Adverse events in women giving birth in a labor ward: a retrospective record review study

Abstract

Background Childbirth could negatively affect the woman’s health through adverse events. To prevent adverse events and increase patient safety it is important to detect and learn from them. The aim of the study was to describe adverse events, including the preventability and severity of harm during planned vaginal births, in women giving birth in the labor ward. Methods The study had a descriptive design with a retrospective birth record review to assess the preventability of adverse events using the Swedish version of the Global Trigger Tool. The setting was a labor ward in Sweden with low-risk and risk childbirths. Descriptive statistics, Pearson’s Chi-square test and Student’s t-test were used. Results A total of 38 adverse events (12.2%) were identified in 311 reviewed birth records. Of these, 28 (73.7%) were assessed as preventable. Third- or fourth-degree lacerations and distended urinary bladder were most prevalent together with anesthesia-related adverse events. The majority of the adverse events were classified into the harm categories of ‘prolonged hospital care’ (63.2%) and ‘temporary harm’ (31.6%). No permanent harm were identified, but over two-thirds of the adverse events were assessed as preventable. Conclusions This first study using Global Trigger Tool in a labor ward in Sweden identified a higher incidence of adverse events than previous studies in obstetric care. No permanent patient harm was found, but over two-thirds of the adverse events were assessed as preventable. The results draw particular attention to 3rd-or 4th-degree lacerations, distended urinary bladder and anesthesia-related adverse events. The feedback on identified adverse events should be used for systematic quality improvement and clinical recommendations how to prevent adverse events must be implemented.

Reducing preventable adverse events in obstetrics by improving interprofessional communication skills – Results of an intervention study

“…AEs, responsible for morbidity and mortality in hospitalized patients, are reported to be between 3 and 17%, and up to 50% are considered preventable [ 3 ]. In obstetrics, an incidence of up to 5.9% is reported [ 10 ]. In statistics, obstetrics is often not evaluated separately but subsumed under the specialist discipline of gynecology, which makes it difficult to state the exact number of AEs in obstetrics.…”

“…In statistics, obstetrics is often not evaluated separately but subsumed under the specialist discipline of gynecology, which makes it difficult to state the exact number of AEs in obstetrics. Studies that explicitly consider obstetrics give incidences between 0.4% and 3.6% with a preventability of more than 50% [ 10 , 22 ]. In our evaluation, the incidence of AEs is 23% and 29%, respectively.…”

“…Most of the events were grade 3/4 perineal tears, bladder voiding disorders, and anesthesia-related complications. In addition, a distinction was made between prolonged hospitalization (63.2%) and temporary harm (31.6%) [ 10 ].…”

“…PAEs also occur in obstetrics. In a study in Sweden 12.2% adverse events were detected of which 73.7% were assessed as preventable [ 10 ]. The special feature of obstetrics as a medical discipline lies in the coincidence of unpredictable emergencies, as well as the simultaneous responsibility for the expectant mother and the unborn child.…”

Importance of Quality of Medical Record: Differences in Patient Safety Incident Inquiry Results According to Assessment for Quality of Medical Record

“…5,6 However, the quality of the medical record should be considered when using medical record review methods to identify adverse events, 3,7 as poor quality can compromise the validity and utilization value of the findings. [8][9][10] Although various retrospective medical record review studies have been conducted to identify adverse events, 5,[11][12][13][14][15] few have examined the impact of medical record quality on them. A study that did examine this association reported that missing medical record information was associated with a lower rate of identification of adverse events, while poor medical record quality was associated with a higher rate of identification of adverse events.…”