Human error most common cause of birth asphyxia
Findings from a 15-year study published in Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology, indicate that human error is the most common cause of infant asphyxiation at birth. Inadequate fetal monitoring, lack of clinical skills, and failure to obtain senior medical staff assistance are most often cited in Norwegian compensation claims following birth asphyxia.
In Norway there are roughly 60,000 births each year, with The Norwegian System of Compensation to Patients (NPE) receiving 65 claims for obstetric injury to the child. A previous study by the current research team found that asphyxia was the most common cause for compensation - between 20 and 25 cases annually. Prior research estimate that lifelong compensation for injury caused by birth asphyxia averages about €430,000 ($574,000) in Norway, with costs more than 10 times higher in the U.S.
“While fetal brain injury or death is uncommon during childbirth, when it occurs the effects are devastating,” explains Dr. Stine Andreasen with the Department of Obstetrics and Gynecology at Nordlandssykehuset (Nordland Hospital) in Bodø, Norway. “Our study investigates claims made to the NPE for neurological injury or death following birth asphyxia.”
For the present study, researchers examined 315 claims made to the NPE between 1994 and 2008 that were associated with alleged birth asphyxia. The team looked at hospital records, assessments by experts, along with NPE and courts of law decisions. Of the claims made, there were 161 cases that were awarded compensation.
Results show that in the compensated cases there were 107 infants who survived, with 96 having neurological injury, and 54 children who died. Human error was the most common cause of birth asphyxia with 50% attributed to inadeuate fetal monitoring, 14% lack of clinical knowledge, 11% non-compliance to clinical guidelines, 10% failure to ask for senior medical assistance, and 4% were errors in drug administration. In cases of substandard care, the obstetrician and midwife were documented as the responsible staff at 49% and 46%, respectively.
“In most compensated cases, poor fetal monitoring led to an inadequate supply of oxygen to the infant,” concludes Dr. Andreasen. “Training for midwives and obstetricians, along with high-quality audits, could help to reduce claims for compensation after birth asphyxia.”
Birth asphyxia occurs when a baby doesn’t receive enough oxygen before, during or just after birth. There are many reasons that birth asphyxia may occur.
Some of the causes of decreased oxygen before or during the birth process may include:
Inadequate oxygen levels in the mother’s blood due to heart or respiratory problems or lowered respirations caused by anesthesia
Low blood pressure in the mother
Inadequate relaxation of the uterus during labor that prevents oxygen circulation to the placenta
Early separation of the placenta from the uterus, called placental abruption
Compression of the umbilical cord that decreases blood flow
Poor placenta function that may occur with high blood pressure or in post-term pregnancies, particularly those past 42 weeks
Factors that may lower oxygen in the baby after birth include:
Severe anemia, or a low blood cell count, that limits the oxygen-carrying ability of the blood
Low blood pressure or shock
Respiratory problems that limit oxygen intake
Heart or lung disease
Low oxygen levels may decrease a baby’s heart rate, blood pressure and blood flow out of the heart. This may limit the blood flow to organs and tissues, leading to improper cell function or damage. Organs typically affected by lowered oxygen include the brain, heart and blood vessels, gastrointestinal tract, lungs and kidneys.
Full citation: “Claims for Compensation After Alleged Birth Asphyxia: A Nationwide Study Covering 15 Years.” Stine Andreasen, Bjørn Backe and Pål Øian. Acta Obstetricia et Gynecologica Scandinavica; Published online: November 18, 2013 (DOI: 10.1111/aogs.12276).
Birth Asphyxia and Birth Hypoxia in Newborn Infants
Birth asphyxia or birth hypoxia occurs when a baby does not receive an adequate oxygen supply either before, during, or immediately after birth. It is normal for many infants to receive a reduced oxygen supply during the birthing process, the uterus provides a reserve supply of oxygen and blood to the infant through the placenta when this happens.
Most infants who experience birth asphyxia are able to be helped with stimulation after they are born and will likely not suffer any serious or permanent brain damage. Depending on the specific situation, birth hypoxia may cause temporary or permanent brain damage to the baby. The amount of damage to the brain will depend on how much oxygen is reduced to the baby, how long the baby is deprived of an adequate oxygen supply, and how promptly the baby receives treatment. If the oxygen supply was cut off for a short period of time and treatment is provided quickly then the baby should fully recover. If the lack of oxygen was severe and the baby was lacking the proper oxygen supply for a long period of time, permanent and severe damage may occur to the baby’s brain, heart, lungs, kidneys and other organs.
Birth asphyxia or hypoxia may be caused by the following factors:
A restricted oxygen supply to the brain of the baby before or during birth
If the umbilical cord cuts off the oxygen supply to the infant
If the placenta separates from the uterus prematurely
If there is a prolonged or difficult delivery
If the mother has either too high or too low blood pressure
If the infants airway is blocked
Medical professionals use a fetal heart rate monitor to help monitor the condition of the baby. The fetal heart rate monitor measures the infant’s heart rate during labor and in essence is the baby’s way of communicating with the doctors and nurses. If a medical emergency occurs that deprives the baby of a proper supply of blood or oxygen, the fetal heart rate monitor will alert the medical staff so they can take immediate action to prevent permanent injuries to the baby. If the medical staff negligently fails to monitor the fetal heart rate monitor or ignores the warning signs, the baby can be impacted by serious birth injuries that will permanently affect the child for life; the baby may also die.
About the Journal
Acta Obstetricia et Gynecologica Scandinavica is the official scientific journal of the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). It is a clinically oriented journal that covers all aspects of obstetrics, gynecology and reproductive health, including perinatology, gynecologic endocrinology, female urology and gynecologic oncology. The journal is published in English and includes: editors´ messages, editorials, Acta commentaries, Acta reviews and original articles under the main categories of investigation, pregnancy, birth, fertility, infection, gynecology, gynecologic urology, oncology and surgery.
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