Obstetrics & Gynaecology: Common Areas of Clinical Negligence

Obstetrics consistently accounts for one of the largest shares of both claim numbers and total NHS Resolution damages — a reflection of how catastrophic the consequences can be when things go wrong during labour and delivery, and of how often successive national inquiries have found the same failures recurring.

Why Claims Arise in This Area

The Shrewsbury and Telford review, the East Kent maternity investigation, and the 2026 Ockenden report into Nottingham's maternity services have each identified strikingly similar recurring themes: failures to listen to women, inadequate staffing and training, and poor investigation and candour after harm occurred. Clinically, the standard expected is set out in RCOG green-top guidelines and NICE intrapartum care guidance (CG190), applied against what the fetal monitoring, observations, and clinical picture actually showed at the time.

Common Areas of Negligence

CTG misinterpretation and delayed escalation

Cardiotocograph (CTG) interpretation remains the single most litigated issue in maternity care. Claims typically involve a trace showing recognised features of fetal compromise — reduced variability, decelerations, or a rising baseline — that was not correctly classified, or was classified correctly but did not lead to the escalation (obstetric review, fetal blood sampling, or emergency caesarean section) that the trace warranted. Because CTG interpretation is a skill with well-documented inter-observer variability even among experienced clinicians, these claims often turn on detailed, real-time reconstruction of what the trace showed at each point and how quickly the response should have followed.

Shoulder dystocia mismanagement

Shoulder dystocia is an obstetric emergency requiring a specific, time-critical sequence of manoeuvres (as set out in RCOG's green-top guideline). Claims arise where excessive traction is applied in a way that causes brachial plexus injury (Erb's palsy), where the recognised manoeuvres are attempted out of sequence or not at all, or where the delay between recognising the dystocia and delivering the baby is longer than a competently managed emergency should take — with the resulting hypoxic injury forming the basis of the claim.

Failure to detect or manage pre-eclampsia

Pre-eclampsia is progressive and, in its most severe form, life-threatening for both mother and baby. Claims commonly involve blood pressure and proteinuria trends that, viewed together over several antenatal visits, should have prompted closer monitoring or admission but were instead assessed in isolation at each appointment — allowing the condition to progress to eclampsia, HELLP syndrome, or placental abruption before it was properly recognised and treated.

Missed or delayed ectopic pregnancy diagnosis

Early pregnancy bleeding or pain is common and usually benign, which is precisely why ectopic pregnancy is so often missed until it becomes an emergency. Claims typically centre on whether appropriate early pregnancy assessment — serial hCG measurement, transvaginal ultrasound, and safety-netting advice — was arranged promptly enough given the presenting symptoms, given that a ruptured ectopic pregnancy can cause rapid, life-threatening internal haemorrhage.

Perineal trauma and repair failures

Third- and fourth-degree perineal tears require accurate grading and a structured repair, typically in theatre by a suitably trained clinician, followed by appropriate follow-up. Claims arise where the degree of tearing is under-graded at the time of birth, where the repair itself is technically inadequate, or where postnatal follow-up fails to identify ongoing symptoms (incontinence, pain, or wound breakdown) that should have prompted specialist referral.

Gynaecological surgical injury and delayed cancer diagnosis

On the gynaecological side, recurring themes include injury to the bowel, bladder, or ureter during hysterectomy or laparoscopic procedures — sometimes not recognised until a patient re-presents with post-operative complications — and delayed diagnosis of ovarian, endometrial, or cervical cancer where symptoms or abnormal results were not investigated with the urgency current NICE suspected-cancer guidance requires.

What the Law Requires

As with any clinical negligence claim, a bad outcome is not, of itself, evidence of negligence. The legal test of breach asks whether the care fell below that of a reasonably competent clinician practising in the relevant field at the time (Bolam v Friern Hospital Management Committee), and whether that view would withstand logical scrutiny (Bolitho v City and Hackney Health Authority). Where the claim concerns what a patient was told about risks and alternatives before treatment, the test is different: Montgomery v Lanarkshire Health Board requires that a patient be told of any risk to which a reasonable person in their position would attach significance, judged from the patient's perspective rather than a standard clinician's script. On causation, the claimant must generally show that the breach made a material difference to the outcome — though in some multi-cause or cumulative-harm scenarios, a material contribution to the injury can suffice.

What Good Expert Evidence Establishes

Maternity claims frequently require input from more than one expert — typically an obstetrician and a midwife, and often a neonatologist where the baby suffered hypoxic injury — because responsibility for a failure in the birthing process is rarely confined to a single professional group. The national maternity inquiries also highlight a consistent secondary issue relevant to litigation: poor contemporaneous documentation and delayed candour after the event, both of which shape how a case is proved as much as the clinical facts themselves.

Given how document-heavy these claims are — CTG traces, partograms, and multiple sets of professional notes often need to be read together — a chronology built early in the case tends to pay for itself many times over.