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Re: Who Will Deliver Our Grandchildren From: ainsron (ainsron@sbcglobal.net) Tue Oct 18 13:42:20 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Who Will Deliver Our Grandchildren" Previous message: art fougner, md: "OB: Who Will Deliver Our Grandchildren" In reply to: art fougner, md: "OB: Who Will Deliver Our Grandchildren" This is news?? You're preaching to the choir. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art fougner, md Sent: Tuesday, October 18, 2005 10:33 AM To: Multiple recipients of list OB-GYN-L Subject: OB: Who Will Deliver Our Grandchildren >From JAMA Who Will Deliver Our Grandchildren? Implications of Cerebral Palsy Litigation Alastair MacLennan, MD; Karin B. Nelson, MD; Gary Hankins, MD; Michael Speer, MD JAMA. 2005;294:1688-1690. It has never been safer to have a baby and never more dangerous to be an obstetrician. In a recent survey, 76% of obstetricians in the United States reported having faced litigation at some point in their careers—most often for having allegedly caused cerebral palsy (CP).1 Similar trends have been seen in Australia, where the 2% of physicians who are obstetricians are now associated with 18% of the cost of all medical indemnity claims.2-3 The median award for "medical negligence in childbirth cases" is $2.3 million.4 Consequently, obstetricians pay some of the highest premiums for malpractice insurance—up to $200 000 per year in some states. These figures might seem to indicate an epidemic of errors in the delivery room, except that the common assumption that obstetric caregivers can prevent CP by actions taken during labor and delivery is based largely on erroneous assumptions and obsolete science. Despite this, in the United States, 60% of malpractice insurance premiums paid by obstetricians cover lawsuits for alleged birth-related CP.5 Less than 10% of plaintiffs in CP cases receive any compensation, and more than 60% of obstetric premiums are spent on the legal process.5 In CP trials, the plaintiff’s expert witness often testifies that the damage to the child’s brain was caused by oxygen deprivation during delivery and that if the defendant had performed a cesarean delivery, or performed a cesarean delivery earlier, the child would have escaped harm. That was once the prevailing view of how CP occurred. Well-designed studies, however, have shown that lack of oxygen causes only a small proportion of CP cases,6-7 and despite serious efforts, CP due to birth asphyxia has not been shown to be preventable.8 Antenatal risk factors for CP under current investigation are indicators of viral infection, fetal thrombophilias, and polymorphisms of genes regulating inflammation, coagulation, and endothelial activation.9-10 Known risk factors for CP include chorioamnionitis, death of a co-twin in utero, arterial ischemic stroke in the fetus or newborn, an umbilical cord wrapped tightly around the neck of the fetus, and premature birth.11 In none of these problems has obstetric intervention been demonstrated to reduce the risk of CP, largely because useful and specific indicators of intrauterine events do not yet exist. In most cases of CP, the cause cannot be determined. Litigation based on assumptions to the contrary, there is no evidence that immediate delivery upon diagnosis of chorioamnionitis or a nonreassuring fetal heart rate pattern prevents or ameliorates CP.8, 12-13 Despite the dramatic account of legal action related to severe brain damage in a survivor of co-twin death,14 there is no evidence that rapid delivery of the survivor prevents CP.15 http://jama.ama-assn.org/cgi/content/full/294/13/1688 Art -- art fougner, md "I knew I was going to take the wrong train, so I left early." Lawrence Peter Berra Next message: art fougner, md: "Re: Who Will Deliver Our Grandchildren" Previous message: art fougner, md: "OB: Who Will Deliver Our Grandchildren" In reply to: art fougner, md: "OB: Who Will Deliver Our Grandchildren"

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