Taiwanese Journal of Obstetrics and Gynecology
Volume 45, Issue 1 , Pages 1-9, March 2006

Litigation in Obstetrics: a Lesson Learnt and a Lesson to Share

  • Min Min Chou

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr. Min Min Chou, Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, 160, Section 3, Taichungkang Road, Taichung 407, Taiwan

Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Chung Shan Medical University, Hung Kuang University and School of Medicine, National Yang Ming University, Taichung, Taiwan

Received 26 December 2005; received in revised form 22 January 2006; accepted 23 January 2006.

Article Outline

Summary

A perfect baby is the expectation of all parents, and a perfect outcome is the mission of obstetrics. Every obstetrician dreads to hear that there is an unexpected maternal mortality and/or severe fetal injury at the hospital. The role of a perceived public expectation of perfection in obstetric medicine reflects a belief that bad outcomes in obstetrics should not be tolerated and that every maternal-fetal injury merits financial compensation and punishment. What has brought these troubling times to obstetric medicine? The drivers behind malpractice crises are the four leading interest groups in the medical-legal debate: pregnant patients and their environment (husband, parents, relatives, friends, legislators, and the media), health-care providers, insurance companies, and trial attorneys. Litigation in obstetrics is the result of a complex of events when malpractice (presumed or real) impacts on the attitude of pregnant women and their environment. In such complexity, information is mandatory but may often be misinterpreted. If messages are not tailored to the receiver's capacity, communicating well with the pregnant patient becomes crucial. Therefore, to reduce medical-legal issues in obstetrics, increasing attention and an applicable standard of obstetric care to avoid negligence and medical errors should go along with better communication with pregnant women. Communication should be clear, targeted, effective, flexible, and empathic to share a common language and decisions. This review briefly presents and discusses some of the most frequently encountered medical-legal claim cases in obstetric practice. In-depth review of pregnancy-related deaths and major morbidities can help determine strategies needed to continue making pregnancy safer.

Key Words:  litigation , malpractice , maternal mortality , obstetrics , pregnancy

