Changing trends in the incidence of caesarean section

Analysis of 500 obstetric and gynecologic malpractice claims: causes and prevention

Five hundred obstetric and gynecologic malpractice litigation claims were analyzed to determine the incidence of claims that could not be defended because of breach of standards of care, problems with documentation, or both. Of the 500 claims, 294 were obstetric and 206 were gynecologic. Of the obstetric claims, 79 (27%) were indefensible because of breaches of standards of care (71%), problems with documentation (5%), or both (24%). Of the 206 gynecologic claims, 45 (22%) were indefensible because of breaches of standards of care (62%), problems with documentation (24%), or both (13%). The incidence of indefensible obstetric and gynecologic claims was 25%. Indefensible claims were analyzed to determine the common medical and surgical problems that instigated the malpractice suits. Recommendations are made that should reduce the incidence of indefensible malpractice suits.

Inconsistencies in clinical decisions in obstetrics

Analysis of the increasing incidence of caesarean section in an English teaching hospital over a 15-year period revealed that emergency caesarean section for the diagnosis of fetal distress in labour made a major contribution to this increasing trend. A retrospective audit of a sample of these operations by the consultants of the hospital indicated that 30% of the operations were unnecessary. There were two other disturbing findings in our audit. First, there was significant disagreement between auditors in the decision whether to do a caesarean section or not. Second, and perhaps more importantly, when faced with identical information at a different time, the auditors were inconsistent in 25% of cases. The disturbing clinical situation highlighted by this study may have implications for medical jurisprudence.