Obstetric litigation: The importance of the quality of clinical files and its influence on expertise conclusions

Domingues, Ana Patrícia; Moura, Paulo; Vieira, Duarte Nuno

doi:10.3109/01443615.2014.948816

Cited by 6 publications

(10 citation statements)

References 19 publications

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“…Yet, until that time, evaluating cord blood gases remains one of the most reliable ways of detecting but also excluding fetal hypoxia (20,28,29). Moreover, in today's era of defensive medicine and prenatal diagnostics, it is important to rule out IA as a contributing cause for the poor neurological outcome of neonates diagnosed prenatally with complex malformations such as holoprosencephaly, Galen vein aneurism or other brain anomalies (30)(31)(32)(33)(34)(35).…”

Section: Resultsmentioning

confidence: 99%

Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia

et al. 2020

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Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH.

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Section: Resultsmentioning

confidence: 99%

Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia

et al. 2020

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“…Dominiquez warns of insufficient medical records and clinical information necessary to evaluate litigation procedures, and as many as 85 % of clinical documentation cases are defective. The reasons for litigation were the same as those of other authors and include asphyxia, traumatic birth, and FSD [5,10,19]. Medical records must include the delivery course with the consent of the pregnant woman/mother; they should be written chronologically, include time of the FSD, time of the team alarm, description of the procedures, perinatal outcome, and the neonatal report.…”

Section: Discussionmentioning

confidence: 99%

“…Medical records must include the delivery course with the consent of the pregnant woman/mother; they should be written chronologically, include time of the FSD, time of the team alarm, description of the procedures, perinatal outcome, and the neonatal report. After the delivery and the neonatal procedure, it is obligatory for parents to understand the condition, possible consequences of the complications of FSD and to document their issues and conditions [5,10,19].…”

Section: Discussionmentioning

confidence: 99%

A Forensic Aspect of Fetal Shoulder Dystocia

Habek

Cerovac

2020

Z Geburtshilfe Neonatol

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Fetal shoulder dystocia (FSD) is an unpredictable and critical obstetric intrapartum emergency, where an objective problem is the relationship between the mother's pelvis and the child, i. e., an anthropometric disorder of delivery mechanics and dynamics. It is evident that the need to perform other maneuvers indicates the severity of FSD, which in turn correlates with the consequent iatrogenic injury of the fetus and/or mother. FSD is certainly the most controversial forensic obstetric problem, with the most disputes, compensation for damages due to peripartum injury to the child and/or mother, pain suffered, the need for someone else's care, and permanent disability. Suboptimal procedures and inadequate documentation are factors of forensic risk and subsequent litigations. Prevention of FSD is generally not possible, although good antenatal care can sometimes exclude risky cases of FSD, and some rare, chronic intrauterine disorders can result in orthopedic and neurological sequelae, which is especially important in forensic analysis. Because FSD is largely impossible to predict, it must be viewed as an intrapartum acceptable risk. During childbirth, FSD may compromise the safety of the mother and unborn child, therefore education and skills acquisition are necessary for obstetric work. Risk control, proper procedures, and proper documentation, along with good communication with the pregnant women and their families, significantly reduce litigation procedures.

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“…The technical-scientific opinions emitted by the Council regarding each case and the influence of the clinical files quality on these conclusions was reported and commented elsewhere 20,21 .…”

Section: Discussionmentioning

confidence: 99%