Medico-legal safeguards in obstetrics and gynaecology: a narrative review of legislative frameworks and preventive strategies

Garima Wadhwa; Apurva Maheshwari; Nilanchali Singh

doi:10.18203/2320-1770.ijrcog20262155

Authors

Garima Wadhwa Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
Apurva Maheshwari Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
Nilanchali Singh Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20262155

Keywords:

Medical negligence, Informed consent, Obstetrics, Gynaecology, MTP act, PCPNDT act, ART act, Surrogacy, Litigation, Consumer protection act

Abstract

Obstetrics and gynaecology (OB-GYN) is recognized as one of the most litigious medical fields worldwide. The nature of care often involves two lives simultaneously, with high emotional and ethical implications, which makes it vulnerable to legal scrutiny. Legal actions usually arise from allegations of medical negligence, improper consent, or failure to meet standard protocols during antepartum, intrapartum, or postpartum care. However, understanding the application of relevant legal frameworks can help mitigate the risk of litigation. Any guidelines or acts stated by the government, if diligently followed, significantly reduce the risk of litigation by promoting transparency, ethical standards, patient safety, proper documentation and accountability. This narrative review was conducted through a systematic search of PubMed, Medline, and Google Scholar, supplemented by Government of India legislative documents and guidelines from professional bodies including FOGSI, WHO, and ICMR. Nine key legislative frameworks were identified as relevant to OB-GYN practice in India-the medical termination of pregnancy (MTP) act (1971, amended 2021), pre-conception and pre-natal diagnostic techniques (PCPNDT) act (1994, amended 2003), assisted reproductive technology (ART) Act (2021), surrogacy (Regulation) act (2021), protection of children from sexual offences (POCSO) act (2012), Family planning indemnity scheme (FPIS) (2005), clinical establishments act (2010), Indian medical council ethics regulations (2002), and the consumer protection act (CPA) (1986, amended 2019). Common medicolegal pitfalls included deficiencies in informed consent, inadequate documentation, errors in foetal and neonatal management, surgical oversights, and delayed emergency referrals. Comprehensive understanding of applicable laws, combined with clinical documentation, valid informed consent, and systematic risk management, substantially mitigates medicolegal vulnerability in OB-GYN practice.

References

Ghaith S, Campbell RL, Pollock JR, Torbenson VE, Lindor RA. Medical malpractice lawsuits involving trainees in obstetrics and gynaecology in the USA. Healthcare. 2022;10(7):1328.

Samuels A. Obstetrics and gynaecology and the law. Med Leg J. 2022;90(3):143-6.

Medicolegal Aspects of Obstetric Critical Care. Indian J Crit Care Med. 2022;25(S3):S279-82.

Vickers H, Jha S. Medicolegal issues in gynaecology. Obstet Gynaecol Reproduct Med. 2019;30(2):43-7.

Gowda SL, Ambarisha Bhandiwad, Anupama NK. Litigations in Obstetric and Gynecological Practice: Can it be prevented? A Probability to Possibility. J Obstet Gynecol India. 2016;66(S1):541-7.

Raveesh B, Nayak R, Kumbar S. Preventing medico-legal issues in clinical practice. Ann Indian Academy Neurol. 2018;19(5):15.

Government of India. The Medical Termination of Pregnancy Act, 1971. Available at: https://www.indiacode.nic.in/bitstream/123456789/6832/1/mtp-act-1971.pdf. Accessed on 15 April 2026.

Kumari S, Kishore J. Medical Termination of Pregnancy (Amendment Bill, 2021): Is it Enough for Indian Women Regarding Comprehensive Abortion Care?? Indian J Community Med. 2021;46(3):367-9.

Government of India. The Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994. Available at: https://pndt.mohfw.gov.in/WriteReadData/l892s/PC-PNDT%20ACT-1994.pdf. Accessed on 15 April 2026.

Bhaktwani A. The PC-PNDT act in a nutshell. Indian Journal of Radiology and Imaging. 2012;22(2):133.

Government of India. Assisted Reproductive Technology (Regulation) Act, 2021. Available from: https://www.indiacode.nic.in/handle/123456789/17031?locale=en. Accessed on 15 April 2026.

Yadav A, Singh Jamwal V. The assisted reproductive technology (regulation) act, 2021: A step in the right direction. Indian J Community Med. 2022;48(1):4-6.

Singh S. An overview of the Surrogacy (Regulation) Act, 2021. Legal Bites; 2024. Available at: https://www.legalbites.in/topics/articles/an-overview-of-the-surrogacy-regulation-act-2021-986640. Accessed on 15 April 2026.

Government of India. The Protection of Children from Sexual Offences Act, 2012. Available at: https://www.indiacode.nic.in/bitstream/123456789/9318/1/sexualoffencea2012-32.pdf. Accessed on 15 April 2026.

Ministry of Health and Family Welfare. Manual for Family Planning Indemnity Scheme, 2013. Available at: https://nhm.gov.in/images/pdf/programmes/family-planing/schemes/FP_Indemnity_Scheme_2013.pdf. Accessed on 15 April 2026.

Government of India. The Clinical Establishments (Registration and Regulation) Act. Available at: http://www.clinicalestablishments.gov.in/cms/Home.aspx. Accessed on 15 April 2026.

Medical Council of India. Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. Available at: https://wbconsumers.gov.in/writereaddata/ACT%20&%20RULES/Relevant%20Act%20&%20Rules/Code%20of%20Medical%20Ethics%20Regulations.pdf. Accessed on 15 April 2026.

Vajawat B, Dinakaran D, Nandimath OV. The Consumer Protection Act, 2019: A critical analysis from a medical practitioner's perspective. Indian J Med Ethics. 2024;9(1):65-9.

Sharma V. How to Safeguard Against Litigations and Consumer Cases during the Medical Practice? Open Access J Ophthalmol. 2023;8(1):1-3.

Gupta P. Avoiding litigation in clinical practice. J Indian Associat Pediat Surg. 2019;24(3):158.