identical FHR tracings and doubled the likelihood of judging obstetrical care as below the standard of care, demonstrating the considerable influence of hindsight and outcome bias on retrospective clinical assessment.
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Blackwell et al. (2026) conducted an RCT in Fetal heart rate interpretation and obstetric care quality assessment (n=128). Knowledge of an adverse neonatal outcome vs. Knowledge of a healthy neonatal outcome was evaluated on Judging care as below the standard of care (RR 2.0, 95% CI 1.4-2.8, p=0.0001).
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