Professional liability claims and Central Association of Obstetricians and Gynecologists members: Myth versus reality

Chauhan, Suneet P.; Chauhan, Vidya B.; Cowan, Bryan D.; Hendrix, Nancy W.; Magann, Everett F.; Morrison, John C.

doi:10.1016/j.ajog.2004.12.058

Cited by 29 publications

(15 citation statements)

References 16 publications

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“…Although this experience may not be applicable to other hospitals in other states where there may be a greater propensity for litigation, it should be noted that in survey of 658 members of Central Association of Obstetricians and Gynecologists, who did $2,399,040 deliveries, there were 57 cases of litigation for BPI or 1 litigation per 42,088 births. 12 One surprising finding was that extraction of the posterior arm occurred much less frequently than we expected. Indeed in both groups (►Table 2), McRoberts maneuver, usually combined with suprapubic pressure, was successful in relieving the impaction.…”

Section: Commentsmentioning

confidence: 65%

A Multicenter Assessment of 1,177 Cases of Shoulder Dystocia: Lessons Learned

et al. 2013

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The purposes of this review were to describe deliveries complicated by shoulder dystocia (SD) at three tertiary centers and discern the differences between SD with and without brachial plexus injury (BPI). The inclusion criteria for this multicenter, retrospective study were singletons, delivered vaginally with SD. To discern the risk factors for SD with and without injury, a case (SD and BPI) versus control (3 SD without injury at the same institution) design was used. Multiple linear regression was employed. Over a 7-year period, among 46,637 vaginal deliveries, SD occurred in 1,177 cases (2.5%) and BPI was noted in 11%. The results of multiple regression indicate that gestational age, operative delivery, and the number of maneuvers and concomitant fracture (4%) were statistically associated with BPI following SD (p < 0.001). SD was not associated with BPI in 89% and 88% of the cases that were resolved with McRoberts maneuver and suprapubic pressure, whereas only 0.2% of cases were litigated.

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Section: Commentsmentioning

confidence: 65%

A Multicenter Assessment of 1,177 Cases of Shoulder Dystocia: Lessons Learned

et al. 2013

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“…In the United States, financial claims are the most common concern that obstetricians may face with respect to responding to cesarean requests [26][27][28]. On the other hand, Europeans are more afraid of legislation and medical jurisdiction [23].…”

Section: Discussionmentioning

confidence: 99%

Attitudes of Obstetricians toward Cesarean Delivery in Challenging Cases

Samadi

Gholizadeh

Shoar

et al. 2013

J Obstet Gynecol India

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Objective To assess the behavior and preferred delivery method among Iranian obstetricians in challenging cases. Method Using the revised Jackson personality inventory questionnaire, the attitudes of obstetricians toward cesarean delivery were assessed in challenging childbirth cases. The study was conducted at the Mashhad University of Medical Sciences in Mashhad, Iran. Result Seventy-five obstetricians answered each item reflecting varying levels of preference and risk attitudes. However, a significant number of respondents avoided the risk of requesting a cesarean because of legislation and legal issues. Conclusion Iranian obstetricians prefer low-risk behavior for managing ambiguous delivery cases. Fear of legislation and medicolegal issues appear to be of great importance in this cohort primarily comprising female physicians.

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“…Compounding the matters further, neither demographics, obstetric complications, intrapartum events or neonatal factors help differentiate this small number of infants destined to have encephalopathy from the vast majority without this clinical diagnosis. Unfortunately, the surrogate ICD-9 codes, which most closely correspond to the clinical diagnosis of HIE, are also likely to be linked with professional liability issues if permanent neurological damage does occur [2,13]. These litigious activities are also correlated with the largest monetary awards since they usually involve supporting the neurologically abnormal infants for many years.…”

Section: Discussionmentioning

confidence: 99%

“…Even though these ICD-9/10 code diagnoses are rarely linked with specific intrapartum events, HIE is often reported as associated with events in and around the time of delivery resulting in a clinical diagnosis of HIE and the ICD-9/10 codes of birth trauma/asphyxia in the newborn chart. These diagnoses may often lead to professional medical liability [2]. The clinical utility of birth asphyxia and fetal distress as pediatric/obstetric diagnoses is very imprecise and according to the American College of Obstetrics and Gynecology (ACOG) should not be used [3].…”

Section: Introductionmentioning

confidence: 99%

Does the International Classification of Disease (ICD-9) Code Accurately Identify Neonates Who Clinically Have Hypoxic-Ischemic Encephalopathy?

Vance

Niederhauser

Chauhan

et al. 2010

Gynecol Obstet Invest

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Background/Aims: Hypoxic-ischemic encephalopathy (HIE) refers to neonatal neurological signs and symptoms of hypoxia and/or ischemia. Our aim was to determine the accuracy of ICD-9 codes to identify newborns with HIE confirmed by umbilical cord blood analysis. Methods: ICD-9 codes in the newborn chart for birth trauma, birth asphyxia, intrauterine hypoxia, and fetal distress were used to identify newborns with suspected HIE by neonatal personnel. Maternal charts were reviewed for umbilical cord gases meeting the HIE clinical criteria. Results: There were 21,008 deliveries at center I and 17,540 at center II. ICD-9 codes identified 172 neonates, 49 infants (2.3‰ births) at center I and 123 neonates (7‰) at center II. Only 3 neonates (6%) were ≧34 weeks and none met ACOG criteria [umbilical artery pH <7.00 or base excess (BE) ≧12 mmol/l at center I]. At center II, 80 infants were ≧34 weeks but only 5/123 (4%) met the ACOG clinical criteria for HIE (pH <7.00, BE ≧12 mmol/l, and Apgar ≤3 at 5 min). Conclusions: ICD-9 codes are unreliable in identifying birth asphyxia and cannot identify newborns meeting the clinical criteria for intrapartum HIE.

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Professional liability claims and Central Association of Obstetricians and Gynecologists members: Myth versus reality

Cited by 29 publications

References 16 publications

A Multicenter Assessment of 1,177 Cases of Shoulder Dystocia: Lessons Learned

A Multicenter Assessment of 1,177 Cases of Shoulder Dystocia: Lessons Learned

Attitudes of Obstetricians toward Cesarean Delivery in Challenging Cases

Does the International Classification of Disease (ICD-9) Code Accurately Identify Neonates Who Clinically Have Hypoxic-Ischemic Encephalopathy?

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