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The Patient Insurance (PI) scheme in Sweden was instituted on 1 January 1975. From the PI it is possible for a patient to obtain acknowledgement of an injury sustained in connection with medical treatment or operation--and receive financial compensation therefore--without having to prove that the injury was the result of fault or neglect. Special conditions of undertaking are laid down for the guidance of PI assessors which, if fulfilled, will entitle the patient to indemnity from the respective county council (via the PI) for injury sustained in connection with medical care received from county institutions or staff. As the Swedish PI scheme was the first of its kind in the world, an evaluation of its application during the first 5 years seemed justified. The present work constitutes the obstetrical-gynaecological part of that project. The objectives of the study were: to analyse and group according to injury all claims concerning obstetrical or gynaecological intervention submitted to the PI during 1975-79; to evaluate available literature on such injuries in relation to the present findings; to make recommendations for changes in the treatment routines of frequently occurring or serious injuries; and to study the working procedures of the PI, especially regarding its assessment of patient claims. Chapter I sets out the historical background of the PI. The extent of a patient's right to indemnity from the PI is discussed, covering the conditions of undertaking that must be fulfilled on the patient's part, and the PI's obligations. The Patient Injuries Committee is presented, to which injured parties can appeal against decisions of the PI. Chapters II--X. During the period studied, altogether 275 claims concerning obstetrical and gynaecological treatment were submitted to the PI, i.e. 2.5% of all claims received by the PI during that period. Most of the injuries resulted from surgical intervention. The claims have been grouped into six gynaecological and three obstetrical chapters. The reporting frequency to the PI was low during this period and therefore no statistical information can be derived from the analysis. A review of the current literature revealed a similar pattern of severe complications as that found among claims to the PI. In one respect, however, the present study is unique, since complications resulting from certain types of intervention, though performed under so varying circumstances, have never before been compiled and evaluated. The reported injuries were fairly evenly distributed among the 26 counties and the three different sizes of hospital.(ABSTRACT TRUNCATED AT 400 WORDS)

The Swedish Patient Insurance scheme is presented, and experience gained during the first 10 years discussed. About 70% of the claims concerned treatment injuries sustained during surgical intervention. During the first 5 years (1975-79), altogether 9,968 claims were submitted; 275 claims (2.8%) concerned obstetrical and gynecological treatment. These cases have been analysed and the pattern of complications was consistent with that found in the literature reviewed. Continuous follow-up and reporting of the claims is suggested. The need for stricter definitions of compensibility is obvious.

Risk factors during pregnancy and delivery of immigrant women are analysed. Individual birth delivery records of 1 235 immigrant women and of 412 Swedish women are studied. Most of the immigrants--65%--were Scandinavians, while 10% had come from Southern Europe and 4% were non-Europeans. The immigrant groups differed somewhat amongst themselves, and also vis-à-vis the Swedes in some social and demographic respects. Participation in antenatal care was not lower among the immigrants than in the control group, but the former did not attend antenatal exercises to the same extent. The perinatal mortality and prematurity rates were 1.5% and 5%--about the same as among the Swedish women. The rate of premature delivery was found to be related to the duration of residence in Sweden. Women who had lived less than one year in this country more often delivered prematurely than did the more settled immigrant women. Further studies on the emotional reactions of immigrant women during pregnancy and delivery are proposed.