In the United States, perinatal morbidity and mortality generate concerns: In 2022, for the first time in 20 years, the National Center for Health Statistics reported an increase in the perinatal mortality rate, and racial disparities in outcomes remain prominent.
To improve obstetric care by advising practitioners, this analysis of medical malpractice claims explores perinatal allegations related to the fetus and neonate, their major injuries, and associated contributing factors.
Study Design
This was a descriptive, exploratory study using an evidence-based taxonomy.1 The Doctors Company medical professional liability (MPL) closed claims from the loss years of 2010 through 2023 were included.
Inclusion criteria included major responsible service of obstetrics; major allegation; injury severity; major injuries with a focus on perinatal injury; contributing factors; primary drivers; the practice setting of the event that precipitated the malpractice allegation; procedures, comorbidities, diagnostic tests, and medications involved (if any); and average indemnity paid (if any).
Study Results
The study findings included:
- Injury severity: High-severity injuries had occurred in 78 percent of the claims, including the almost 24 percent of claims that were founded upon fetal/infant deaths.
- Allegations: The most common major perinatal allegations were delay in the treatment of fetal distress (31 percent), improper performance of vaginal delivery (22 percent), and improper management of pregnancy (18 percent).
- Contributing factors: Clinical judgment (66 percent), communication (44 percent), and technical skill (40 percent) featured prominently as the top three contributing factors to perinatal claims.* Another notable contributing factor was insufficient or lack of documentation (20 percent).
- Comorbidities: In 52 percent of the claims, the mothers had no comorbidities.
- Financial impact: Over 49 percent of the perinatal claims resulted in an indemnity payment. The average indemnity was approximately $820,000, with a median indemnity of approximately $500,000.
Risk Mitigation Strategies
The following patient safety and risk mitigation strategies may help improve perinatal and obstetric care and patient outcomes.
Simulate: Simulation training and drills strengthen clinical judgment, technical skills, and communication by allowing practitioners to practice recognition, decision making, and execution in high-risk scenarios. Simulation drills provide an opportunity to discover systems issues before they impede the response to an actual emergency.
Debrief: After any adverse event, debrief with the healthcare team.
Disclose: Disclosing events to the patient and significant others is helpful and is recommended immediately after delivery, then at 12 to 24 hours postpartum.
Communicate with fellow practitioners: Poor communication and lack of teamwork can lead to poor outcomes.
- Take advantage of safety programs: The Agency for Healthcare Research and Quality (AHRQ) offers a safety program for perinatal care.
- Build high-reliability teams: The features of these teams include permission for any team member to ask questions or challenge the status quo, and a focus on communication.
- Attend educational offerings: A variety of educational offerings are available for practitioners.
Communicate with the patient and family: Set realistic expectations about labor and delivery.
Discuss risks and benefits in advance: Introducing a topic like cesarean delivery in the office can alleviate misunderstandings later. Document this discussion.
Plan to disclose unintended outcomes: Establish and practice a process for disclosing unintended outcomes.
Conclusion
The presence of malpractice litigation does not necessarily indicate the absence of quality practice. Shoulder dystocia, for instance, is a serious complication that is also unpredictable—this type of injury can occur even with the best care.
Through presenting this analysis of adverse events and malpractice claims, as well as steps that practices and organizations can take to elevate their preparedness, The Doctors Company endeavors to aid medical professionals in mitigating risk so that they can focus on the joys of their healing profession.
Download Study and Risk Mitigation Tips
Read our related study on maternal closed claims
*Events leading up to medical malpractice allegations may have multiple contributing factors. Therefore, percentages total more than 100 percent.
Reference
1CRICO-Candello Clinical Taxonomy Manual, V4.0, 2021. Copyrighted by and used with permission of Candello a division of The Risk Management Foundation of the Harvard Medical Institutions Incorporated, all rights reserved.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
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