Clin Obstet Gynecol
December 2008
Malpractice risk bedevils obstetricians. Suits can be a nuisance or emotionally and financially devastating. In this chapter, we ask simple questions and provide empiric data to demonstrate that interpersonal factors trigger suits.
View Article and Find Full Text PDFIntroduction: The Content of Prenatal Care report of the US Preventative Health Service (USPHS) Expert Panel established an important benchmark when published in 1989, but has not been significantly updated since that time.
Methods: The literature since 1989 is reviewed to assess which recommendations have been validated and/or implemented. Additionally, new findings that support the recommendations put forth or expand the scope of prenatal care outlined in the 1989 report are examined and discussed.
Background: Identifying the etiologies of real or perceived adverse clinical events and undesired outcomes is an important step in improving patient safety and reducing malpractice risks. Systematic analysis of obstetrics and gynecology-related risk management files allows a more complete examination of ways that human and systems factors may contribute to adverse events.
Objective: To learn the medical complaints of patients who experienced apparent adverse events, the general causes of those adverse events, and the significant specific causal factors involved in obstetrics and gynecology-related risk management cases.
Obstet Gynecol
December 1999
Objective: To determine the frequency of and risk factors for serious morbidity resulting in a prolonged hospital stay or readmission among women enrolled in Tennessee's Medicaid program who delivered live or dead infants in 1991.
Methods: This retrospective cohort study included 33,251 women of white or black ethnicity. Main outcome measures included childbirth-related medical conditions serious enough to result in death, prolonged delivery hospitalization, or readmission within 60 days of delivery.
Arch Pediatr Adolesc Med
January 1999
Objective: To compare compensation systems for birth-related injuries.
Design: Retrospective cohort study.
Setting: Florida.
Objective: To describe postdelivery mortality rates among residents of Tennessee from 1989 through 1991 and to compare these rates with those of women who had not delivered a live or stillborn infant in the previous year.
Methods: Postdelivery deaths (those occurring within a year of delivery of a live or stillborn infant) were identified using a computerized linkage of birth and fetal death certificates to death certificates of female decedents aged 15-44 years. Each identified postdelivery death was reviewed and categorized as either pregnancy-related (temporally and causally related to pregnancy) or pregnancy-associated-but-not-related (temporally but not causally related to pregnancy).
Objective: To determine whether Florida's implementation of a no-fault system for birth-related neurologic injuries reduced lawsuits and total spending associated with such injuries, and whether no-fault was more efficient than tort in distributing compensation.
Methods: We compared claims and payments before and after implementation of a no-fault system in 1989. Data came from the Department of Insurance's medical malpractice closed claim files and no-fault records.
Objective: To examine the relationship between admitting children to a neonatal intensive care unit (NICU) and mothers' satisfaction with obstetric care.
Methods: Mothers of live-born infants who are now normal were interviewed about their perceptions of the interpersonal, organizational, and technical care they and their babies received during pregnancy, delivery, and the neonatal period, and their and their infants' health. Comparisons between the responses of mothers whose babies were admitted to the normal nursery (n = 595) and those whose babies were sent to an NICU (n = 72) were made by chi2 analysis (1 df) and Wilcoxon rank sum tests.
Pelvic organ prolapse presents a wide array of distressing symptoms to the female patient. Stress urinary incontinence is often considered a normal phenomenon of aging and tolerated for years before seeking medical attention. A detailed history outlining specific complaints and a targeted pelvic examination can usually elucidate the anatomic problems responsible for producing symptoms.
View Article and Find Full Text PDFMost major health reform proposals include reform of medical malpractice. A major objective of the current medical malpractice system is to improve quality of care. The authors examine the effect of variations in the threat of medical malpractice, measured by claims frequency and payments per exposure year, on various indicators of birth outcomes, fetal deaths, low Apgar score, death within 5 days of birth, infant death, and death or permanent impairment at 5 years of age.
View Article and Find Full Text PDFObjective: To determine how obstetricians' opinions regarding universal screening of pregnant women for group B streptococcus (GBS) and their responses to positive culture results vary from American Academy of Pediatrics recommendations, and to determine the physician characteristics that predict divergent opinions.
