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Malpractice Claims Drop 39% Under Perinatal Safety Initiative

Cheryl Clark, for HealthLeaders Media, December 6, 2012

That bundle requires that caregivers document that they estimated the fetal weight, assessed fetal heart rate, performed a pelvic exam before administering oxytocin and recognized and managed excessively frequent contractions, called tachysystole.

But if the caregivers failed to do one of those things, the team received no credit for doing any of them.

The PPSI found that there was significant improvement in observing the bundles. For example, adherence to the augmentation bundle improved from 33% to 72%; the elective induction bundle from 58% to 88% and the vacuum bundle from 9% to 51%.

A most important strategy is that obstetrical units resist pressure from pregnant women and their obstetricians to have their babies electively induced prior to 39 weeks gestation, a period that is becoming increasingly acknowledged as one that may result in newborn developmental or behavioral issues due to insufficient brain or other organ gestation.

On this point, DeVore expressed a personal concern involving her daughter-in-law, "who told me that her physician wanted to do her C-section at 38 weeks. It (prompted) this conversation about why you would do it at 38 weeks, and why would the physician want to do it?  I think we just have to know the questions to ask and have the data that would indicate there are some best practices here that we want to replicate nationally."

Some of the participant hospitals talked about "hard stop" policies, which prohibit obstetricians from performing C-sections or inductions in women prior to 39 weeks of gestation in the absence of medical necessity.

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