Claims for compensation after alleged birth asphyxia: a nationwide study covering 15 years

Andreasen, Stine; Backe, Bjørn; Øian, Pål

doi:10.1111/aogs.12276

Cited by 17 publications

(17 citation statements)

References 32 publications

(44 reference statements)

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“…In sub-Saharan Africa, asphyxia at birth is responsible for 280,000 deaths per year, especially on the first day of life [9]. Poor quality of care, inadequate fetal monitoring, and lack of skills of the health personnel are frequently associated with asphyxia at birth [20]. The training and equipment of community health workers for basic neonatal resuscitation can combat neonatal asphyxia and death which are linked [6] [16].…”

Section: Neonatal Deathsmentioning

confidence: 99%

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

Kouéta¹,

Nagalo²,

Ouedraogo³

et al. 2015

OJPed

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Introduction: In developing countries, many neonatal deaths still occur at home and the causes of these deaths are not ascertained. Objective: To identify the causes of stillbirths and neonatal deaths that occur at home and the factors that have contributed to these deaths. Materials and Method: We have used the method of verbal autopsy to investigate the stillbirths and neonatal deaths in nine villages in the health area of Namsiguia, health district of Ouahigouya, Burkina Faso, during the period January 1, 2007 to December 8, 2012. Results: Over these six years, we have recorded 19 stillbirths and 36 neonatal deaths among 1507 live births, demonstrating a neonatal mortality rate of 28.8 per1000 and a rate of stillbirths of 12.6 per 1000. The average age of newborns at death was 5.6 days and the sex-ratio was 1.6. The major cause of stillbirths was antenatal hypoxia and birth asphyxia (42.1%). The direct causes of neonatal deaths were neonatal sepsis (41.7%), preterm birth (19.4%) and hypoxia and birth asphyxia (11.1%). There were 42.1% deliveries and 58.3% neonatal deaths, which occurred at home. We have noted 89.5% fresh stillbirths. Death occurred more often during the early neonatal period (55.5%). Factors significantly associated with neonatal death were, lack of school education of mothers (OR = 4), precocious marriage of the mother (OR = 8), poor follow-up of pregnancies (OR = 3), birth at home (OR = 4), low socioeconomic level (OR = 6), and low geographical access to the health facility (OR = 4). Conclusions: Strengthening of the health infrastructure and improving their accessibility, reinforcement of the staff for high quality care, and communication for a change in behavior in rural communities, will contribute toward reducing neonatal mortality in the area of health of Namsiguia.

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Section: Neonatal Deathsmentioning

confidence: 99%

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

Kouéta¹,

Nagalo²,

Ouedraogo³

et al. 2015

OJPed

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“…Based on the studies analyzing obstetric compensation claims, [3][4][5] we hypothesized that errors in CTG management were mainly a problem of lack of knowledge that could be addressed with CTG ed- only be the cause of cerebral palsy in 10% of cases and consensus criteria for a causal relation between intrapartum events and cerebral palsy have been developed to minimize the risk of cerebral palsy being mislabeled as due to intrapartum hypoxia. 25 These criteria are not universally applied in all studies analyzing obstetric compensation claims, which weakens the association between CTG management errors and hypoxic brain injuries.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Studies indicate an association between errors in the management of cardiotocography (CTG) and hypoxic brain injuries among newborns. [3][4][5] Since the implementation of CTG, the desired aim of reducing the incidence of cerebral palsy has not been achieved. 6 Adjunctive methods have been introduced without conclusive improvements in neonatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

Thellesen

Bergholt

Sørensen

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Studies indicate an association between errors in cardiotocography (CTG) management and hypoxic brain injuries among newborns. Continuing professional education is recommended. We aimed to examine whether the implementation of a national interprofessional CTG education program in Denmark was associated with a decrease in risk of fetal hypoxia measured by umbilical cord pH < 7.00, 5‐minute Apgar score <7 or neonatal therapeutic hypothermia. As a secondary aim, we assessed whether the educational intervention was associated with an increase in operative deliveries. Material and methods We conducted a historical cohort study from 2009 to 2015 including all intended vaginal deliveries with liveborn singletons in cephalic presentation and gestational age ≥37 weeks. Data were retrieved from the Medical Birth Register and the National Patient Register. The study period was divided in three: pre‐implementation (2009‐2012), implementation (2013) and post‐implementation (2014‐2015). Using logistic regression we estimated odds ratios (OR) of fetal hypoxia outcomes using the pre‐implementation period as reference. Analyses were adjusted for potential maternal, neonatal and delivery‐associated confounders. Missing data were accounted for by multiple imputation. Results In all, 331 282 deliveries were included. Overall risks of pH < 7.00, Apgar score <7 and therapeutic hypothermia were respectively 0.45%, 0.58% and 0.06%. Adjusted OR in the post‐implementation period were 1.12 (95% confidence interval [CI] 1.00‐1.26), 0.99 (95% CI 0.90‐1.10) and 1.34 (95% CI 0.99‐1.82) for the three outcomes, respectively. The pH missingness equaled 12.4%. Odds of emergency cesarean section was unaltered, whereas the odds of assisted vaginal delivery decreased by 14% (0.86, 95% CI 0.84‐0.89). Conclusions Healthcare professionals are considered the weakest link of CTG technology. We did not find that increasing healthcare professionals’ CTG interpretation skills affected the risk of fetal hypoxia. Missing data for pH values were substantial and represent a limitation of the study. We cannot with certainty rule out that missingness masked a true effect of the intervention. Our study indicates that assisted vaginal deliveries can be decreased without an increased risk of fetal hypoxia. Dilution of effect in a complex clinical setting, rare outcomes, insufficient intervention and a possible overestimation of the impact of errors in CTG management might explain the lack of effect.

