title: Lessons from a decade of technical-scientific opinions in obstetrical litigation.
abstract: The authors aimed to assess the Portuguese circumstances concerning situations of medico-legal dispute in Obstetrics, evaluate the conclusions of technical-scientific opinions and analyze their consequences. The analysis of all cases of Obstetrics medical responsibility examined in Medico-legal Council since the creation of the National Institute of Legal Medicine was performed. Technical-scientific opinions of those files were examined according to the existence of a causal link and of infringement of the 'leges artis'. The most common reasons for dispute in Obstetrics were perinatal asphyxia (50%), traumatic injuries of the newborn (24%), maternal sequelae (19%) and issues related to prenatal diagnosis and/or obstetric ultrasound (5.4%). In the technical-scientific opinions of files examined, the existence of a causal link was established in 17.4%, and the infringement of the 'leges artis' was suggested in 15.5% of cases, numbers which have grown significantly over the years and which are particularly relevant in the proceedings of perinatal asphyxia and traumatic lesions of the newborn. In 11% of cases the opinion was inconclusive due to the poor quality of the clinical process sent for analysis. These results highlight the impact that litigation can have on the professional activity and personal lives of obstetricians. It should alert them for the need to better fulfill medical clinical files in order to reduce or avoid medico-legal conflicts, as well as to the fact of the increasing practice of defensive medicine and its consequences in daily clinical routine for doctors and patients.
authors.affiliation: Obstetrics Department, Maternidade Dr Daniel de Matos, Coimbra University Hospitals, Portugal. Electronic address: anapatriciadomingues@hotmail.com.
authors.forename: Ana Patrícia
authors.initials: AP
authors.lastname: Domingues
authors.affiliation: Obstetrics Department, Maternidade Dr Daniel de Matos, Coimbra University Hospitals, Portugal; Obstetrical Clinic of Coimbra Faculty of Medicine, Coimbra University, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Moura
authors.affiliation: Coimbra Faculty of Medicine, Coimbra University, Portugal; National Institute of Legal Medicine, Portugal.
authors.forename: Duarte Nuno
authors.initials: DN
authors.lastname: Vieira
mesh_terms: D001238:Asphyxia Neonatorum / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000331:legislation & jurisprudence; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D008318:Malpractice / Q000331:legislation & jurisprudence*; D009774:Obstetrics / Q000331:legislation & jurisprudence*; D011174:Portugal / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011296:Prenatal Diagnosis; D011644:Puerperal Disorders / Q000453:epidemiology
keywords: Defensive medicine; Medico-legal; Obstetric litigation; Technical–scientific opinions