Gynecologists and obstetricians are dedicated to providing quality preventative and critical care for female-specific health conditions at every stage of a woman’s life — and ensuring the health and safety of expectant mothers and their newborns throughout pregnancy and at delivery.

Because of the high-risk nature of gynecological illnesses and pregnancy complications, OB/GYN specialists are especially challenged to avoid any misdiagnoses, procedural errors, or mismanagement of post-op patients that could lead to allegations of medical malpractice. As an OB/GYN physician, you can reduce your risk of financial loss by securing robust malpractice insurance from an “A” rated carrier with the right coverage and rates for your OB/GYN specialty. In addition, you can benefit from having a strong risk management plan in place to potentially limit exposure to litigation while improving patient outcomes.

This article focuses on key findings from a recent study of obstetrics and gynecology malpractice cases by MedPro Group, an “A++” rated medical malpractice insurance carrier. Use this information to identify the leading malpractice allegations for your specialty, assess your risk for litigation, and develop a proactive risk management strategy.

Obstetrics: Major malpractice allegations and contributing factors

73% of the total OB malpractice cases reviewed in the MedPro study resulted in high clinical severity of patient injury, with 28% of high severity cases resulting in patient death. Overall, allegations of delay in treating fetal distress resulted in the largest share of total dollars paid to plaintiffs, as well as for the highest proportion of cases that closed with an indemnity payout. All allegations with financial severity cited in the MedPro study are ranked as follows, from most to least severe:

  • Delay in treatment of fetal distress

  • Improper management of pregnancy

  • Improper performance of vaginal delivery

  • Delay in delivery (induction/surgical)

  • Improper performance of operative delivery

  • Improperly managed labor

  • Improper choice of delivery method

  • Improper management of post-partum patient

  • Retained foreign body

The following are the top contributing factors in OB malpractice cases and the most common allegations related to each:

  • Clinical judgment

    • 96% Delay in treating fetal distress
    • 96% Improper management of pregnancy
    • 95% Improper performance of vaginal delivery
  • Technical skill

    • 79% Improper performance of vaginal delivery
  • Communication

    • 61% Delay in treating fetal distress
    • 50% Improper management of pregnancy
    • 32% Improper performance of vaginal delivery
  • Clinical environment

    • Allegations of “delay in treatment of fetal distress” were cited in nearly 50% of claims with clinical environment as a contributing factor, indicating that malpractice risk spans the continuum of OB care:

    1. Labor/delivery environment

    • Delay in the treatment of fetal distress was the top allegation among all claims in this category. Other alleged iatrogenic patient injuries included fetal encephalopathy, uterine ruptures, hemorrhaging, and infections.

    2. Ambulatory/office and clinic

    Diagnosis-related allegations were related to tubal pregnancies, underlying maternal cancers, and chromosome anomalies. Failure to recognize and address developing symptoms, delays in ordering diagnostic tests, and poor communication among providers when reporting or responding to test results were cited in these cases.

Gynecology: Major malpractice allegations and contributing factors

75% of GYN malpractice claims and 85% of total payouts were found to be triggered by incidents of improper performance of surgery, improper management of surgical patients, and poor communication leading to diagnostic delays. In 58% of the cases, allegations were described as having medium clinical severity, such as infections, drug side-effects, delayed recovery, and other non-disabling patient injuries. 36% of the cases cited patient injuries classified as high clinical severity, such as severe brain damage or other significant permanent disablement, or patient death.

The following are the top contributing factors in GYN malpractice cases and the most common allegations related to each:

  • Technical/procedural skill

    • 96% Improper performance of surgery
    • 64% Improper management of surgical patient
  • Clinical judgment

    • 94% Diagnostic-related
    • 84% Improper management of surgical patient
    • 70% Improper performance of surgery
  • Communication

    • 51% Diagnostic-related
    • 52% Improper management of surgical patient
    • 33% Improper performance of surgery
  • Improper performance of surgery

    Among allegations of improper performance of surgery, the study found that the most frequently cited surgical procedures were hysterectomy, oophorectomy, laparoscopy, and incontinence-related procedures. The most common patient injuries included: the need for additional surgery; punctures/lacerations/tears; infections; genitourinary dysfunction.

  • Improper management of surgical patient

    Common allegations in GYN cases cited the surgeon’s delay or failure to identify, manage, monitor, or prevent a developing complication — before, during, or after surgery — from becoming a serious adverse outcome.

  • Diagnostic-related allegations

    Delays in diagnosing uterine, ovarian, and breast cancers triggered allegations in two-thirds of the GYN cases. Delays in diagnosing procedural lacerations and post-op infections were also cited. Other contributing allegations included narrow diagnostic focus, inadequate patient assessment, the failure to order a consultation, and overall poor communication among providers when reporting or following up with diagnostic test results.

Build a strategy for proactive OB/GYN risk management

Based on the MedPro study findings, a proactive plan to reduce malpractice risk for OB/GYN specialists must focus on improvements in clinical decision making, procedural skills, and communication. Key recommendations from the study include:

  • Stay up to date with current and emerging OB/GYN procedural skills and techniques, especially for treating incidents of fetal distress across all phases of the pregnancy, as well as severe fetal and maternal complications during labor and delivery.

  • Improve patient communication. Ensure that OB/GYN patients give informed consent and understand the risks of the specific type of delivery method or gynecological surgery that is prescribed.

  • Emphasize communication among providers and care teams to avoid delays in diagnostic testing and reporting of test results, most critically in GYN cases involving uterine, ovarian, and breast cancers.

  • Establish “repetitive drills” and procedures to ensure that OB care teams quickly identify, respond to, and manage incidents of fetal distress and other incidents of high clinical severity.

  • Improve clinical decision-making across all OB clinical environments. Ensure that the labor and delivery team has access to the patient’s outpatient prenatal records citing maternal or fetal risk factors — for example, preeclampsia, and test results for congenital fetal conditions.

  • Be diligent in documenting all physician/patient interactions, diagnostic test orders and results, pre-operative assessments, intra-operative steps, and the sequence of post-operative events. If you are sued for malpractice, your lawyers can build a stronger case when you provide complete case documentation.

Need Medical Malpractice Insurance for Your OBGYN Practice? SURGPLI can Help.

Our experienced SURGPLI insurance brokers save OBGYNs time and effort by researching and recommending your best options for malpractice insurance coverage, rates, and carrier. Get a fast quote or call 1-800-969-1339

SURGPLI is a division of MEDPLI, an independent insurance brokerage that specializes in making medical malpractice insurance simple for doctors.

Max Schloemann

About the Author

Max Schloemann is a medical malpractice insurance broker, focused on helping physicians secure Medical Professional Liability coverage. He helps Doctors and Surgeons, as well as Physician Assistants, Nurse Practitioners, and healthcare entrepreneurs launch new medical practices across the country. Max graduated Magna cum Laude from Southern Illinois University College of Business and was named the Outstanding Management Senior. Max’s career in medical malpractice insurance began in 2008 with an industry-leading firm. Max founded SURGPLI in 2023 to help surgeons navigate the complexities of medical malpractice insurance in the new era of healthcare. Max’s wife, Kristen, a Physician Assistant, and their 4 kids (plus 1 dog) enjoy hiking, golf, and cooking.

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