Defects in outpatient obstetric and gynecological care: expert evaluation, impact on labor outcome

Objective. To investigate the pattern of prehospital obstetric and gynecological care defects, claims for which have not been settled within the healthcare system and have resulted in legal proceedings. Material and methods. During the investigation, the author studied 152 clinical cases associated with the provision of obstetric and gynecological care. In the pattern of these cases, there were 70 adverse outcomes of obstetric care, 69 disputes on gynecological care quality, and 13 cases related exclusively to outpatient care in the pre- and postpartum periods. The materials were anonymized in the open-access databases. Forensic medical expert opinions were reviewed. The inclusion criteria were clinical cases that had led to a judicial dispute between the healthcare facility (HCF) and the female patient, her relatives, and representatives. Results. In the presence of unfavorable obstetric care outcomes, medical care defects were identified in 59/70 (84.3%) cases. These defects were arbitrarily divided into 7 groups. The relationship of defects to an unfavorable obstetric care outcome was assessed. The leading factors were incorrect delivery tactics generally due to the underestimation of an obstetric risk and the inadequate follow-up of the maternal and infant health status, as well as prehospital obstetric care defects. The nature of a direct or indirect relationship between the defect and the outcome affected the responsibility of a healthcare facility. The direct relationship between the outcome and the outpatient care defect was established if the pathology caused by severe birth defects was undetected. The pattern of defects in the outpatient management of pregnant women was as follows: inappropriate examination and follow-up (ultrasound diagnosis, CT scanning, screening, etc.) in 15 (63%) patients, incomplete history in 10 (41%), non-observance of the schedule for visits to physicians in 8 (33%), no perinatal conference in the three-level healthcare facility in 8 (33%), untimely hospitalization in 5 (21%), and pathology overdiagnosis in 1 (4%). A complex of defects generally took place. In gynecological practice, defects in the outpatient phase accounted for almost three quarters of trials. Conclusion. Outpatient medical care defects in the pattern of obstetric cases with adverse obstetric care outcomes have a high frequency. A significant number of unresolved conflicts within the healthcare system are caused by the communication deficits between the woman and the physician (the midwife).

obstetric and gynecological care, unfavorable outcomes, obstetric and gynecological care defects, outpatient obstetric care phase