Litigation in Obstetrics Overview

Potential Areas of Litigation in Obstetrics

• Litigation in obstetrics refers to legal disputes arising from perceived medical negligence during pregnancy, childbirth, and the postpartum period.
• Obstetric malpractice can lead to significant morbidity and mortality, prompting litigation.
• Litigation occurs when a patient believes they suffered adverse effects from negligent care.
• Litigation is the process of taking an argument between parties to a court of law.

Learning Objectives

• Students will be able to define litigation in obstetrics.
• Students will be able to outline potential areas of litigation in antepartum, intrapartum, and postpartum care.

Antepartum Care

• Pregnancy is typically treated as a natural process.
• History taking (complete and comprehensive): a crucial aspect.
• Diagnosis confirmation: employing biochemistry and ultrasound (if necessary).
• Investigations: essential tests include Hb, ABO, Rh, blood grouping, blood sugar, HbsAg, VDRL, and HIV testing.
• Subsequent visits: crucial for monitoring pregnancy progression and identifying potential issues.
• Screening for congenital abnormalities.
• Detection of intrauterine growth retardation (IUGR).
• Concerns regarding multiple pregnancies, intrauterine fetal death, procedures for sex selection, and women with HIV.
• Drug usage during pregnancy and lactation.

Intrapartum Care

• Intrapartum care covers the period from labor commencement to childbirth.
• Common areas of potential litigation include: issues with fetal monitoring during labor (CTG misinterpretation, delays in action).
• Caesarean sections: delays in decision-making or elective procedures may lead to complications.
• Issues with difficult vaginal deliveries such as shoulder dystocia, breech presentation, and instrumental deliveries (forceps/vacuum).
• Operative deliveries (risk of injury to maternal/fetal structures)

Postpartum Care

• Maternal care post-childbirth
• Common areas of potential litigation include: postnatal tears, obstetric anal sphincter injuries (OASIS).
• Damage to bones, viscera, and brain damage.
• Postpartum issues with analgesia and anesthesia.
• Drugs used during pregnancy and lactation.
• Bleeding disorders.
• Pulmonary embolism (leading to stroke).

Case Records

• Maintain accurate case records: detailed records are necessary to defend against claims.
• Ensure legibility for records.
• Avoid non-standard abbreviations.
• Each sheet must accurately contain patient information (name, age, hospital number).
• Include documentation of actions taken and dates for accountability.

Consent

• Competent adults have the right to consent or refuse to accept examinations, investigations, and procedures.
• Any treatment without consent may constitute battery.
• Informed consent is crucial and must include full information.
• Consent must be signed before administering premedication by both the patient and doctor.
• Doctors must honor consent and avoid exceeding their authority.

Delegation

• Delegation of procedures to less experienced colleagues should be avoided unless the junior member is competent in the procedure.

Skills Awareness and Consultation

• Avoid performing procedures if inexperienced or infrequent.
• Seek advice from a colleague if concerns arise about a procedure's outcome.
• Seeking advice, supervision, or consultations if a procedure or condition is associated with significant mortality or morbidity .

Reducing Legal Issues in Obstetrics

• Agreement and adherence to standards of clinical practice among healthcare team members can minimize potential injuries.

Multiple Pregnancy

• Risks regarding fetal and maternal issues like premature birth, low birth weight, and birth defects are high.
• Caesarean delivery is often preferred currently.

Sex Selection and PNDT Act

• Laws prohibit prenatal sex selection, leading to potential discrimination against women.
• The Act prohibits pre-natal diagnostic techniques for determining fetal sex to prevent female feticide.