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Wang Y, Ram S(S, Scahill S. Risk identification and prediction of complaints and misconduct against health practitioners: a scoping review. Int J Qual Health Care 2024; 36:mzad114. [PMID: 38155372 PMCID: PMC10791111 DOI: 10.1093/intqhc/mzad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/17/2023] [Accepted: 12/26/2023] [Indexed: 12/30/2023] Open
Abstract
Identifying the risk and predicting complaints and misconduct against health practitioners are essential for healthcare regulators to implement early interventions and develop long-term prevention strategies to improve professional practice and enhance patient safety. This scoping review aims to map out existing literature on the risk identification and prediction of complaints and misconduct against health practitioners. This scoping review followed Arksey and O'Malley's five-stage methodological framework. A comprehensive literature search was conducted on MEDLINE, EMBASE, and CINAHL databases and finished on the same day (6 September 2021). Articles meeting the eligibility criteria were charted and descriptively analysed through a narrative analysis method. The initial search generated 5473 articles. After the identification, screening, and inclusion process, 81 eligible studies were included for data charting. Three key themes were reported: methods used for identifying risk factors and predictors of the complaints and misconduct, synthesis of identified risk factors and predictors in eligible studies, and predictive tools developed for complaints and misconduct against health practitioners. The findings reveal that risk identification and prediction of complaints and misconduct are complex issues influenced by multiple factors, exhibiting non-linear patterns and being context specific. Further efforts are needed to understand the characteristics and interactions of risk factors, develop systematic risk prediction tools, and facilitate the application in the regulatory environment.
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Affiliation(s)
- Yufeng Wang
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Sanyogita (Sanya) Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Shane Scahill
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
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Bergamin E, Fiorillo A, Grassi VM, Lodise M, Vetrugno G, De-Giorgio F. Medical Professional Liability in Obstetrics and Gynecology: A Pilot Study of Criminal Proceedings in the Public Prosecutor's Office at the Court of Rome. Healthcare (Basel) 2023; 11:healthcare11091331. [PMID: 37174872 PMCID: PMC10178439 DOI: 10.3390/healthcare11091331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Criminal trials and claims against physicians for malpractice-related damages have increased dramatically in recent years, and, with Obstetrics and Gynecology being one of the medical specialties that is at the highest risk, we carried out a retrospective analysis aimed at examining all Obstetrics- and Gynecology-related medical professional liability prosecutions within the General Register of Criminal Records of the Rome Public Prosecutor's Office between the years 2000 and 2014. The number of prosecutions increased steadily in the years 2000-2005, with varying trends in the following years. A total of 727 healthcare professionals were involved in criminal charges, and most prosecuted crimes were related to Articles 590 and 589 of the Italian Penal Code, followed by violations of Article 17 of Law 194/78. In most cases, filing was requested and granted without opposition. In 95 cases, an expert witness was appointed by the Court, and in 68 cases, the technical consultants of the State Prosecutor found culpable conduct. Public hospitals, private nursing homes and outpatient clinics, or private practices were mostly involved; in 45% of the cases, the physicians were hospital employees. In this setting, Italy is prepared to introduce new measures and regulations to address the issues posed by defensive medicine and charges of professional liability for healthcare providers.
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Affiliation(s)
- Eva Bergamin
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Annamaria Fiorillo
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Vincenzo M Grassi
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Risk Management Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Maria Lodise
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Giuseppe Vetrugno
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Risk Management Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Fabio De-Giorgio
- Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Roma, Italy
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Chauhan SP, Chang KWC, Ankumah NAE, Yang LJS. Neonatal brachial plexus palsy: obstetric factors associated with litigation. J Matern Fetal Neonatal Med 2016; 30:2428-2432. [DOI: 10.1080/14767058.2016.1252745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Suneet P. Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA and
| | - Kate W-C. Chang
- Department of Neurosurgery and Brachial Plexus Program, University of Michigan, Ann Arbor, MI, USA
| | - Nana-Ama Esi Ankumah
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA and
| | - Lynda J-S. Yang
- Department of Neurosurgery and Brachial Plexus Program, University of Michigan, Ann Arbor, MI, USA
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Association of Fetal Abdominal-Head Circumference Size Difference With Shoulder Dystocia: A Multicenter Study. AJP Rep 2015; 5:e099-104. [PMID: 26495163 PMCID: PMC4603871 DOI: 10.1055/s-0035-1548544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/29/2015] [Indexed: 11/28/2022] Open
Abstract
Objective This study aims to determine if shoulder dystocia is associated with a difference in the fetal abdominal (AC) to head circumference (HC) of 50 mm or more noted on antenatal ultrasound. Study Design A multicenter matched case-control study was performed comparing women who had shoulder dystocia to controls who did not. Women with vaginal births of live born nonanomalous singletons ≥ 36 weeks of gestation with an antenatal ultrasound within 4 weeks of delivery were included. Controls were matched for gestational age, route of delivery, and diabetes status. Results We identified 181 matched pairs. Only 5% of the fetuses had an AC to HC of ≥ 50 mm. The proportion of AC to HC difference of ≥ 50 mm was significantly higher in shoulder dystocia cases (8%) than controls (1%, p = 0.002). With multivariate regression, the three significant factors associated with shoulder dystocia were AC to HC ≥ 50 mm (odds ratio [OR], 7.3; confidence interval [CI], 1.6-33.3; p = 0.010), femur length (OR, 1.1; CI, 1.0-1.2; p = 0.002), and induced labor (OR, 1.8; CI, 1.1-3.1; p = 0.027). Conclusion A prenatal ultrasound finding of a difference in AC to HC of ≥ 50 mm while uncommon is associated with shoulder dystocia.
