dc.contributor.advisor | Øian, Pål | |
dc.contributor.author | Andreasen, Stine | |
dc.date.accessioned | 2015-11-20T13:10:38Z | |
dc.date.available | 2015-11-20T13:10:38Z | |
dc.date.issued | 2015-10-16 | |
dc.description.abstract | Birth injuries to mother or child are infrequent in Norway, but very serious to all patients and
their families. The consequences of an asphyxiated child might be severe, and the payouts
from the Norwegian System of Compensation to Patients (NPE) are huge. These payouts may
compensate some of the economical expenses, but neither the physical sequela nor the
social consequences. Despite this fact, the information concerning these cases has not
previously been described.
Evaluating the 278 obstetric claims receiving compensation between January 1st 1994 and
November 13th 2008, we found that sphincter injury, injury of intestines or urinary tract,
hemorrhage and infection were the most common injuries of the mother. Asphyxia and
sequela after shoulder dystocia were the most common injuries of the child. The most
frequent reasons for inadequate care in all cases receiving compensation were failures in
obstetrical and surgical skills (27%). Among the 314 patients claiming compensation due to
alleged asphyxia to the child, we found inadequate fetal monitoring to be the most
important factor leading to compensation (50%), including omission of monitoring despite
indication or neglecting signs of fetal distress. According to the medical experts, the health
personnel involved in the substandard treatment were an obstetrician in 49% and a midwife
in 46% of the cases. Human error seems to be an important factor of inadequate obstetric
care.
When we assessed the consistency of medical experts’ evaluations of negligence in care, we
found only moderate agreement. In the question concerning causality between the given
care and the injury we found fair agreement, but there was an astonishingly low
concordance between the experts in the evaluation of asphyxia and sphincter tear.
Describing cases of inadequate care is important when trying to decrease the frequency of
obstetric injuries caused by inadequate care. Studying the experts’ evaluations may increase
the consistency in the judgment of these claims. | en_US |
dc.description.doctoraltype | ph.d. | en_US |
dc.description.popularabstract | Fødselsskader i Norge er sjeldne, men alvorlige for involverte pasienter og familier. Hensikten med denne studien var å undersøke hvilke typer fødselsskader som er vanligst i Norge, hvorfor de oppstår, og ut fra dette om mulig å kunne komme med forslag til endring som kan redusere forekomsten av slike skader i fremtiden. Vi ønsket også å undersøke om det er lik vurderingen av fødselsskadesakene som meldes til NPE.
Vi studerte 397 innmeldte fødselssaker til NPE i perioden 1994-2008 og fant at de vanligste skadene hos mor i medholdssaker var alvorlige fødselsrifter, skade på blære og tarm, stor blødning og infeksjon etter fødsel. Vanligste skade på barnet var oksygenmangel under fødsel. Menneskelig svikt i form av mangelfull fosterovervåkning, manglende faglige kvalifikasjoner og manglende tilkalling av kompetent personale i vanskelige situasjoner, var vanligste årsak til skade. Jordmor var ansvarlig nesten like ofte som fødselslege.
I ekspertenes vurdering av fødselsskadesaker med tanke på avslag eller medhold i NPE fant vi kun moderat samsvar i vurderingene.
Det er viktig at fagmiljøene arbeider med å redusere risikoen for at slike skader skal inntreffe i et forbedrings- og pasientsikkerhetsperspektiv. Det kan angripes på mange måter, bl.a. gjennom å sørge for gode rutiner og systemer som sikrer at eventuelle feil blir oppdaget og korrigert. Tverrfaglig simuleringstrening og opplæring bør trolig også prioriteres framover. Alvorlige fødselsskader hos mor og barn kan fortsatt reduseres i Norge. | en_US |
dc.description.sponsorship | NPE/NGF | en_US |
dc.description | The papers of this thesis are not available in Munin.<br>Paper I. A nationwide descriptive study of obstetric claims for compensation in Norway. Andreasen, S., Backe, B., Jørstad, R.G. and Øian, P. Available in <a href=http://dx.doi.org/10.1111/j.1600-0412.2012.01409.x>Acta Obstetricia et Gynecologica Scandinavica 2012; 91: 1191–1195</a><br>Paper II. Claims for compensation after alleged birth asphyxia: a nationwide study covering 15 years. Andreasen S., Backe B. and Øian P. Available in <a href=http://dx.doi.org/10.1111/aogs.12276>Acta Obstetricia et Gynecologica Scandinavica 2014; 3:152-158</a><br>Paper III. The consistency of experts’ evaluation of obstetric claims for compensation. Andreasen S., Backe B., Lydersen S., Øvrebø K. and Øian P. Available in <a href=http://dx.doi.org/10.1111/1471-0528.12979>BJOG: An International Journal of Obstetrics and Gynaecology, 2014</a> | en_US |
dc.identifier.uri | https://hdl.handle.net/10037/8288 | |
dc.identifier.urn | URN:NBN:no-uit_munin_7859 | |
dc.language.iso | eng | en_US |
dc.publisher | UiT The Arctic University of Norway | en_US |
dc.publisher | UiT Norges arktiske universitet | en_US |
dc.rights.accessRights | openAccess | |
dc.rights.holder | Copyright 2015 The Author(s) | |
dc.subject.courseID | DOKTOR-003 | en_US |
dc.subject | VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Gynekologi og obstetrikk: 756 | en_US |
dc.subject | VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Gynecology and obstetrics: 756 | en_US |
dc.title | Claims for compensation after alleged birth injury in
Norway.
A study of obstetric claims to the Norwegian System of Compensation to
Patients from 1994-2008 | en_US |
dc.type | Doctoral thesis | en_US |
dc.type | Doktorgradsavhandling | en_US |