Characteristics of successful claims for payment by the Florida Neurologic Injury Compensation Association Fund.
OBJECTIVE
Our purpose was to examine the obstetric characteristics of claims paid by the State of Florida after the birth of a neurologically impaired child.


METHODS
The Florida Birth Related Neurological Injury Compensation plan is a no-fault alternative to litigation for compensation after a catastrophic neurologic birth injury. The plan has specific criteria for inclusion. We retrospectively analyzed claims for compensation that were accepted and paid (n = 64) after a birth-related neurologic injury. Simple description statistics were compiled for the relative frequencies of various obstetric correlates found in successful claims for payment.


RESULTS
Seventy percent of infants (45) were delivered by cesarean section and 15 of 19 vaginal deliveries (79%) were operative (forceps or vacuum), yielding a 94% operative delivery rate. A persistent nonreassuring fetal heart rate tracing was seen before delivery in all cases. The 5-minute Apgar score was < or = 6 in 91% of deliveries and the 10-minute Apgar score was < 6 in 86% of deliveries. When first examined in the labor and delivery suite, 17 women had a nonreassuring fetal heart rate, and a nonreassuring tracing developed in labor in 47. Nine attempts at vaginal birth after a cesarean section led to a uterine rupture. Seven of these deliveries were either inductions or augmentations against an unfavorable cervix. Forty-five percent (27) of deliveries were associated with meconium-stained amniotic fluid, including 17 infants with meconium aspiration syndrome. There were three shoulder dystocias and four infants with group B streptococcal sepsis. In eight cases (12.5%), there appeared to be a breach of the published standard of care, which contributed to the poor outcome.


CONCLUSIONS
Most of these cases should not have been eligible for compensation in a traditional tort-based system because the applicable standard of care was not breached. Meeting the published standard for perinatal care failed to prevent these devastating neurologic injuries. Obviously, not all intrapartum injuries can be prevented; however, if we are to prevent similar injuries in the future, we will need to examine the clinical management in these or similar case for clues to develop novel strategies to respond to intrapartum emergencies. An unexpected finding was the frequency of catastrophic birth injuries after an attempted vaginal birth after cesarean section with the predominance of these deliveries associated with oxytocin stimulation against an unripe cervix. It is apparent that the push to lower cesarean section rates is not without some risk.
Stalnaker
B L
BL
Department of Obstetrics and Gynecology, University of Florida, Pensacola, USA.
Maher
J E
JE
Kleinman
G E
GE
Macksey
J M
JM
Fishman
L A
LA
Bernard
J M
JM
D001720:Birth Injuries / Q000191:economics*; D002547:Cerebral Palsy; D002585:Cesarean Section; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis; D005431:Florida; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007345:Insurance Claim Review; D007351:Insurance, Liability; D007743:Labor, Obstetric; D008318:Malpractice / Q000191:economics; D008471:Meconium Aspiration Syndrome; D011247:Pregnancy; D013997:Time Factors; D020196:Trauma, Nervous System