Clinical Characteristics and Liability Determination of Severe Maternal-Fetal Adverse Outcomes in Obstetric Medical Disputes: A Case Series

Purpose: This study aimed to characterize the clinical features and liability determination patterns of obstetric medical dispute cases involving severe maternal-fetal outcomes, specifically stillbirth, neonatal death, maternal death, and severe maternal morbidity.Methods: From a total of 46 closed obstetric/gynecologic dispute cases at the Korea Medical Dispute Mediation and Arbitration Agency, 16 cases involving the aforementioned severe outcomes were selected. For each selected case, a blinded Clinical Decision-Making Intensity score (ranging from 0 to 5) and the liability determination, systematically coded from expert opinion texts, were compared across different outcome categories.Results: The 16 cases were distributed as follows: 8 cases of stillbirth/neonatal death, 4 cases of maternal death, 3 cases of severe maternal morbidity, and 1 case of severe neonatal morbidity (hypoxic-ischemic encephalopathy). Liability was recognized in 100% of maternal death, severe maternal morbidity, and severe neonatal morbidity cases. In contrast, liability was determined in only 3 out of 7 determinable stillbirth/neonatal death cases (42.9%); notably, 2 of the remaining 4 cases were resolved through a no-fault compensation scheme. This disparity in liability rates was statistically significant (Fisher exact test, p=0.026). Furthermore, two neonatal death cases presented a shared pattern of warning signs (respiratory distress, cyanosis, and vomiting) that were observed for several hours prior to either an escalation of care or transfer to a higher-level facility.Conclusion: The severity of the outcome did not consistently correlate with liability determination. Specifically, stillbirth/neonatal death cases demonstrated a significantly lower liability rate compared to other categories (42.9% vs. 100%; Fisher exact test, p=0.026), which may partly reflect the unpredictable nature of certain obstetric emergencies. However, a recurring and potentially preventable pattern of delayed escalation following the recognition of warning signs was also identified. This finding underscores the critical need for standardized escalation protocols within newborn nurseries to improve patient safety.