Forensic expertise in obstetrics and gynecology - Forensic expert experience.

Objective: Obstetric-gynecologic forensic is based on the principles of the good clinical practice, analysis of clinical risk factors, organization and communication, and ethical-deontological principles.

Study Design: In retrospective study, we analyzed our own Croatian and international completed forensic cases in the field of obstetrics and gynecology collected during 2000-2020.

Results: During the study period, 322 forensic obstetric-gynecologic expertise/opinions were performed, including 283 cases from clinical obstetric-gynecologic forensics and 39 interdisciplinary criminal law cases of sexual abuse. According to diagnosis, there were 241 (85.1 %) cases of obstetric and 42 (14.8 %) cases of gynecologic expertise. As for responsibility in cases of defined malpractice, gynecologist-obstetrician was responsible in 63.7 %, resident in gynecology/obstetrics in 4.34 %, midwife in 2.89 %, emergency physician in 5.79 %, and midwifery-obstetric-neonatal-anesthesiology team in 23.18 % of cases. Out of the 283 clinical forensic expertise cases, 214 (75.61 %) were classified as complications, fateful course and adverse events, and 69 (24.38 %) as errors/malpractice. The 55,6 % highest proportion of expertise cases were ordered for peripartum term asphyxia (n = 55), preterm delivery (n = 28) and shoulder dystocia (n = 36) associated with consequential permanent disability due to hypoxic-ischemic, nerve injury (brachioparesis) or perinatal death.

Conclusion: Using the procedures associated with birth injuries should be reduced, while investing more efforts in continuing education and training in emergency clinical conditions, and reversing the irrational increase in cesarean sections, unnecessary operative procedures and other interventions; medical documentation should be clear, concise and accurate, communication and organization of the work improved, while clinical risk must be clearly defined and analyzed.