title: Retained placental tissue as an emerging cause for malpractice claims.
abstract: BACKGROUND
  Removal of retained placental tissue postpartum and retained products of conception (RPOC) abortion is done by uterine curettage or hysteroscopy. Trauma to the endometrium from surgical procedures, primarily curettage, can cause intrauterine adhesions (Asherman's syndrome) and subsequent infertility. The incidence of malpractice claims relating to intrauterine adhesions is rising, justifying reevaluation of the optimal way of handling these complications.
  
  
  OBJECTIVE
  To review malpractice claims regarding intrauterine adhesions, and to explore the clinical approach that might reduce those claims or improve their medical and legal outcomes.
  
  
  METHODS
  We examined 42 Asherman's syndrome claims handled by MCI, the largest professional liability insurer in Israel. The clinical chart of each case was reviewed and analyzed by the event preceding the adhesion formations, timing and mode of diagnosis, and outcome. We also assessed whether the adverse outcome was caused by substandard care and it it could have been avoided by different clinical practice. The legal outcome was also evaluated.
  
  
  RESULTS
  Forty-seven percent of the cases occurred following vaginal delivery, 19% followed cesarean section, 28% were RPOC following a first-trimester pregnancy termination, and 2% followed a second-trimester pregnancy termination.
  
  
  CONCLUSIONS
  It is apparent that due to the lack of an accepted management protocol for cases of RPOC, it is difficult to legally defend those cases when the complication of Asherman syndrome develops.
authors.forename: Moshe D
authors.initials: MD
authors.lastname: Fejgin
authors.forename: Tal Y
authors.initials: TY
authors.lastname: Shvit
authors.forename: Yael
authors.initials: Y
authors.lastname: Gershtansky
authors.forename: Tal
authors.initials: T
authors.lastname: Biron-Shental
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005260:Female; D006175:Gynatresia / Q000209:etiology / Q000628:therapy; D006801:Humans; D007345:Insurance Claim Review; D007557:Israel; D016365:Liability, Legal; D008318:Malpractice / Q000706:statistics & numerical data*; D013513:Obstetric Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D009774:Obstetrics / Q000331:legislation & jurisprudence / Q000379:methods; D017063:Outcome Assessment, Health Care; D018457:Placenta, Retained / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy