Learning from the law: a review of 21 years of litigation for anaesthetic negligence resulting in peripartum hypoxic ischaemic encephalopathy

One of the most devastating complications that can result from medical mismanagement during labour and delivery is hypoxic ischaemic encephalopathy. Hypoxic ischaemic encephalopathy has profound implications for the newborn and its family, as well as for the healthcare team involved. Hypoxic ischaemic encephalopathy can take only minutes to develop, but the repercussions of this complication can last a lifetime. A proportion of these injuries arise from failure to deliver the baby within a sufficiently short time frame once fetal compromise has been recognised. Obstetric anaesthetists are often involved in such claims, usually in relation to a perception that provision of anaesthesia for caesarean section was unduly delayed. In the following article, using a database of over 360 cases spanning 21 years, we break down and examine the recurrent components of medicolegal claims concerning the anaesthetic involvement in hypoxic ischaemic encephalopathy, and consider how increased awareness of the anaesthetic contribution to this complication might reduce future harm, improve clinical standards and consequently decrease the need for litigation.