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Background: Although birth-related brain injury is rare, medical errors are costly and commonly found when it occurs. Several reviews indicate that one or more serious errors occur in 40 - 65 % of these cases. (1, 2, 3) In 1998, neurologically impaired infant case payouts averaged $935,952 in the US. Today, the median award for medical liability in childbirth cases - $2,050,000 - is the highest for all types of medical liability cases. (4) It follows that malpractice insurance costs for obstetricians or obstetrical facilities generally lead all other specialties.

Medical challenge: Reviews consistently identify the same problems, namely failure or delay to recognize, communicate and intervene for abnormal fetal heart rate patterns or prolonged labor. All the conditions known to impair situational awareness and hence judgment re impending danger are prevalent in obstetrics, including task overload, fatigue, stress, and poor information. Reviews of the literature also conclude that prediction of shoulder dystocia is very difficult or impossible. (5)

LMS Medical Systems is a healthcare technology company specializing in computer software for obstetrical management. The CALM™ system (Computer Assisted Labor Monitoring) integrates data from multiple sources. The CALM suite comprises many modules. The decision support modules are based on probabilistic models and designed to provide clinicians with an objective real-time bedside means to more clearly and accurately assess clinical conditions, improve situational awareness and reduce risk in 3 primary areas.

  1. CALM Curve provides analysis of labor progression to help clinicians determine whether or not a caesarean section is appropriate for women demonstrating symptoms of dystocia (slow labor).
  2. CALM Patterns contains specialized algorithms and neural networks that detect and measure patterns in fetal heart rate recordings, including baseline, accelerations, decelerations, and variability. These events are interpreted using rule-based systems to help identify the fetus at risk for brain injury from oxygen deprivation. (CALM ANNi™, using probabilistic models, is under development.)
  3. CALM Shoulder Screen algorithms estimate the risk of shoulder dystocia with permanent injury based mainly on anthropometric maternal and fetal characteristics. Depending upon preferred thresholds its detection rates between 44.8% and 61.1% could translate to multi million dollar savings in large hospital systems.

LMS also provides the framework to transform the safety culture within obstetrical labor and delivery units. Providing the tools (LMS technology, processes, peer education and gap analysis) CALM OB PEP™ (Obstetrical Practice Excellence Program) integrates critical risk prevention techniques into clinical and administrative processes to further entrench patient safety as the cornerstone of quality care.

These intelligent tools are housed in specialized software, CALM CIS™ that performs a number of other useful functions including electronic medical record keeping, surveillance, alerts and archiving, display of fetal monitor recordings and web accessibility, all meeting national regulatory and medical record security and privacy requirements. Together this ensemble brings objective and mathematically sound metrics to help clinicians make decisions in areas where errors are relatively common and very costly.

1. JCAHO. Sentinel event alert issue 30-July 21, 2004. Preventing infant death and injury during delivery. Adv Neonatal Care. 2004;4(4):180-1.
2. Draper ES, Kurinczuk JJ, Lamming CR, Clarke M, James D, Field D.A confidential enquiry into cases of neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2002;87(3):F176-80.
3. Ransom SB, Studdert DM, Dombrowski MP, Mello JD, Brennan TA. Reduced medicolegal risk by compliance with Obstetric Clinical pathways: A case-control study. Obstet Gynecol 2003;101:751-5.
4. 4. Excessive Litigation Compromises the Delivery of Obstetric Care - American College of Obstetricians and Gynecologists - February 2004 referenced by the National Association of Health Underwriters http://www.nahu.org
5. American College of Obstetricians and Gynecologists. Shoulder dystocia. ACOG Practice Bulletin, Number 40 2002; 1-5