Citation Information :
Rafael TJ, Chervenak FA. An Ounce of Prevention: A Review of the Most Common Errors in OB/GYN Ultrasound Leading to Litigation and How to Avoid Them. Donald School J Ultrasound Obstet Gynecol 2021; 15 (4):380-386.
The use of ultrasound in the field of Obstetrics and Gynecology (OB/GYN) has become ubiquitous. As OB/GYN is a higher-risk specialty pertaining to the risk of litigation, it is no surprise that lawsuits involving ultrasound in OB/GYN are not uncommon. Errors in ultrasound are not rare, with certain types of errors seemingly more prone to litigation. Upon examination of the past 40 years of literature, it appears that the most frequent types of errors fall into one of three categories: (1) technical/procedural, (2) perception/interpretation, and (3) communication/documentation. The aim of this review is to break down the types of ultrasound errors that fall into these categories and utilize “take-home” summary points as a way of strategizing the prevention of these types of errors. Among other methods, these summary points emphasize adequate ultrasound training and continuing education, knowledge of the guidelines, ample patient counseling, effective communication with referring providers, and meticulous documentation. Upon completion of this review, it is hoped that the reader has an appreciation of the steps a practitioner can take to avoid these types of lawsuits in the future.
Meire HB. Ultrasound-related litigation in obstetrics and gynecology: the need for defensive scanning. Ultrasound Obstet Gynecol 1996;7(4):233–235. DOI: 10.1046/j.1469-0705.1996.07040233.x
Jena AB, Seabury S, Lakdawalla D, et al. Malpractice risk according to physician specialty. N Engl J Med 2011;365(7):629–636. DOI: 10.1056/NEJMsa1012370
Goergen S, Schultz T, Deakin A, et al. Investigating errors in medical imaging: lessons for practice from medicolegal closed claims. J Am Coll Radiol 2015;12:988–997. DOI: 10.1016/j.jacr.2015.03.025
Schaffer AC, Jena AB, Seabury SA, et al. Rates and characteristics of paid malpractice claims among US physicians by specialty, 1992–2014. JAMA Intern Med 2017;177(5):710–718. DOI: 10.1001/jamainternmed.2017.0311
Domingues AP, Belo A, Moura P, et al. Medico-legal litigation in obstetrics: a characterization analysis of a decade in Portugal. Rev Bras Ginecol Obstet 2015;37(5):241–246. DOI: 10.1590/SO100-720320150005304
Anumba DO. Errors in prenatal diagnosis. Best Pract Res Clin Obstet Gynaecol 2013;27(4):537–548. DOI: 10.1016/j.bpobgyn.2013.04.007
Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 2005;293(21):2609–2617. DOI: 10.1001/jama.293.21.2609
Chervenak FA, Chervenak JL. Medical legal issues in obstetric ultrasound. Clin Perinatol 2007;34(2):299–308. DOI: 10.1016/j.clp.2007.03.007
Bundy AL, Jones TB. Guidelines for obstetrical scanning and reporting: the legal necessity. J Ultrasound Med 1985;4(9):483–484. DOI: 10.7863/jum.1922.214.171.1243
Sanders RC. Changing patterns of ultrasound-related litigation: a historical survey. J Ultrasound Med 2003;22:1009–1015. DOI: 10.7863/jum.2003.22.10.1009
Milunsky A. Obstetrics, genetics, and litigation. Acta Obstet Gynecol Scand 2021;100:1–9. DOI: 10.1111/aogs.14095
AIUM-ACR-ACOG-SMFM-SRU Practice parameter for the performance of standard diagnostic obstetric ultrasound examinations. J Ultrasound Med 2018;37(11):E13–E24. DOI: 10.1002/jum.14831
Committee on Practice Bulletins – Obstetrics and the American Institute of Ultrasound in Medicine Practice bulletin no. 175: ultrasound in pregnancy. Obstet Gynecol 2016;128(6):e241–e256. DOI: 10.1097/AOG.0000000000001815
Shwayder JM, Copel JA, Stohl H. Coding and legal issues in obstetric and gynecologic ultrasound. Obstet Gynecol Clin N Am 2019;46:853–862. DOI: 10.1016/j.ogc.2019.07.012
AIUM practice parameter for the performance of detailed second- and third-trimester diagnostic obstetric ultrasound examinations. J Ultrasound Med 2019;38(12):3093–3100. DOI: 10.1002/jum.15163
American Institute of Ultrasound in Medicine. AIUM Physician Training Guidelines. American Institute of Ultrasound in Medicine 2021. Available from: http://www.aium.org/resources/ptGuidelines.aspx [accessed 05-05-21].