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Unwin E, Woolf K, Wadlow C, Potts HWW, Dacre J. Sex differences in medico-legal action against doctors: a systematic review and meta-analysis. BMC Med 2015; 13:172. [PMID: 26268807 PMCID: PMC4535538 DOI: 10.1186/s12916-015-0413-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The relationship between male sex and poor performance in doctors remains unclear, with high profile studies showing conflicting results. Nevertheless, it is an important first step towards understanding the causes of poor performance in doctors. This article aims to establish the robustness of the association between male sex and poor performance in doctors, internationally and over time. METHODS The electronic databases MEDLINE, EMBASE, and PsycINFO were searched from inception to January 2015. Backward and forward citation searching was performed. Journals that yielded the majority of the eligible articles and journals in the medical education field were electronically searched, along with the conference and poster abstracts from two of the largest international medical education conferences. Studies reporting original data, written in English or French, examining the association between sex and medico-legal action against doctors were included. Two reviewers independently extracted study characteristics and outcome data from the full texts of the studies meeting the eligibility criteria. Study quality was assessed using the Newcastle-Ottawa scale. A random effect meta-analysis model was used to summarize and assess the effect of doctors' sex on medico-legal action. Extracted outcomes included disciplinary action by a medical regulatory board, malpractice experience, referral to a medical regulatory body, complaints received by a healthcare complaints body, criminal cases, and medico-legal matter with a medical defence organisation. RESULTS Overall, 32 reports examining the association between doctors' sex and medico-legal action were included in the systematic review (n=4,054,551), of which 27 found that male doctors were more likely to have experienced medico-legal action. 19 reports were included in the meta-analysis (n=3,794,486, including 20,666 cases). Results showed male doctors had nearly two and a half times the odds of being subject to medico-legal action than female doctors. Heterogeneity was present in all meta-analyses. CONCLUSION Male doctors are more likely to have had experienced medico-legal actions compared to female doctors. This finding is robust internationally, across outcomes of varying severity, and over time.
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Affiliation(s)
- Emily Unwin
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Katherine Woolf
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Clare Wadlow
- UCL Medical School, University College London, Royal Free Hospital, London, NW3 2PF, UK.
| | - Henry W W Potts
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
| | - Jane Dacre
- Royal College of Physicians, 11 St Andrews Place, London, NW1 4LE, UK.
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Affiliation(s)
- Suneet P Chauhan
- Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology UT Health Science Center at Houston Houston, TX
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Abstract
Though subjective in nature, both the American College of Obstetricians and Gynecologists practice bulletin and the Royal College of Obstetricians and Gynaecologists green guideline are in agreement on the descriptor of shoulder dystocia: requirement of additional obstetric maneuvers when gentle downward traction has failed to affect the delivery of the shoulders. The rate of shoulder dystocia is about 1.4% of all deliveries and 0.7% for vaginal births. Compared to non-diabetics (0.6%), among diabetics, the rate of impacted shoulders is 201% higher (1.9%); newborns delivered by vacuum or forceps have 254% higher likelihood of shoulder dystocia than those born spontaneously (2.0% vs. 0.6%, respectively). When the birthweight is categorized as <4000, 4000-4449, and >4500 g, the likelihood of shoulder dystocia in the US vs. other countries varies significantly. Future studies should focus on lowering the rate of shoulder dystocia and its associated morbidities, without concomitantly increasing the rate of cesarean delivery.
