?Every case of asphyxia can be used as a learning example?. Conclusions from an analysis of substandard obstetrical care.
Summary of "?Every case of asphyxia can be used as a learning example?. Conclusions from an analysis of substandard obstetrical care."
Abstract Aim: To propose suggestions for improvements in care based on conclusions from studies on low Apgar scores and substandard care during labor. Setting and patients: Studies on infants with low Apgar scores in a general obstetric population 2004?2006 and claims for financial compensation on the behalf of infants, based on the suspicion that substandard care in conjunction with childbirth has caused severe asphyxia or neonatal death in Sweden 1990?2005. Results: The most common flaws were related to insufficient fetal surveillance, defective interpretation of cardiotocography (CTG) tracings, not acting in a timely fashion on abnormal CTG, and the incautious use of oxytocin. Besides, in half of the infants a suboptimal mode of delivery added further trauma to the already asphyxiated infant. Additionally, resuscitation was unsatisfactory in many of these infants. The most critical flaw was defective compliance with the guidelines concerning ventilation and the early paging of skilled personnel in cases of imminent asphyxia or known complications during labor. In many case reports, the documentation of the neonatal resuscitation was insufficient to enable accurate and reliable evaluation. Conclusions: Examples of proposed improvements in care during labor are the introduction of a permanent educational atmosphere with aside time for daily educational rounds and discussion, cooperation around the use of standardized terminology in CTG interpretation, the cautious use of oxytocin, and the routine paging of a pediatrician before birth in cases of complicated delivery or imminent asphyxia. The proposed interventions need to be evaluated in clinical trials in the future.
Affiliation
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Journal Details
This article was published in the following journal.
Name: Journal of perinatal medicine
ISSN: 1619-3997
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22080723
- DOI: http://dx.doi.org/10.1515/JPM.2011.108
Medical and Biotech [MESH] Definitions
Empiricism
One of the principal schools of medical philosophy in ancient Greece and Rome. It developed in Alexandria between 270 and 220 B.C., the only one to have any success in reviving the essentials of the Hippocratic concept. The Empiricists declared that the search for ultimate causes of phenomena was vain, but they were active in endeavoring to discover immediate causes. The "tripod of the Empirics" was their own chance observations (experience), learning obtained from contemporaries and predecessors (experience of others), and, in the case of new diseases, the formation of conclusions from other diseases which they resembled (analogy). Empiricism enjoyed sporadic continuing popularity in later centuries up to the nineteenth. (From Castiglioni, A History of Medicine, 2d ed, p186; Dr. James H. Cassedy, NLM History of Medicine Division)
Research
Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws. (Webster, 3d ed)
Transfer (psychology)
Change in learning in one situation due to prior learning in another situation. The transfer can be positive (with second learning improved by first) or negative (where the reverse holds).
Knowledge Of Results (psychology)
A principle that learning is facilitated when the learner receives immediate evaluation of learning performance. The concept also hypothesizes that learning is facilitated when the learner is promptly informed whether a response is correct, and, if incorrect, of the direction of error.
Discrimination Learning
Learning that is manifested in the ability to respond differentially to various stimuli.
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