Obstetric Claims in Finland 2012-2022-A Nationwide Patient Insurance Registry Study

Overview

Journal Acta Obstet Gynecol Scand

Publisher Wiley

Specialty Gynecology & Obstetrics

Date 2024 May 7

PMID 38711236

Authors

Jaana Lojander

Maiju Welling

Anna Axelin

Marja Harkanen

Juho Kopra

Reeta Lamminpaa

Affiliations

Soon will be listed here.

Abstract

Introduction: 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.

Material And Methods: 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.

Results: 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.

Conclusions: 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.

Citing Articles

Obstetric claims in Finland 2012-2022-A nationwide patient insurance registry study.

Lojander J, Welling M, Axelin A, Harkanen M, Kopra J, Lamminpaa R Acta Obstet Gynecol Scand. 2024; 103(7):1377-1385.

PMID: 38711236 PMC: 11168264. DOI: 10.1111/aogs.14869.

References

Johansen L, Braut G, Acharya G, Andresen J, Oian P . How common is substandard obstetric care in adverse events of birth asphyxia, shoulder dystocia and postpartum hemorrhage? Findings from an external inspection of Norwegian maternity units. Acta Obstet Gynecol Scand. 2020; 100(1):139-146. PMC: 7754562. DOI: 10.1111/aogs.13959. View

Cass G, Goyder K, Strachan B, Bahl R . Can we improve women's experience of operative vaginal birth?. Eur J Obstet Gynecol Reprod Biol. 2020; 252:424-430. DOI: 10.1016/j.ejogrb.2020.07.021. View

Johansen L, Braut G, Acharya G, Andresen J, Oian P . Adverse events reporting by obstetric units in Norway as part of their quality assurance and patient safety work: an analysis of practice. BMC Health Serv Res. 2021; 21(1):931. PMC: 8424984. DOI: 10.1186/s12913-021-06956-6. View

McCormick M, Pollock W, Kapp S, Gerdtz M . Organizational strategies to optimize women's safety during labor and birth: A scoping review. Birth. 2021; 48(3):285-300. DOI: 10.1111/birt.12570. View

Smith C, Levett K, Collins C, Dahlen H, Ee C, Suganuma M . Massage, reflexology and other manual methods for pain management in labour. Cochrane Database Syst Rev. 2018; 3:CD009290. PMC: 6494169. DOI: 10.1002/14651858.CD009290.pub3. View

Kempe P, Vikstrom-Bolin M . Women's satisfaction with the birthing experience in relation to duration of labour, obstetric interventions and mode of birth. Eur J Obstet Gynecol Reprod Biol. 2020; 246:156-159. DOI: 10.1016/j.ejogrb.2020.01.041. View

Bossano C, Townsend K, Walton A, Blomquist J, Handa V . The maternal childbirth experience more than a decade after delivery. Am J Obstet Gynecol. 2017; 217(3):342.e1-342.e8. DOI: 10.1016/j.ajog.2017.04.027. View

Kurki T . Analysis of obstetric complications reported to the National Patient Insurance Association in Finland from 1987 to 1995. Acta Obstet Gynecol Scand. 1997; 76(9):839-42. DOI: 10.3109/00016349709024362. View

Muraca G, Lisonkova S, Skoll A, Brant R, Cundiff G, Sabr Y . Ecological association between operative vaginal delivery and obstetric and birth trauma. CMAJ. 2018; 190(24):E734-E741. PMC: 6008188. DOI: 10.1503/cmaj.171076. View

10.

Pratt A, Howat P, Hui L . Maternal and perinatal outcomes for women with body mass index ≥50 kg/m in a non-tertiary hospital setting. Aust N Z J Obstet Gynaecol. 2019; 60(3):361-368. DOI: 10.1111/ajo.13064. View

11.

Wen Q, Muraca G, Ting J, Coad S, Lim K, Lisonkova S . Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study. BMJ Open. 2018; 8(3):e020578. PMC: 5855201. DOI: 10.1136/bmjopen-2017-020578. View

12.

Vilkko R, Raisanen S, Gissler M, Stefanovic V, Kalliala I, Heinonen S . Busy day effect on adverse obstetric outcomes using a nationwide ecosystem approach: Cross-sectional register study of 601 247 hospital deliveries. BJOG. 2023; 130(11):1328-1336. DOI: 10.1111/1471-0528.17502. View

13.

Pettker C, Grobman W . Obstetric Safety and Quality. Obstet Gynecol. 2015; 126(1):196-206. DOI: 10.1097/AOG.0000000000000918. View

14.

Amiri A . Role of nurses and midwives in improving patient safety during childbirth: Evidence from obstetric trauma in OECD countries. Appl Nurs Res. 2020; 56:151343. DOI: 10.1016/j.apnr.2020.151343. View

15.

Chawanpaiboon S, Titapant V, Pooliam J . Maternal complications and risk factors associated with assisted vaginal delivery. BMC Pregnancy Childbirth. 2023; 23(1):756. PMC: 10601252. DOI: 10.1186/s12884-023-06080-9. View

16.

Humphreys A, Linsell L, Knight M . Factors associated with infection after operative vaginal birth-a secondary analysis of a randomized controlled trial of prophylactic antibiotics for the prevention of infection following operative vaginal birth. Am J Obstet Gynecol. 2022; 228(3):328.e1-328.e11. DOI: 10.1016/j.ajog.2022.08.037. View

17.

Falk M, Nelson M, Blomberg M . The impact of obstetric interventions and complications on women's satisfaction with childbirth a population based cohort study including 16,000 women. BMC Pregnancy Childbirth. 2019; 19(1):494. PMC: 6907327. DOI: 10.1186/s12884-019-2633-8. View

18.

Eppes C, Han S, Haddock A, Buckler A, Davidson C, Hollier L . Enhancing Obstetric Safety Through Best Practices. J Womens Health (Larchmt). 2020; 30(2):265-269. PMC: 8020520. DOI: 10.1089/jwh.2020.8878. View

19.

Floris L, Irion O, Courvoisier D . Influence of obstetrical events on satisfaction and anxiety during childbirth: a prospective longitudinal study. Psychol Health Med. 2016; 22(8):969-977. DOI: 10.1080/13548506.2016.1258480. View

20.

Blomquist J, Munoz A, Carroll M, Handa V . Association of Delivery Mode With Pelvic Floor Disorders After Childbirth. JAMA. 2018; 320(23):2438-2447. PMC: 6583632. DOI: 10.1001/jama.2018.18315. View