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Affiliation(s)
- Alexandra Hansen
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Health Science Center at Houston, Houston, Texas.
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Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol 2014; 38:210-8. [PMID: 24863027 DOI: 10.1053/j.semperi.2014.04.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Epidemiological knowledge of the incidence, prevalence, and temporal changes of neonatal brachial plexuses palsy (NBPP) should assist the clinician, avert unnecessary interventions, and help formulate evidence-based health policies. A summary of 63 publications in the English language with over 17 million births and 24,000 NBPPs is notable for six things. First, the rate of NBPP in the US and other countries is comparable: 1.5 vs. 1.3 per 1000 total births, respectively. Second, the rate of NBPP may be decreasing: 0.9, 1.0 and 0.5 per 1,000 births for publications before 1990, 1990-2000, and after 2000, respectively. Third, the likelihood of not having concomitant shoulder dystocia with NBPP was 76% overall, though it varied by whether the publication was from the US (78%) vs. other countries (47%). Fourth, the likelihood of NBPP being permanent (lasting at least 12 months) was 10-18% in the US-based reports and 19-23% in other countries. Fifth, in studies from the US, the rate of permanent NBPP is 1.1-2.2 per 10,000 births and 2.9-3.7 per 10,000 births in other nations. Sixth, we estimate that approximately 5000 NBPPs occur every year in the US, of which over 580-1050 are permanent, and that since birth, 63,000 adults have been afflicted with persistent paresis of their brachial plexus. The exceedingly infrequent nature of permanent NBPP necessitates a multi-center study to improve our understanding of the antecedent factors and to abate the long-term sequela.
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Affiliation(s)
- Suneet P Chauhan
- Department of Obstetrics and Gynecology, University of Texas, Houston, TX.
| | - Sean B Blackwell
- Department of Obstetrics and Gynecology, University of Texas, Houston, TX
| | - Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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Sex differences among obstetrician-gynecologists: a review of survey studies. Obstet Gynecol Surv 2014; 68:235-53. [PMID: 23945840 DOI: 10.1097/ogx.0b013e318286f0aa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Whether practice differences exist between the sexes is a question of clinical and educational significance. The obstetrician-gynecologist (ob-gyn) workforce has been shifting to majority women. An examination of sex differences in ob-gyn practice contributes to the discussion about how the changing workforce may impact women's healthcare. We sought to review survey studies to assess whether there are specific topics in which differences in attitudes, opinions, and practice patterns between male and female ob-gyns are apparent. We conducted a systematic review to identify all survey studies of ob-gyns from the years 2002-2012. A total of 93 studies were reviewed to identify statements of sex differences and categorized by conceptual theme. Sex differences were identified in a number of areas. In general, women report more supportive attitudes toward abortion. A number of differences were identified with regard to workforce issues, such as women earning 23% less than their male counterparts as reported in 1 study and working an average of 4.1 fewer hours per week than men in another study. Men typically provide higher selfratings than women in a number of areas. Other noted findings include men tending toward more pharmaceutical therapies and women making more referrals for medical conditions. Although a number of areas of difference were identified, the impact of such differences is yet to be determined. Additional research may help to clarify the reasons for such differences and their potential impact on patients. TARGET AUDIENCE Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to determine how the relevance of studying sex differences among physicians, specifically ob-gyns, can help improve patient care, assess whether there are topical areas in which male and female ob-gyns have reported different beliefs, practices, attitudes, and opinions, and examine how the limitations of survey studies and systematic reviews can affect the findings of these studies and reviews.
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Samadi S, Gholizadeh N, Shoar N, Shoar S. Attitudes of Obstetricians toward Cesarean Delivery in Challenging Cases. J Obstet Gynaecol India 2013; 63:301-5. [PMID: 24431663 DOI: 10.1007/s13224-013-0401-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 03/27/2013] [Indexed: 10/26/2022] Open
Abstract
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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Affiliation(s)
- Sareh Samadi
- Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naeimeh Gholizadeh
- Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrin Shoar
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Saeed Shoar
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences (TUMS), No. 54, Boostan e Qods (Shilat) Dormitory, Shahed Alley, Qods Street, Keshavarz Boulevard, Tehran, Iran
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Maternity care and liability: pressing problems, substantive solutions. Womens Health Issues 2013; 23:e7-13. [PMID: 23312715 DOI: 10.1016/j.whi.2012.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/02/2012] [Accepted: 11/07/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND This paper summarizes a new report presenting the best available research about the impact of the liability environment on maternity care, and policy options for improving this environment. Improved understanding of these matters can help to transcend polarized discourse and guide policy intervention. METHODS We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable. FINDINGS The best available research does not support a series of widely held beliefs about maternity care and liability, including the economic impact of liability insurance premiums on maternity care clinicians, the existence of extensive defensive maternity care practice, and the impact of limiting the size of awards for non-economic damages in a malpractice lawsuit. In the practice of an average maternity caregiver, negligent injury of mothers and newborns seems to occur more frequently than any claim and far more frequently than a payout or trial. Many important gaps in knowledge relating to maternity care and liability remain. Some improvement strategies are likely to be more effective than others. CONCLUSIONS Empirical research does not support many widely held beliefs about maternity care and liability. The liability system does not currently serve well childbearing women and newborns, maternity care clinicians, or those who pay for maternity care. A number of promising strategies might lead to a higher functioning liability system, whereas others are unlikely to contribute to needed improvements.
