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Keywords:

  • Asphyxia;
  • fetal monitoring;
  • human error;
  • obstetrics;
  • system failure

Abstract

Objective

To analyze compensation claims with neurological sequela or death following alleged birth asphyxia.

Design

A cohort study.

Setting

A nationwide study in Norway.

Sample

All claims made to The Norwegian System of Compensation to Patients (NPE) concerning sequela related to alleged birth asphyxia, between 1994 and 2008. A total of 315 claims of which 161 were awarded compensation.

Methods

Examination of hospital records, experts' assessments and the decisions made by the NPE, the appeal body and courts of law.

Main outcome measures

Characteristics of deliveries resulting in intrapartum asphyxia and causes of substandard care categorized in eight groups.

Results

In the 161 compensated cases, 107 children survived (96 with neurological sequela), and 54 children died. Human error was a frequent reason of substandard care, seen as inadequate fetal monitoring (50%), lack of clinical knowledge and skills (14%), noncompliance with clinical guidelines (11%), failure in referral for senior medical help (10%) and error in drug administration (4%). System errors were registered in only 3%, seen as poor organization of the department, lack of guidelines and time conflicts. The health personnel held responsible for substandard care was an obstetrician in 49% and a midwife in 46%.

Conclusions

Substandard care is common in birth asphyxia, and human error is the cause in most cases. Inadequate fetal monitoring and lack of clinical knowledge and skills are the most frequent reasons for compensation after birth asphyxia.