Obstetric Litigation Is Asphyxiating Our Maternity Services

Hankins, Gary D.V.; MacLennan, Alastair H.; Speer, Michael E.; Strunk, Albert L.; Nelson, Karin B.

doi:10.1097/01.aog.0000220531.25707.27

Cited by 39 publications

(21 citation statements)

References 16 publications

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“…51 Accountability in health care remains a reality, however, and 76% of obstetricians surveyed in 2003 reported a litigation event at some point in their careers, most often for allegedly causing cerebral palsy, a condition that cannot be eradicated by cesarean delivery. 37,52 Because of the complexity of this question, the decision-making approach required to process and deliberate all aspects of this may vary for each individual. In addition to the medical impact, discussions should also include psychologic, economic, and sociologic considerations and may focus on mental and behavioral characteristics, probabilities and finances, or societal implications.…”

Section: An Ethical Questionmentioning

confidence: 99%

Cesarean Delivery on Maternal Request: the Impact on Mother and Newborn

Lee

D’Alton

2008

Clinics in Perinatology

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Section: An Ethical Questionmentioning

confidence: 99%

Cesarean Delivery on Maternal Request: the Impact on Mother and Newborn

Lee

D’Alton

2008

Clinics in Perinatology

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“…2 The effects of cerebral palsy litigation were worldwide. 3 In virtually every industrialized country, even those with government-sponsored universal health care systems, trial lawyers, not physicians, dictated birth practices. And a medical phenomenon previously unseen in medicine's long history appeared-defensive medicine.…”

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confidence: 99%

Cerebral Palsy Litigation

Sartwelle

Johnston

2014

J Child Neurol

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The cardinal driver of cerebral palsy litigation is electronic fetal monitoring, which has continued unabated for 40 years. Electronic fetal monitoring, however, is based on 19th-century childbirth myths, a virtually nonexistent scientific foundation, and has a false positive rate exceeding 99%. It has not affected the incidence of cerebral palsy. Electronic fetal monitoring has, however, increased the cesarian section rate, with the expected increase in mortality and morbidity risks to mothers and babies alike. This article explains why electronic fetal monitoring remains endorsed as efficacious in the worlds' labor rooms and courtrooms despite being such a feeble medical modality. It also reviews the reasons professional organizations have failed to condemn the use of electronic fetal monitoring in courtrooms. The failures of tort reform, special cerebral palsy courts, and damage limits to stem the escalating litigation are discussed. Finally, the authors propose using a currently available evidence rule-the Daubert doctrine that excludes ''junk science'' from the courtroom-as the beginning of the end to cerebral palsy litigation and electronic fetal monitoring's 40-year masquerade as science.

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“…Additional psychological and social support should be offered to the women (parents) on informing them on IUFD as well as during the delivery and postpartum period. Medical records should be carefully and appropriately kept from admission to discharge from the hospital, because of the possible forensic implications [25] .…”

Section: Discussionmentioning

confidence: 99%

Delivery Course of Macerated Stillborn Fetuses in the Third Trimester

Habek

2008

Fetal Diagn Ther

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Aim: We present and discuss delivery (maternal and fetal) outcome of macerated stillbirths in the third trimester. Material and Methods: In this retrospective observational study, the course of labor was analyzed in 10 stillborn fetuses with a varying grade of maceration during the third trimester. Medical documentation on the course of pregnancy, maternity ward history and histopathology was used to analyze maternal demography data, course of labor, fetal birth weight and birth length, fetal findings (grade of maceration, concomitant finding of cord accidents) and maternal peripartum outcome. Results: Chronic cigarette smoking was recorded in 6, gestational hypertensive disease in 2, intrauterine growth retardation in 2 and abruptio placentae in 3 patients (in 2 of them due to gestational hypertensive disease). Six deliveries were induced by PGE₂ vaginal gel, 2 were stimulated by oxytocin and 1 was initiated spontaneously. One primary cesarean section was performed for evident fetopelvic disproportion. Outlet vacuum extraction for prolonged second labor stage was performed in the macrosomic child in the quadripara and 1 manual assistance according to Bracht was necessary at delivery of a macerated stillborn fetus due to breech presentation. In 1 case of macerated stillborn fetus, head traction resulted in decapitation, therefore extraction with Braun hooks placed into axillary fossae was done to extract the retained macerated fetal body. According to pathoanatomical evaluation, there were 2, 4, 3 and 1 stillbirths with grade 0, I, II and III maceration, respectively. Nuchal cord strangulation and tightened knot were detected in 3 cases each. In 2 cases of abruptio placentae, the parturients developed obstetric shock with uterine atony and disseminated intravascular coagulation. There was no maternal mortality and no fetal malformations in our material. Conclusion: The peripartum course can be considerably compromised due to potential complications induced by autolytic (macerating) lesions and difficult course of labor and maternal outcome.

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Obstetric Litigation Is Asphyxiating Our Maternity Services

Cited by 39 publications

References 16 publications

Cesarean Delivery on Maternal Request: the Impact on Mother and Newborn

Cesarean Delivery on Maternal Request: the Impact on Mother and Newborn

Cerebral Palsy Litigation

Delivery Course of Macerated Stillborn Fetuses in the Third Trimester

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