High-risk obstetrics, medicolegal problems

Forensic expertise in obstetrics and gynecology - Forensic expert experience

OBJECTIVE

Obstetric-gynecologic forensic is based on the principles of the good clinical practice, analysis of clinical risk factors, organization and communication, and ethical-deontological principles.

STUDY DESIGN

In retrospective study, we analyzed our own Croatian and international completed forensic cases in the field of obstetrics and gynecology collected during 2000-2020.

RESULTS

During the study period, 322 forensic obstetric-gynecologic expertise/opinions were performed, including 283 cases from clinical obstetric-gynecologic forensics and 39 interdisciplinary criminal law cases of sexual abuse. According to diagnosis, there were 241 (85.1 %) cases of obstetric and 42 (14.8 %) cases of gynecologic expertise. As for responsibility in cases of defined malpractice, gynecologist-obstetrician was responsible in 63.7 %, resident in gynecology/obstetrics in 4.34 %, midwife in 2.89 %, emergency physician in 5.79 %, and midwifery-obstetric-neonatal-anesthesiology team in 23.18 % of cases. Out of the 283 clinical forensic expertise cases, 214 (75.61 %) were classified as complications, fateful course and adverse events, and 69 (24.38 %) as errors/malpractice. The 55,6 % highest proportion of expertise cases were ordered for peripartum term asphyxia (n = 55), preterm delivery (n = 28) and shoulder dystocia (n = 36) associated with consequential permanent disability due to hypoxic-ischemic, nerve injury (brachioparesis) or perinatal death.

CONCLUSION

Using the procedures associated with birth injuries should be reduced, while investing more efforts in continuing education and training in emergency clinical conditions, and reversing the irrational increase in cesarean sections, unnecessary operative procedures and other interventions; medical documentation should be clear, concise and accurate, communication and organization of the work improved, while clinical risk must be clearly defined and analyzed.

Obstetric and gynecologic malpractice claims in Saudi Arabia: Incidence and cause

INTRODUCTION

The occurrence of a bad outcome, injury or death of a patient during treatment increases the chance of malpractice litigation, increases legal responsibility and leads to increased fees for malpractice insurance. Physicians practicing obstetrics and gynecology face among the highest risks of malpractice litigation, and such litigation has led to an increase in the practice of defensive medicine and has made this specialty less appealing. Previous clinical data from Saudi Arabia have shown that more malpractice litigation concerns claims in obstetrics and gynecology than claims in any other field of medicine.

OBJECTIVE

To identify the main causes of obstetrics and gynecology (OBGYN) professional liability claims in Saudi Arabia to have a better understanding and management of risks.

METHODS

All OBGYN claims opened in Saudi Arabia between 2008 and 2013 were analyzed to identify the most common causes of claims. The results of these claims and the times until a final judgment made were also analyzed.

RESULTS

Out of a total of 463 malpractice claims that were closed during the study period, 114 (24.6%) claims were in obstetrics and gynecology, and 92 (80.7%) of these claims concerned complications related to delivery room events. The most common causes of obstetric malpractice litigation were shoulder dystocia (brachial plexus injury) and fetal distress (hypoxic ischemic encephalopathy). Urinary system injury was the most common cause of gynecology cases. Most cases were decided in favor of the defendants with the exception of cases for which maternal and/or fetal death was the cause of litigation; nearly all of those cases were decided against the defendants.

CONCLUSION

Obstetricians face a high risk of malpractice claims in Saudi Arabia, although most claims do not end in payments to plaintiffs. However, the effects of such claims on obstetric care should not be underestimated. Adherence to standards of care and careful documentation may decrease litigation and the number of indefensible malpractice claims.

Analysis of obstetrics and gynecology professional liability claims in Catalonia, Spain (1986-2010)

OBJECTIVE

To identify relevant factors involved in obstetrics and gynecology (OG) professional liability claims to help archive better management of risks.

STUDY DESIGN

Analysis of 885 OG claims opened between 1986 and 2010, with the identification of the most common events leading to a claim, the economical and juridical characteristics of the claims, as well as the relevant trends over the study period.

RESULTS

Most claims related to obstetrics. Labor, delivery and its complications accounted for 33.1% of the claims; 12.77% related specifically to cesarean. Oncological diseases, fetus death during labor and delivery, neurologically impaired infant and histerectomy-related problems were the most frequently claimed events. Most cases ended up without an indemnity payment and 37.7% of closed files were solved by an out-of-court procedure. Average payment was higher for the obstetric procedures than for those concerning gynecology cases. The proportion of claims relating to obstetrics increased during the study period, as well as the average payment.

CONCLUSION

OG is at high-risk for malpractice claims, but compensation awards are not frequent. However, particular events, such as retained foreign objects, tubal ligation, ultrasound diagnosis or neurologically impaired newborns, deserve special attention regarding medico-legal issues.

Antenatal predictors of the neurologic sequelae at 3 years of age: a multivariate analysis

OBJECTIVE

To study the association between fetal blood flow abnormalities and the occurrence of long-term neurologic sequelae.

STUDY DESIGN

Umbilical, aortic and middle cerebral artery blood flow parameters were obtained by Doppler examination and retrospectively analyzed in 128 high-risk singleton pregnancies, followed by neurologic examination of the surviving children at 3 years of age. Traditional parameters of neurologic outcome (Apgar scores, intrauterine growth retardation (IUGR), umbilical artery pH and base deficit, gestational age, birth weight, newborn encephalopathy, mode of delivery, fetal heart rate, neurosonographic examination) were included as possible confounding factors. Mann-Whitney U-test, Student's t-test, analysis of variance or Fisher's exact test, where applicable, were used for the univariate analysis. A stepwise logistic regression procedure was conducted to test the independent association of selected perinatal risk factors on neurological outcome. Statistical significance was assumed at P<0.05.

RESULTS

Eighteen out of 114 surviving children suffered neurologic illness at 3 years of age. Four children had major neurologic dysfunction and the remaining 14 suffered minor or mild form of the disease. Although blood flow parameters and various perinatal parameters did not differ significantly between the group of children with major neurologic dysfunction and healthy children, aortic resistance index showed an independent association with occurrence of minor or mild neurologic disabilities.

CONCLUSION

Antenatal evaluation of the aortic blood flow might be an important predictive variable for permanent neurologic disturbances.