A 10-year analysis of obstetric malpractice litigation according to court of cassation (Yargıtay) decisions (2016–2025): A descriptive study

Abstract

Aim

The judicial trajectory, clinical features, and institutional context of obstetric malpractice litigation in Türkiye have not been systematically examined over an extended interval. We analysed obstetric malpractice decisions rendered by the Court of Cassation (Yargıtay) between 2016 and 2025 to describe temporal patterns in the number of identified appellate decisions, lawsuit type, institutional distribution, clinical outcomes, expert-report fault assessment, and judicial outcomes.

Material and methods

A structured search of the public Court of Cassation decision database (https://karararama.yargitay.gov.tr), last performed in March 2026, identified 166 unique obstetric malpractice decisions meeting the predefined criteria. Cases were stratified into two consecutive five-year periods (Period I: 2016–2020, n = 60; Period II: 2021–2025, n = 106). Associations were tested with the chi-square or Fisher exact test; for the appellate outcome (affirmation versus pooled reversal/partial reversal) a Firth penalised logistic regression was additionally fitted because the expert-report variable produced near-complete separation.

Results

The mean annual number of identified decisions was approximately 77% higher in Period II (21.2/year) than in Period I (12.0/year). Civil/compensation proceedings rose from 68.3% to 88.7% and criminal proceedings fell from 31.7% to 10.4% (p = 0.002). Private hospitals accounted for 82.5% of cases overall (68.3% in Period I, 90.6% in Period II; p = 0.001); obstetrician-gynaecologists were the named defendant in 92.8%. Maternal mortality occurred in 18.1%, fetal/neonatal mortality in 25.3% and severe maternal or perinatal morbidity in 75.9%. The proportion of first-instance decisions not affirmed by the Court of Cassation fell from 85.0% in Period I to 38.7% in Period II (p < 0.001). No clinical severity variable was associated with the appellate outcome (all p > 0.05), whereas the expert-report fault assessment showed a strong and independent association (χ² = 120.9, df = 2, p < 0.001; Firth-adjusted odds ratios remained large but imprecise owing to separation); 98.4% of decisions recording contradictory expert reports were at least partially reversed.

Conclusion

Within the appellate case pool, the dominant correlate of the Court of Cassation outcome was not the severity of the clinical event but the fault assessment recorded in the expert report. Because a substantial minority of reversals rested on non-evidentiary legal grounds and the dataset reflects only cases reaching the Court of Cassation, the findings should be read as associations within an appellate sample rather than as measures of malpractice incidence, institutional burden, or expert-report quality.