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, et al. Pregnancy-related mortality surveillance-United States, 1991–1999 . MMWR Surveill Summ . 2003;52:1–8
  2. de Swiet M . Maternal mortality: confidential enquiries into maternal deaths in the United Kingdom . Am J Obstet Gynecol . 2000;182:760–766
  3. Panting-Kemp A , Geller SE , Nguyen T , Simpson L , Nuwayhid B , Castro L . Maternal deaths in an urban perinatal network, 1992–1998 . Am J Obstet Gynecol . 2000;183:1207–1212
  4. Berg CJ , Harper MA , Atkinson SM , et al.   Preventability of pregnancy-related deaths: results of a state-wide reviews . Obstet Gynecol . 2005;106:1228–1234
  5. Doyle NM , Ramirez MM , Mastrobattista JM , Monga M , Wagner LK , Gardner MO . Diagnosis of pulmonary embolism. A cost-effectiveness analysis . Am J Obstet Gynecol . 2004;191:1019–1023
  6. Bechtel JJ , Mountford MC , Ellinwood WE . Massive pulmonary embolisim in pregnancy treated with tissue plasminogen activator . Obstet Gynecol . 2005;106:1156–1158
  7. Marty AT , Hilton FL , Spear RK , Greyson B . Postcesarean pulmonary embolism, sustained cardiopulmonary resuscitation, embolectomy, and near-death experience . Obstet Gynecol . 2005;106:1153–1155
  8. Bechtel JJ , Mountford MC , Ellinwood WE . Massive pulmonary embolism in pregnancy treated with catheter fragmentation and local thrombolysis . Obstet Gynecol . 2005;106:1158–1160
  9. Bonnar J . Can more be done in obstetric and gynecologic practice to reduce morbidity and mortality associated with venous thromboembolism . Am J Obstet Gynecol . 1999;180:784–791
  10. Lockwood CJ . Maternal mortality: we must do better . Contemp Ob Gyn . 2002;1:10–14
  11. Seligsohn U , Lubetsky A . Genetic susceptibility to venous thrombosis . N Engl J Med . 2001;344:1222–1231
  12. Gerhardt A , Scharf RE , Beckmann MW , et al.   Prothrombin and factor V mutations in women with a history of thrombosis during pregnancy and the puerperium . N Engl J Med . 2000;342:374–380
  13. Lockwood CJ . Preventing VTE: part 3-the pregnant patient . Contemp Ob Gyn . 2005; May 1.
  14. Lockwood CJ . Inherited thrombophilias in pregnant patients: detection and treatment paradigm . Obstet Gynecol . 2002;99:333–341
  15. Weinstein L . Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy . Am J Obstet Gynecol . 2005;193:859–863
  16. Sibai BM , Ramadan MK , Usta I , Salama M , Mercer BM , Friedman SA . Maternal morbidity and mortality in 442 pregnancies with hemlolysis, elevated liver enzymes and low platelets . Am J Obstet Gynecol . 1993;169:1000–1006
  17. Martin JN , May WL , Magann EF Terrone DA , Rinehart BK , Blake PG . Early risk assessment of severe preeclampsia: admission battery of symptoms and laboratory tests to predict likelihood of subsequent significant maternal morbidity . Am J Obstet Gynecol . 1999;180:1407–1414
  18. Matchaba P , Moodley J . Corticosteroids for HELLP syndrome in pregnancy . Cochrane Database Syst Rev . 2004; CD002076.
  19. Fonseca JE , Mendez F , Catano C , Arias F . Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a double-blind, placebo-controlled, randomized clinical trial . Am J Obstet Gynecol . 2005;193:1591–1598
  20. O'Brien JM , Milligan DA , Barton JR . Impact of high-dose corticosteroid therapy for patients with HELLP syndrome . Am J Obstet Gynecol . 2000;183:921–924
  21. Martin JN , Thigpen BD , Rose CH , Cushman J , Moore A , May WL . Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome . Am J Obstet Gynecol . 2003;189:830–834
  22. Sibai BM , Barton JR . Dexamethasone to improve maternal outcome in women with hemolysis, elevated liver enzymes, and low platelets syndrome . Am J Obstet Gynecol . 2005;193:1587–1590
  23. Martin JN , Files JC , Blake PG , Perry KG , Morrison JC , Norman PH . Postpartum plasma exchange for atypical preeclampsiaeclampsia as HELLP syndrome . Am J Obstet Gynecol . 1995;172:1107–1127
  24. Isler CM , Rinehart BK , Terrone DA , Martin RW , Magann EF , Martin JN . Maternal mortality associated with HELLP syndrome . Am J Obstet Gynecol . 1999;181:924–928
  25. Hsieh YY , Chang CC , Li PC , Tsai HD , Tsai CH . Successful application of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation as lifesaving therapy for a patient with amniotic fluid embolism . Am J Obstet Gynecol . 2000;183:496–497
  26. Clark SL , Hankins GDV , Dudley DA , Dildy GA , Porter TF . Amniotic fluid embolism: analysis of the national registry . Am J Obstet Gynecol . 1995;172:1158–1169
  27. Benson MD , Lindberg RE . Amniotic fluid embolism, anaphylaxis and tryptase . Am J Obstet Gynecol . 1996;175:737–738