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Neonatal brachial plexus palsy with vaginal birth after cesarean delivery: a case-control study. Am J Obstet Gynecol 2013; 208:229.e1-5. [PMID: 23211545 DOI: 10.1016/j.ajog.2012.11.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/13/2012] [Accepted: 11/30/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective was to determine the rate of neonatal brachial plexus palsy (NBPP) among women with vaginal birth after cesarean delivery (VBAC) and to compare the peripartum characteristics with control subjects. STUDY DESIGN The Maternal-Fetal Medicine Unit cesarean registry data were used to identify nonanomalous singleton pregnancies with VBAC and NBPP at gestational age of ≥37 weeks (term) and 4 control subjects (matched for gestational age and diabetes mellitus status but without brachial injury). Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. RESULTS Among 11,313 VBACs at term, there were 23 women with NBPP (rate of 2.0/1000 women). Newborn infants with NBPP, compared with control infants, were significantly more likely to weigh ≥4000 g (48% vs 10%, respectively; OR, 8.45; 95% CI, 2.58-28.44) and to require admission to the neonatal intensive care unit (30% vs 13%; OR, 12.98; 95% CI, 2.61-72.18). CONCLUSION Women who desire VBAC should be informed about the low rate of NBPP and, if eligible, encouraged to have a trial of labor after cesarean delivery.
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Chauhan SP, Dahlke JD, Magann EF, Chang E, Gupta L, Mol BW, Lewis DF. Isolated intrauterine growth restriction: a survey of Central Association of Obstetricians Gynecologists (CAOG) members. J Matern Fetal Neonatal Med 2012; 26:497-502. [DOI: 10.3109/14767058.2012.741632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vance GA, Niederhauser A, Chauhan SP, Magann EF, Dahlke JD, Muraskas JK, Morrison JC. Does the International Classification of Disease (ICD-9) code accurately identify neonates who clinically have hypoxic-ischemic encephalopathy? Gynecol Obstet Invest 2010; 71:202-6. [PMID: 21160147 DOI: 10.1159/000318204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 06/24/2010] [Indexed: 11/19/2022]
Abstract
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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Affiliation(s)
- Gregory A Vance
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Miss., USA
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A Proposed Evidence-Based Neonatal Work-up to Confirm or Refute Allegations of Intrapartum Asphyxia. Obstet Gynecol 2010; 116:261-268. [DOI: 10.1097/aog.0b013e3181e7d267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Obstetricians’ Perception of Medico-legal Problems in Al Madinah Al Munawarah Kingdom of Saudi Arabia. J Taibah Univ Med Sci 2010. [DOI: 10.1016/s1658-3612(10)70135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Fuglenes D, Øian P, Kristiansen IS. Obstetricians' choice of cesarean delivery in ambiguous cases: is it influenced by risk attitude or fear of complaints and litigation? Am J Obstet Gynecol 2009; 200:48.e1-8. [PMID: 18973870 DOI: 10.1016/j.ajog.2008.07.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 04/23/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to test the hypothesis that obstetricians' choice of delivery method is influenced by their risk attitude and perceived risk of complaints and malpractice litigation. STUDY DESIGN The choice of delivery method in ambiguous cases was studied in a nationwide survey of Norwegian obstetricians (n = 716; response rate, 71%) using clinical scenarios. The risk attitude was measured by 6 items from the Jackson Personality Inventory-Revised. RESULTS The proportion of obstetricians consenting to the cesarean request varied both within and across the scenarios. The perceived risk of complaints and malpractice litigation was a clear determinant of obstetricians' choice of cesarean in all of the clinical scenarios, whereas no impact was observed for risk attitude. CONCLUSION Obstetricians' judgments about cesarean request in ambiguous clinical cases vary considerably. Perceived risk of complaints and litigation is associated with compliance with the requested cesarean.
