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Related Experiment Video

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FISH for Pre-implantation Genetic Diagnosis
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Obstetrics, genetics, and litigation.

Aubrey Milunsky1,2

  • 1Center for Human Genetics, Cambridge, MA, USA.

Acta Obstetricia Et Gynecologica Scandinavica
|January 23, 2021
PubMed
Summary

Medical errors during pregnancy, especially those involving genetic disorders or congenital abnormalities in offspring, frequently lead to litigation. Early detection and comprehensive genetic evaluation are crucial to prevent adverse outcomes and legal disputes.

Keywords:
adverse pregnancy outcomecongenital malformationsdecision-makingencephalopathyethicsgenetic disorderslitigationmalpracticesyndromes

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Area of Science:

  • Medical-Legal
  • Genetics
  • Obstetrics

Background:

  • Medical negligence claims are common, often arising from unexpected adverse pregnancy outcomes.
  • Neurodevelopmental sequelae in offspring can be linked to genetic disorders or congenital abnormalities, complicating litigation.

Purpose of the Study:

  • To analyze 297 cases of pregnancy complications linked to genetic disorders/congenital abnormalities in offspring that resulted in litigation.
  • To assess causation in these complex medical-legal cases.

Main Methods:

  • Review of 297 cases involving pregnancy complications and subsequent litigation due to offspring's genetic disorders or abnormalities.
  • Expert assessment and testimony on causation.

Main Results:

  • Hypoxic ischemic encephalopathy cases were often compounded by genetic disorders or congenital abnormalities.
  • Missed diagnoses (ultrasound, lab), failed carrier detection, teratogenic medication, and inadequate genetic referrals were common issues.
  • Ethical breaches and cognitive biases contributed to litigation.

Conclusions:

  • Most errors involved multiple caregivers.
  • Serial ultrasounds, recognizing decreased fetal movement as a potential indicator, and considering family history/ethnicity are vital.
  • Cognitive biases significantly impact decision-making; even simple errors can have severe consequences.