孕产妇死亡医疗纠纷案例的法医病理学分析

Forensic Pathological Analysis of Maternal Death with Medical Disputes

目的从法医病理学角度分析引起医疗纠纷的孕产妇死亡原因、医疗纠纷发生原因并提出相关防范措施。方法对1999年1月-2008年12月间46例引起医疗纠纷的孕产妇死亡案例进行回顾性分析。结果孕产妇死亡年龄以30岁以上多见,死亡时妊娠时间以围产期居多(87.0%)。死亡原因中产科失血性休克死亡21例(45.7%),栓塞类疾病死亡8例(17.4%),感染性疾病死亡5例(10.8%),其他原因死亡12例(26.1%)。46例中属非医疗过失性医疗纠纷8例(17.4%),医疗过失性纠纷38例(82.6%),医疗过失的原因主要为抢救不及时、处理不当、误诊误治等。涉及纠纷的医院以县区级医院居多(54.3%)。结论通过法医病理学司法鉴定查明死亡原因,明确医疗责任及医疗纠纷原因,已成为解决孕产妇死亡医疗纠纷的重要手段。

Objective To analyze the causes of maternal death with medical disputes,the causes of medical disputes,and to recommend the related preventions through a forensic pathological angle.Methods We retrospectively analyzed 46 cases of maternal death with medical disputes which were collected by West China Center of Forensic Medicine Service in Sichuan between January 1999 and December 2008.Results Most maternal deaths occurred over 30 years old.They most frequently happened during the perinatal period（87.0%）.The causes of death included obstetric hemorrhagic shock in 21 cases（45.7%）,embolism-like diseases in 8 cases（17.4%）,infectious diseases in 5 cases（10.8%） and other reasons in 12 cases（26.1%）.Among all the 46 cases of medical disputes,8（17.4%） were not due to medical malpractices,while the other 38 cases（82.6%） had something to do with such medical malpractices as delayed or inappropriate treatment,misdiagnosis and so on.Most of the malpractices in these cases involved medical institutions at a county level（54.3%）.Conclusion Forensic judicatory appraisal is important to resolve medical disputes of maternal death by finding out the cause of death,clarifying the medical responsibility and clearing the cause of medical disputes.