孕产妇死亡医疗纠纷案法医病理研究

目的探讨孕产妇死亡医疗纠纷案的特点、主要死因及其防范对策。方法采用回顾性研究的方法,对我室1985年至2003年12月的法医尸体解剖案例资料进行统计,并对其中存在医疗纠纷的孕产妇死亡案例进行分析。结果31例存在医疗纠纷的死亡孕产妇法医尸检案例中:(1)围产期死亡26例(83.9%),妊娠早期人工流产后死亡5例(16.1%);(2)产科出血引起的失血性休克死亡22例(71.0%),羊水栓塞死亡5例(16.1%),其它原因死亡4例(12.9%);(3)乡镇医疗机构17例(54.8%),地县级医院占7例(23.6%),市级医院占4例(12.9%),其他占3例(9.7%);(4)纠纷产生的原因中疑为误治14例(45.2%),误诊的9例(29.0%),抢救不及时的7例(22.6%),其他1例(3.2%)。结论孕产妇死亡医疗纠纷案主要发生在围产期,其次是妊娠早期;产科出血是导致孕产妇死亡的最主要因素之一;乡镇及县级医疗机构易引起纠纷;引起纠纷的主要原因是误诊、误治和抢救不及时。

Forensic pathological study on maternal death cases involved in medical dissension

Objective To study primary cause and the characteristics of maternal death cases involved in medical dissension and to improve the ability to prevent it.Methods 31 maternal death cases of legal medical autopsy involved in medical dissension were reviewed and analyzed.Results Of 31 maternal death cases involved in medical dissension:1) 26 cases died in perinatal period,5 cases died of artificial abortion in the forepart of pregnancy;2) 22 cases died of obstetric hemorrhagic shock,5 cases died of amniotic fluid embolism,and 4 cases died of other reasons.3) 17 cases died in medical institution of town,7 cases died in medical institution of county,4 cases died in medical institution of city,3 cases died in other medical institution;4) the reasons for medical dissension: 14 cases died of improper treatment,9 cases died of misdiagnosis,7 cases died of lingering salvage,1 case died of other reasons.Conclusions Maternal deaths happen most frequently in perinatal period,secondly in the forepart of pregnancy;The primary cause of maternal death was obstetric hemorrhage;Most medical dissensions were caused by town or county medical institutions;The main reasons for medical dissension were misdiagnosis?improper treatment and lingering salvage.