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Abenhaim HA, Benjamin A, Koby RD, Kinch RA, Kramer MS. Comparison of obstetric outcomes between on-call and patients' own obstetricians. CMAJ 2007; 177:352-6. [PMID: 17698823 PMCID: PMC1942095 DOI: 10.1503/cmaj.060920] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The question "will you be delivering my baby?" is one that pregnant women frequently ask their physicians. We sought to determine whether obstetric outcomes differed between women whose babies were delivered by their own obstetrician (regular-care obstetrician) and those attended by an on-call obstetrician who did not provide antenatal care. METHODS We performed a cohort study of all live singleton term births between 1991 and 2001 at the Royal Victoria Hospital in Montréal. We excluded breech deliveries, elective cesarean sections and deliveries with placenta previa or prolapse of the umbilical cord. Logistic regression analysis was used to compare obstetric outcomes (e.g., cesarean delivery, instrumental vaginal delivery and episiotomy) between the regular-care and on-call obstetricians after adjustment for potential confounders. RESULTS A total of 28,332 eligible deliveries were attended by 26 obstetricians: 21,779 (76.9%) by the patient's own obstetrician and 6553 (23.1%) by the on-call obstetrician. Compared with women attended by their regular-care obstetrician, those attended by an on-call obstetrician had higher rates of cesarean delivery (11.9% v. 11.4%, adjusted odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03-1.24, p < 0.01) and of third-or fourth-degree tears (7.9% v. 6.4%, adjusted OR 1.21, 95% CI 1.07-1.36, p < 0.01) but lower rates of episiotomy (38.5% v. 42.9%, OR 0.77, 95% CI 0.72-0.82, p < 0.001). No differences were observed between the groups in the rate of instrumental vaginal delivery. The increase in the overall rate of cesarean delivery among women attended by an on-call obstetrician was due mainly to an increase in cesarean deliveries during the first stage of labour because of nonreassuring fetal heart tracing (2.9% v. 1.7%, adjusted OR 1.79, 95% CI 1.49-2.15, p < 0.001). The time of day of delivery did not modify the observed effects. INTERPRETATION The type of attending obstetrician (regular care v. on call) had a minor effect on obstetric outcomes.
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Affiliation(s)
- Haim A Abenhaim
- Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montréal, Que.
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Seubert DE, Huang WM, Wasserman-Hoff R. Medical legal issues in the prevention of prematurity. Clin Perinatol 2007; 34:309-18, vii. [PMID: 17572237 DOI: 10.1016/j.clp.2007.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Preterm birth remains the leading cause of neonatal morbidity and mortality in the world today. This article discusses ways the treatment team can inform parents of probable outcomes and help them reach decisions about treatment for the newborn under emotionally fraught conditions. In addition to supporting the patient, these approaches may help the clinician avoid malpractice litigation.
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Affiliation(s)
- David E Seubert
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Medical Center, 550 First Avenue, 9N27-BH, New York, NY 10016, USA.
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Chauhan SP, Morrison JC. Reply. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2005.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Closing Discussion by Dr Chauhan. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Closing discussion by Dr Chauhan. Am J Obstet Gynecol 2005. [DOI: 10.1016/j.ajog.2005.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chauhan SP, Rose CH, Gherman RB, Magann EF, Holland MW, Morrison JC. Brachial plexus injury: a 23-year experience from a tertiary center. Am J Obstet Gynecol 2005; 192:1795-800; discussion 1800-2. [PMID: 15970811 DOI: 10.1016/j.ajog.2004.12.060] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the data on brachial plexus injury and its relationship with shoulder dystocia from a tertiary center for a 23-year period. STUDY DESIGN A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial plexus injury who were delivered at our center. RESULTS During the 23 years (1980-2002), there were 89,978 deliveries, of which there were 85 cases of brachial plexus injury (1/1000 births) with vaginal delivery. The injury was permanent (> or =1 year) in 12% of the cases, and only 2 cases have been litigated. Newborn infants that weighed > or =4 kg were significantly more common among those infants who had shoulder dystocia and brachial plexus injury than those infants without injury (odds ratio, 6.55; 95% CI, 2.30, 18.63). The rate of permanent brachial plexus injury was similar between the 2 groups. CONCLUSION A case of brachial plexus injury occurs 1 time in every 1000 births, is permanent in 1 of every 10,000 deliveries, and is litigated 1 time for every 45,000 deliveries. The infrequent nature of injury may preclude prevention.
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