  28. Robillard J , Gauvin F , Molinaro G , Leduc L , Adam A , Rivard GE . The syndrome of amniotic fluid embolism: a potential contribution of bradykinin . Am J Obstet Gynecol . 2005;193:1508–1512
  29. Chou MM . Prenatal diagnosis and perinatal management of placenta previa accrea: past, present and future . Taiwanese J Obstet Gynecol . 2004;43:64–71
  30. Chou MM , Ho ESC , Lee YH . Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound . Ultrasound Obstet Gynecol . 2000;15:28–35
  31. Chou MM , Tseng JJ , Ho ESC , Hwang JI . Three-dimensional color power Doppler imaging in the assessment of uteroplacental neovascularization in placenta previa incretapercreta . Am J Obstet Gynecol . 2001;185:1257–1261
  32. Chou MM , Hwang JI , Tseng JJ , Ho ESC . Internal iliac artery embolization before hysterectomy for placenta accreta . J Vasc Interv Radiol . 2003;14:1195–1199
  33. Chou MM , Tseng JJ . Ho ESC Usefulness of gray-scale ultrasound and complementary color Doppler ultrasound in the prenatal diagnosis of placenta previa accrete . Am J Obstet Gynecol . 2005;192:1349–1350
  34. Tseng SW , Lin CH , Hwang JI , Chen WH , Ho ESC , Chou MM . Experience with conservative strategy of uterine artery embolization in the treatment of placenta percreta in the first trimester of pregnancy . Taiwanese J Obstet Gynecol . 2006; (in press).
  35. Chauhan SP , Martin JN , Henrichs CE , Morrison JC , Magann EF . Maternal and perinatal complications with uterine rupture in 142,075 patients who attempted vaginal birth after cesarean delivery: a review of the literature . Am J Obstet Gynecol . 2003;189:408–417
  36. Ofir K , Sheiner E , Levy A , Katz M , Mazor M . Uterine rupture: risk factors and pregnancy outcome . Am J Obstet Gynecol . 2003;189:1042–1046
  37. Landon MB , Hauth JC , Leveno KJ , et al.   Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery . N Engl J Med . 2004;351:2581–2589
  38. Macones GA, Cahill A, Stamilio DM, Ratcliffe S, Stevens E, Sammel M, et al. Obstetric outcomes in women with two prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option? . Am J Obstet Gynecol . 2005;192:1223–1228
  39. Zelop CM , Shipp TD , Repke JT , Cohen A , Caughey AB , Lieberman E . Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery . Am J Obstet Gynecol . 1999;181:882–886
  40. Aslan H , Unlu E , Agar M , Ceylan Y . Uterine rupture associated with misoprostol labor induction in women with previous cesarean delivery . Eur J Obstet Gynecol Reprod Biol . 2004;113:45–48
  41. Cheung VY . Sonographic measurement of the lower uterine segment thickness in women with previous caesarean section . J Obstet Gynaecol Can . 2005;27:674–681
  42. Thorp JA . Maternal death after second-trimester genetic amniocentesis . Obstet Gynecol . 2005;106:409
  43. Thorp JA , Helfgott AW , King EA , Aaron A , Minyard AN . Maternal death after second-trimester genetic amniocentesis . Obstet Gynecol . 2005;105:1213–1215
  44. Elchalal U , Shachar IB , Peleg D , Schenker JG . Maternal mortality following diagnostic second-trimester amniocentesis . Fetal Diagn Ther . 2004;19:195–198
  45. Ayadi S , Carbillon L , Varlet C , Uzan M , Pourrist JL . Fatal sepsis due to Escherichia coli after second-trimester amniocentesis . Fetal Diagn Ther . 1998;13:98–99
  46. Mabie WC , Barton JR . Septic shock in pregnancy . Obstet Gynecol . 1997;90:553–561
  47. Harry W , Foley MR . Treating septic shock in ob/gyn patients . Contemp Ob Gyn . 2005; May 1.
  48. Quzounian JG , Gherman RB . Shoulder dystocia: are historic risk factors reliable predictors? . Am J Obstet Gynecol . 2005;192:1933–1938
  49. Mehta SH , Blackwell SC , Hendler I , et al.   Accuracy of estimated fetal weight in shoulder and neonatal birth injury . Am J Obstet Gynecol . 2005;192:1877–1881
  50. Gonen R , Bader D , Ajami M . Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery . Am J Obstet Gynecol . 2000;183:1296–1300
  51. Minkin MJ . A no-fault approach to shoulder dystocia . Contemp Ob Gyn . 2004; Dec. 1.
  52. Jennett RJ , Tarby TJ , Kreinick CJ . Brachial plexus palsy: an old problem revisited . Am J Obstel Gynecol . 1992;166:1673–1677
  53. MacLennan A , Nelson KB , Hankins G , Speer M . Who will deliver our grandchildren? Implications of cerebral palsy litigation . JAMA . 2005;294:1688–1690
  54. Laros RK . Presidential address: Medical-legal issues in obstetrics and gynecology . Am J Obstet Gynecol . 2005;192:1883–1889

PII: S1028-4559(09)60183-2

doi:10.1016/S1028-4559(09)60183-2

Taiwanese Journal of Obstetrics and Gynecology
Volume 45, Issue 1 , Pages 1-9, March 2006

Article Tools