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“…As situações identificadas como motivo são consistentes com a bibliografia existente sobre queixas em Ginecologia e Obstetrícia. [29][30][31][32][33] Das 54 queixas analisadas, 52 resultaram na não penalização do médico e foram arquivadas, enquanto que duas (uma por conflito médico/doente e outra por conluio médico/comércio) continuam a aguardar decisão. Assim, e apesar da Ginecologia e Obstetrícia ser uma especialidade propensa a queixas, o despacho de condenação emitido pelo CD da SRN da OM não reconheceu em nenhum caso matéria para punir disciplinarmente os médicos visados, o que está de acordo com alguma da bibliografia existente que reporta que, apesar do número de queixas ser elevado, as que motivam penalização do arguido e indemnização aos queixosos são em número bastante menor.…”

Section: Discussionunclassified

Ações Disciplinares em Ginecologia e Obstetrícia na Região Norte de Portugal nos Anos 2008 a 2012

2015

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RESUMOIntrodução: As ações disciplinares podem ter um impacto significativo na vida dos médicos e dos doentes. O objetivo deste trabalho foi a avaliação das ações disciplinares em Ginecologia e Obstetrícia ocorridas na região norte We calculated the proportion of disciplinary actions in Obstetrics and Gynaecology over the total number of registered specialists in that speciality. We also analysed the type of complainers, accused, institutions, complaints and decisions. For statistical inference proportions with 95% confidence intervals were estimated. Results: From years 2008 to 2012, we registered 1040 complaints in all medical specialities in the north of Portugal. Obstetrics and Gynecology was the forth most affected specialty, with a total of 54 complaints. Forty-three complaints were related with medical malpractice and if we only consider this type of complaint Obstetrics and Gynecology was the most affected specialty. The most frequent complainers and accused were, respectively, patients themselves and female physicians, with 41 to 60 years of age. Fifty-two complaints were archived without punishment while two still await conclusion. Discussion: The overall results of this study are in agreement with those reported by other authors. Conclusions: Obstetrics and Gynecology was the forth speciality with highest risk for any disciplinary action in the north of Portugal in years 2008 to 2012 and the first one in relation with alleged negligence. All presented and already concluded complaints were archived without penalty, except two that are still under evaluation. Keywords: Gynecology; Liability, Legal; Malpractice; Obstetrics; Portugal; Professional Misconduct. INTRODUÇÃOA profissão médica associa-se, desde tempos imemoriais, a uma forte regulamentação e escrutínio social, plasmados em inúmeros códigos, declarações e regulamentos, de diversas naturezas -ética, jurídica ou deontológica. 1Esta realidade é cada vez mais uma parte integrante do exercício profissional, condicionando-o profundamente. Calcula-se que, em média, os médicos possam estar envolvidos em ações disciplinares ou legais durante 11% dos 40 anos de vida média profissional.2 Trata-se, no entanto, de um assunto difícil de estudar, com pouca informação disponível na literatura médica. É grande a diversidade e complexidade dos processos, com os médicos a poderem ser alvo de ações movidas por entidades patronais, profissionais e judiciais.1 É, por isso, difícil obter um retrato completo dos resultados do escrutínio exercido sobre os médicos.Alguns artigos e relatórios institucionais abordam os problemas no âmbito das ações movidas pelas entidades patronais, de natureza essencialmente administrativa, laboral e de qualidade de desempenho. 3,4 Outros trabalhos interessam-se pelas ações movidas pelas associações profissionais, investidas de legitimidade deontológica e de poder disciplinar, como as ordens e os colégios de

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Claims for compensation after alleged birth asphyxia: a nationwide study covering 15 years

Cited by 17 publications

References 32 publications

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

Verbal Autopsy of Stillbirths and Neonatal Deaths in a Rural Area of Burkina Faso

The impact of a national cardiotocography education program on neonatal and maternal outcomes: A historical cohort study

Ações Disciplinares em Ginecologia e Obstetrícia na Região Norte de Portugal nos Anos 2008 a 2012

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