CHARACTERISTICS OF SUCCESSFUL CLAIMS FOR PAYMENT BY THE FLORIDA-NEUROLOGIC-INJURY-COMPENSATION-ASSOCIATION FUND

OBJECTIVES: Our purpose was to examine the obstetric characteristics o f claims paid by the State of Florida after the birth of a neurologica lly impaired child. STUDY DESIGN: The Florida Birth Related Neurologic al Injury compensation plan is a no-fault alternative to litigation fo r compensation after a catastrophic neurologic birth injury. The plan has specific criteria for inclusion. We retrospectively analyzed claim s 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 (4 5) were delivered by cesarean section and 15 of 19 vaginal deliveries (79%) were operative (forceps or vacuum), yielding a 94% operative del ivery rate. A persistent nonreassuring fetal heart rate tracing was se en before delivery in all cases. The 5-minute Apgar score was less tha n or equal to 6 in 91% of deliveries and the 10-minute Apgar score was <6 in 86% of deliveries. When first examined in the labor and deliver y suite, 17 women had a nonreassuring fetal heart rate, and a nonreass uring tracing developed in labor in 47. Nine attempts at vaginal birth after a cesarean section led to a uterine rupture. Seven of these del iveries were either inductions or augmentations against an unfavorable cervix. Forty-five percent (27) of deliveries were associated with me conium-stained amniotic fluid, including 17 infants with meconium aspi ration syndrome. There were three shoulder dystonias acid four infants with group B streptococcal sepsis. in eight cases (12.5%), there appe ared to be a breach of the published standard of care, which contribut ed to the poor outcome. CONCLUSION: Most of these cases should not hav e been eligible for compensation in a traditional tort-based system be cause the applicable standard of care was not breached. Meeting the pu blished standard for perinatal care failed to prevent these devastatin g neurologic injuries. Obviously, not all intrapartum injuries can be prevented; however, if we are to prevent similar injuries in the futur e, 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 b irth injuries alter an attempted Vaginal birth after cesarean section with the predominance of these deliveries associated with oxytocin sti mulation against an unripe cervix. It is apparent that the push to low er cesarean section rates is no; without some risk.