American Institute of Ultrasound in Medicine. AIUM Ultrasound Practice Accreditation. American Institute of Ultrasound in Medicine 2021. Available from: http://www.aium.org/accreditation/accreditation.aspx [accessed 05-05-21].
James AE, Fleischer AC, Thieme G, et al. Diagnostic ultrasonography: certain legal considerations. J Ultrasound Med 1985;4:427–431. DOI: 10.7863/jum.19126.96.36.1997
Garner B. Black's law dictionary. 7th ed. St. Paul (MN): West Group 1999.
AIUM practice parameter for the performance of limited obstetric ultrasound examinations by advanced clinical providers. J Ultrasound Med 2018;37(7):1587–1596. DOI: 10.1002/jum.14677
ACOG committee opinion no. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol 2017; 130(4):e210–e216. DOI: 10.1097/AOG.0000000000003049
Wu KH, Cheng HH, Cheng FJ, et al. An analysis of closed medical litigations against the obstetrics departments in Taiwan from 2003 to 2012. Int J Qual Health Care 2016;28(1):47–52. DOI: 10.1093/intqhc/mzv093
Pinto A, Brunese L. Spectrum of diagnostic errors in radiology. World J Radiol 2010;2(10):377–383. DOI: 10.4329/wjr.v2.i10.377
Hassan M, Chitty L, Reardon H. Wrongful birth: clinical settings and legal implications. Semin Fetal Neonatal Med 2014;19(5):312–316. DOI: 10.1016/j.siny.2014.08.006
Brezinka C. Obstetric ultrasound and the many faces of malpractice lawsuits. Ultrasound Obstet Gynecol 2000;16:207–209. DOI: 10.1046/j.1469-0705.2000.00267.x
Levi S. Ultrasound in prenatal diagnosis: polemics around routine ultrasound screening for second trimester fetal malformations. Prenat Diagn 2002;22(4):285–295. DOI: 10.1002/pd.306
Sileo FG, Finarelli A, Contu G, et al. Ultrasound screening for fetal anomalies in a single center: diagnostic performances twenty years after the Eurofetus Study. J Matern Fetal Neonatal Med 2021:1–8 (Online ahead of print). DOI: 10.1080/14767058.2021.1911994
Macones AJ, Lev-Toaff AS, Macones GA, et al. Legal aspects of obstetric sonography. Am J Roentgenol 1989;153(6):1251–1254. DOI: 10.2214/ajr.153.6.1251
Byrne JJ, Morgan JL, Twickler DM, et al. Utility of follow-up standard sonography for fetal anomaly detection. Am J Obstet Gynecol 2020;222:615.e1–615.e9. DOI: 10.1016/j.ajog.2020.01.001
Mavroforou A, Mavrophoros D, Koumantakis E, et al. Liability in prenatal ultrasound screening. Ultrasound Obstet Gynecol 2003;21:525–528. DOI: 10.1002/uog.168
Chervenak FA, McCullough LB, Brent RL. The perils of the imperfect expectation of the perfect baby. Am J Obstet Gynecol 2010;203(2):101–105. DOI: 10.1016/j.ajog.2010.01.058
Chervenak FA, McCullough LB. Ethics, an emerging subdiscipline of obstetric ultrasound, and its relevance to the routine obstetric scan. Ultrasound Obstet Gynecol 1991;1(1):18–20. DOI: 10.1046/j.1469-0705.1991.01010018.x
AIUM practice parameter for documentation of an ultrasound examination. J Ultrasound Med 2020;39(1):E1–E4. DOI: 10.1002/jum.15187
Sanders RC. Legal problems related to obstetrical ultrasound. Ann NY Acad Sci 1998;847:220–227. DOI: 10.1111/j.1749-6632.1998.tb08943.x