Department of Nursing Science, University of Turku, Turku, Finland.
The Finnish Patient Insurance center, Helsinki, Finland.
Acta Obstet Gynecol Scand. 2024 Jul;103(7):1377-1385. doi: 10.1111/aogs.14869. Epub 2024 May 6.
Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to describe obstetric claims, their compensation rates, and temporal trends of claims reported to the Patient Insurance center.
A nationwide, register-based study was conducted. Data consisted of obstetric claims reported to the Patient Insurance Center between 2012 and 2022. Data analyzed included the year of injury, compensation criteria, maternal age, birth hospital, delivery method, reported causes of injury, and maternal or neonatal injury. The data were analyzed with descriptive statistics and logistic regression models.
A total of n = 849 obstetric claims were filed during the study period, of which n = 224 (26.4%) received compensation. The rate of claims was 0.15%, and the rate of compensation was 0.04% in relation to the total volume of births during the period. Substandard care was the most common (97.3%) criterion for compensation. There was a curvilinear increase in the claims rate and a linear increase in compensation rates from 2013 to 2019. More claims were filed and compensated for cesarean and vacuum-assisted deliveries than for unassisted vaginal deliveries. Delayed delivery (18.7%) and surgical technique failure (10.9%) were the most reported causes of injuries. Retained surgical bodies were the induced cause of injury with the highest rate of compensated claims (86.7%). The most common maternal injury was infection (17.9%) and pain (11.7%). Among neonatal injuries, severe (19.2%) and mild asphyxia (16.6%) were the most frequent. Burn injuries (93.3%) and fetal or neonatal death (60.5%) had the highest rate of compensated claims.
The study provided new information on substandard care and injuries in obstetric care in Finland. An increasing trend in claims and compensation rates was found. Identifying contributors to substandard care that lead to fetal asphyxia is important for improving obstetric safety. Further analysis of the association of claims and compensation rates with operative deliveries is needed to determine their causality. Frequent review of obstetric claims would be useful in providing more recent data on substandard care and preventable injuries.
芬兰的母婴死亡率在世界上处于最低水平，但每年仍会发生可预防的产科损伤。本研究旨在描述向患者保险中心报告的产科索赔、其赔偿率以及报告索赔的时间趋势。
进行了一项全国范围内的基于登记的研究。数据包括 2012 年至 2022 年期间向患者保险中心报告的产科索赔。分析的数据包括伤害发生年份、赔偿标准、产妇年龄、分娩医院、分娩方式、报告的损伤原因以及产妇或新生儿损伤。使用描述性统计和逻辑回归模型对数据进行分析。
在研究期间共提交了 n = 849 份产科索赔，其中 n = 224 份（26.4%）获得了赔偿。该比率为 0.15%，而在此期间的总分娩量中，赔偿率为 0.04%。标准护理不足是最常见的（97.3%）赔偿标准。从 2013 年到 2019 年，索赔率呈曲线上升，赔偿率呈线性上升。剖宫产和真空辅助分娩的索赔和赔偿数量多于非辅助阴道分娩。延迟分娩（18.7%）和手术技术失败（10.9%）是报告的最常见损伤原因。遗留手术器械是导致赔偿索赔率最高的损伤原因（86.7%）。最常见的产妇损伤是感染（17.9%）和疼痛（11.7%）。在新生儿损伤中，最常见的是严重（19.2%）和轻度窒息（16.6%）。烧伤（93.3%）和胎儿或新生儿死亡（60.5%）的赔偿索赔率最高。
本研究提供了芬兰产科护理中标准护理不足和损伤的新信息。发现索赔和赔偿率呈上升趋势。确定导致胎儿窒息的标准护理不足的因素对于提高产科安全性很重要。需要进一步分析索赔和赔偿率与手术分娩的关系，以确定其因果关系。经常审查产科索赔将有助于提供关于标准护理和可预防损伤的最新数据。
