Jonsson Maria, Nordén Solveig Lindeberg, Hanson Ulf
Department of Women's and Children's Health, Uppsala University Hospital, Uppsala, Sweden.
Acta Obstet Gynecol Scand. 2007;86(3):315-9. doi: 10.1080/00016340601181318.
The objective of this study was to analyse the motives behind disciplinary action in obstetric malpractice cases concerning delivery, and to evaluate the frequency of inappropriate oxytocin use in these cases.
An analysis of all malpractice claims resulting in disciplinary action against physicians and midwives during the period 1996-2003. Investigations and decisions made by the Board of Medical Responsibility were reviewed with special focus on the use of oxytocin.
Of 77 cases, 60 regarded patients in labour. In the majority, there had been a normal pregnancy and spontaneous start of labour (78%). At the beginning of labour, 87% showed a normal fetal heart rate (FHR) pattern, indicating fetal well-being. In 70%, there was adverse fetal outcome with brain damage or death. The most common reason for disciplinary action was improper interpretation of fetal monitor tracings and corresponding failure to recognise fetal distress (76%). Injudicious use of oxytocin was common (68.5%), and was the primary reason for disciplinary action in 33% of the cases.
In a Swedish setting, a few common clinical problems pervade; interpretation of FHR patterns and the use of oxytocin account for the majority of rulings of negligence in malpractice cases regarding delivery. Analysis of the cases suggests that the adverse fetal outcomes could possibly have been prevented.
本研究的目的是分析分娩产科医疗事故案件中采取纪律处分背后的动机，并评估这些案件中催产素不当使用的频率。
对1996年至2003年期间导致对医生和助产士采取纪律处分的所有医疗事故索赔进行分析。特别关注催产素的使用情况，对医疗责任委员会的调查和决定进行了审查。
在77起案件中，60起涉及分娩中的患者。大多数情况下，妊娠正常且自然发动分娩（78%）。分娩开始时，87%的胎儿心率（FHR）模式正常，表明胎儿状况良好。70%的病例出现不良胎儿结局，包括脑损伤或死亡。采取纪律处分的最常见原因是对胎儿监护仪描记图的不当解读以及相应未能识别胎儿窘迫（76%）。催产素的不当使用很常见（68.5%），并且是33%的案件中采取纪律处分的主要原因。
在瑞典的情况下，存在一些普遍的常见临床问题；FHR模式的解读和催产素的使用占分娩医疗事故案件中大多数过失裁决的原因。对这些案件的分析表明，不良胎儿结局可能是可以预防的。
