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Ivert A, Holowko N, Liu X, Edqvist M, Roos N, Gustafson P, Stephansson O. Maternal and pregnancy predictive risk factors for having a compensated maternal injury claim: a Swedish nationwide cohort study. Sci Rep 2023; 13:21731. [PMID: 38066197 PMCID: PMC10709443 DOI: 10.1038/s41598-023-49234-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
To describe trends and identify maternal and pregnancy predictive risk factors for having a compensated claim for a maternal injury during delivery, as a proxy for having received suboptimal care. This nationwide retrospective cohort study included 1 754 869 births in Sweden between 2000 and 2016, including 4488 maternal injury claims filed with The National Swedish Patient Insurance Company (Löf), of which 1637 were compensated. Descriptive statistics on maternal and pregnancy characteristics, trends in filed/compensated claims over time, and distribution of compensated claims by clinical classification are presented. Characteristics associated with suboptimal care were identified using multivariable logistic regression, with mutual adjustment in the final model. Compensated claims were sorted into 14 clinical classifications (ICD-10 codes for main condition, injury, and causality). Overall, there was a two-fold increase in filed claims from 2000 to 2016, peaking in 2014. The rate of compensated claims only increased marginally, and 36.5% of filed claims were deemed avoidable. Perineal and pelvic floor injuries, as well as medical and diagnostic errors, were responsible for the majority of compensated claims. Women with a previous caesarean section, post term delivery, chronic or gestational disease, > 13 antenatal visits, or a multiple pregnancy had increased risk of having a compensated claim for a maternal injury during delivery. Understanding the risk factors for having a compensated maternal injury claim may guide health workers and maternity wards in improving the quality and organisation of care to reduce the risk of childbirth related injuries.
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Affiliation(s)
- A Ivert
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, K2 Medicin, Solna, K2 KEP Stephansson, Solna, 171 77, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - N Holowko
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, K2 Medicin, Solna, K2 KEP Stephansson, Solna, 171 77, Stockholm, Sweden.
| | - X Liu
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, K2 Medicin, Solna, K2 KEP Stephansson, Solna, 171 77, Stockholm, Sweden
| | - M Edqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, K2 Medicin, Solna, K2 KEP Stephansson, Solna, 171 77, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - N Roos
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, K2 Medicin, Solna, K2 KEP Stephansson, Solna, 171 77, Stockholm, Sweden
| | - P Gustafson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Löf - the National Swedish Patient Insurance Company, Stockholm, Sweden
| | - O Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, K2 Medicin, Solna, K2 KEP Stephansson, Solna, 171 77, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
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Ulfsdottir H, Johnson K, Rubertsson C, Ekelin M, Edqvist M. A complex and demanding situation - Midwifery preceptors and midwifery students' experiences of teaching and learning prevention of severe perineal trauma. Women Birth 2023; 36:e118-e124. [PMID: 35568665 DOI: 10.1016/j.wombi.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described. AIM To describe midwifery preceptors and midwifery students' experiences' of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma. METHODS A qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis. RESULTS "A complex and demanding situation with mutual need for feedback, reflection and safety" was the overall theme describing the conditions. Three sub-themes were identified. "Adapting to a unique situation" refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. "Hindering and limiting circumstances" describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. "A trustful and communicative relationship" describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part. CONCLUSION An increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors' confidence in teaching.
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Affiliation(s)
- H Ulfsdottir
- Department of Women's Health and Health professions Karolinska University Hospital, Stockholm, Sweden
| | - K Johnson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - C Rubertsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - M Ekelin
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - M Edqvist
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Edqvist M, Dahlen HG, Häggsgård C, Tern H, Ängeby K, Tegerstedt G, Teleman P, Ajne G, Rubertsson C. Correction to: One Plus One Equals Two-will that do? A trial protocol for a Swedish multicentre randomised controlled trial to evaluate a clinical practice to reduce severe perineal trauma. Trials 2020; 21:993. [PMID: 33267876 PMCID: PMC7709225 DOI: 10.1186/s13063-020-04936-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- M Edqvist
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden. .,Clinical Epidemiology Unit, Department of Medicine, Karolinska, Institutet, Stockholm, Sweden.
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - C Häggsgård
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - H Tern
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - K Ängeby
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.,School of Education, Health and Social Studies, Dalarna University, Karlstad, Sweden
| | - G Tegerstedt
- Department of Obstetrics and Gynaecology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - P Teleman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - G Ajne
- Department of Obstetrics and Gynaecology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - C Rubertsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Edqvist M, Dahlen HG, Häggsgård C, Tern H, Ängeby K, Tegerstedt G, Teleman P, Ajne G, Rubertsson C. One Plus One Equals Two-will that do? A trial protocol for a Swedish multicentre randomised controlled trial to evaluate a clinical practice to reduce severe perineal trauma {1}. Trials 2020; 21:945. [PMID: 33225972 PMCID: PMC7682019 DOI: 10.1186/s13063-020-04837-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Severe perineal trauma sustained during childbirth is a serious complication since it can lead to both short- and long-term consequences for women. Some of the methods used to prevent perineal injuries have been evaluated in clinical trials, but there are still gaps in the evidence. A new clinical practice has been introduced, adopted by more than half of the maternity wards in Sweden with the aim of reducing severe perineal trauma. This procedure involves two midwives assisting the woman during the second stage of labour. Methods/design In this multicentre randomised controlled trial, 2946 women will be randomised to be assisted by one or two midwives during the second stage of labour. Women age 18–47, who plan for their first vaginal birth, with a singleton pregnancy in cephalic presentation, will be asked to participate when admitted to the maternity ward. Five maternity wards comprising 19,500 births/year in different parts of Sweden will participate in this study. The sample size is powered to demonstrate a 50% reduction (from 4.1–2.0%) in primary outcome, which is the prevalence of severe perineal trauma (3rd and 4th degree). Secondary outcomes will include maternal and neonatal outcomes, women’s experiences, midwives’ experiences of the intervention, incontinence, and pelvic floor symptoms. The primary analysis is intention to treat. Questionnaires will be sent to the women at 1 month and 1 year after the birth to assess women’s experiences, pain, incontinence, pelvic floor symptoms, sexual function, and mental health. Discussion It is important for care during labour and birth to be evidence based. There is a strong desire among midwives to reduce the risk of severe perineal trauma. This may lead to new strategies and practices being implemented into practice without scientific evidence. The intervention might have negative side effects or unintended consequences. On the other hand, there is a possibility of the intervention improving care for women. Trial registration {2a} ClinicalTrials.gov NCT03770962. Registered on 10 December 2018
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Affiliation(s)
- M Edqvist
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden. .,Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - C Häggsgård
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - H Tern
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - K Ängeby
- Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.,School of Education, Health and Social Studies, Dalarna University, Karlstad, Sweden
| | - G Tegerstedt
- Department of Obstetrics and Gynaecology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - P Teleman
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - G Ajne
- Department of Obstetrics and Gynaecology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - C Rubertsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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