Methods: One hundred ninety-four practicing obstetricians in the middle Tennessee region were queried by a mail survey. They were asked if they agreed with universal screening for GBS and to indicate whether they would prescribe antibiotics for women in labor, represented by six scenarios that differed with respect to presence or absence of preterm labor, premature rupture of membranes (ROM), prolonged ROM, and a positive GBS cervical culture.
We developed a method to identify maternal deaths (deaths to women within 365 days of delivery) by linking Tennessee vital records. A computerized algorithm compared personal identifiers from the death certificates of reproductive-aged women to maternal identifiers on birth and fetal death certificates. For each decedent record which met the study criteria, the algorithm calculated a "match score" by comparing common elements in both files.
View Article and Find Full Text PDFObjective: To determine the relationship between prior malpractice claims experience and the quality of clinical obstetric care.
Design: Historical cohort study of obstetricians, classified by their prior malpractice claims experience, with blinded review of medical records from their practices 5 to 10 years later.
Setting: Florida obstetricians who lost, settled, or defended malpractice claims between 1977 and 1983 and who were still practicing obstetrics in 1987.
Objective: To examine the relationship between prior physician malpractice experience and patients' satisfaction with care.
Design: Women were interviewed using a questionnaire that contained structured and open-ended questions.
Participants: Mothers of all stillborn infants, infant deaths, and a random sampling of viable infants drawn from 1987 Florida Vital Statistics were sorted into four groups based on the malpractice claims experience of their obstetricians between 1983 and 1986.
Cost-effective care is an increasingly important issue in medicine. This will necessitate re-evaluating many aspects of antenatal and intrapartum care, including health-care delivery systems and routine surveillance techniques for uncommon events such as Down syndrome. It will demand justification for broadening indications for cesarean section by including fetal macrosomia and intensify the search for the causes of preterm labor.
View Article and Find Full Text PDFIt is not currently known whether sufficiently precise data on a previous pregnancy, labor and delivery, and early infancy can be obtained retrospectively. We conducted a telephone survey in 1991 of women who delivered babies between 1984 and 1986 at two teaching hospitals in Nashville, Tennessee, to assess how well mothers recall information on factors predictive of an adverse birth outcome. The survey yielded 102 usable responses that were compared with hospital records for mothers and infants.
View Article and Find Full Text PDFAm J Obstet Gynecol
January 1993
Objective: This analysis was performed to present updated neonatal mortality data by age and birth weight for preterm newborns and to demonstrate the influence of plurality, ethnicity, and infant sex on mortality.
Study Design: Preterm birth weight and gestational age-specific mortality rates were compiled from the five centers that participated in the March of Dimes Multicenter Preterm Birth Prevention Project. In each center gestational age was assessed by standardized methods.
Gonococcal peritonitis occurred after a tubal ligation. Falk's postulated benefit of cornual resection as a preventive measure for recurrent infection does not extend to isthmic interruption. Pelvic inflammatory disease should be considered when a sterilized woman presents with an acute abdomen.
View Article and Find Full Text PDFTransvaginal sonography (TVS) can accurately depict the anteroposterior, width, and long axis of the endometrium. This article describes and illustrates normal and abnormal endometria as depicted by TVS.
View Article and Find Full Text PDFThis article has reviewed and illustrated the sonographic features of the most common pelvic masses that can be encountered in pregnant patients. Sonographic evaluation allows delineation of the size, consistency, and location of pelvic masses occurring during pregnancy. It has an important role in establishing the enlargement or regression of pelvic masses that occur during pregnancy.
View Article and Find Full Text PDFCrit Rev Diagn Imaging
May 1990
This review has discussed and illustrated the numerous applications of TVS for the sonographic detection of the endometrium. Its major applications are in early pregnancy evaluation and in evaluation of patients with endometrial carcinoma. As more clinical experience with this technique is gained, more extensive application of this technique will undoubtedly come about.
View Article and Find Full Text PDFOligohydramnios is associated with increased perinatal mortality and morbidity. Traditional methods of in utero fetal evaluation have been unsuccessful in reliably distinguishing oligohydramnios with normal outcome from that associated with increased perinatal morbidity. A prospective study was undertaken to establish the predictive value of Doppler velocimetry in identifying the fetus with oligohydramnios at increased risk of adverse perinatal outcome.
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