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目的:比较分析各相关因素对围生期妇女、婴儿死亡的影响,对引起死亡及导致医疗纠纷的原因进行总结。方法:回顾分析重庆医科大学法医教研室2000～2009年解剖医疗纠纷案例中围生期死亡妇女、婴儿共120例,其中妇女72例,婴儿48例。统计内容包括:尸检数量、死亡原因、死亡时间、医院级别、分娩方式、产前疾病、临床诊断与尸检诊断符合情况等。结果:①围生期妇女、婴儿死亡导致医疗纠纷主要集中在一级医院和二级医院;②各级医院围生儿组的平均误诊率为77.1%,远高于妇女组的误诊率:40.3%;③发生医疗纠纷的围生期死亡妇女年龄偏高,平均年龄30.5岁,大于28岁的占65.3%;④发生医疗纠纷的围生期死亡妇女职业主要为农民和无业,分别占62%和17%;⑤75%的死亡妇女为高危妊娠,其高危因素的前3位依次是:妊娠合并症、妊娠异常和分娩异常;⑥发生医疗纠纷的围生期妇女死亡原因前5位依次是:产后大出血、羊水栓塞、严重感染、肺动静脉血栓形成、急性坏死性胰腺炎,死亡时间的3个高峰期为:进入产程～分娩结束、分娩结束～产后6h、产后12h～产后24h;⑦发生医疗纠纷的围生期婴儿死亡原因前4位依次为:肺部因素、脐带因素、胎盘因素和产程因素,其中进入产程～出生48h是婴儿死亡的高峰期,占婴儿总死亡例数的77.1%。结论:医疗条件、高危妊娠、治疗抢救是否及时有效是影响围生期妇女、婴儿死亡的重要因素。提高一级医院和二级医院的医疗条件,增强其处理围生期妇女高危妊娠、产后大出血、羊水栓塞、围生儿肺部因素和脐带因素的能力,是降低重庆地区围生期妇女、婴儿死亡率及其导致的医疗纠纷发生率的关键。
OBJECTIVE: To comparatively analyze the impact of various related factors on perinatal women and infants, and to summarize the causes of death and medical disputes. Methods: A retrospective analysis of the cases of anatomical medical disputes in the Department of Forensic Medicine, Chongqing Medical University from 2000 to 2009, involving 120 perinatal women and infants, including 72 women and 48 infants. Statistics include: the number of autopsy, the cause of death, time of death, hospital level, mode of delivery, prenatal disease, clinical diagnosis and autopsy diagnosis meet the situation. Results: ①In the perinatal period, the medical disputes caused by the death of infants and young children mainly concentrated in the first and second level hospitals; ②The average misdiagnosis rate of perinatal children in all levels of hospitals was 77.1%, much higher than the rate of misdiagnosis in the women group: 40.3 %; ③The perinatal deaths of women who experienced medical disputes were over-aged, with an average age of 30.5 years and 65.3% of those over 28 years of age. ④ Perinatal deaths occurred in medical disputes mainly for peasants and unemployed women, accounting for 62% And 17%; ⑤ 75% of the deaths of women for high-risk pregnancy, the top three risk factors were: pregnancy complications, abnormal pregnancy and childbirth abnormalities; ⑥ perinatal medical malpractice causes of death in the top 5 were: Postpartum hemorrhage, amniotic fluid embolism, severe infection, pulmonary arteriovenous thrombosis, acute necrotizing pancreatitis, death time of the three peak: into the labor process ~ delivery end, delivery end ~ postpartum 6h, postpartum 12h ~ postpartum 24h; ⑦ occurred The top four causes of perinatal infant death in medical disputes were pulmonary factors, umbilical cord factors, placental factors and labor factors. Among them, 48 hours of birth to birth was the peak of infant death, accounting for 77.1% of the total number of infant deaths. . Conclusion: Medical conditions, high-risk pregnancy, and timely treatment of salvage are important factors affecting perinatal women and infants. Improving the medical conditions of Tier I and Tier II hospitals and enhancing their ability to deal with perinatal women with high-risk pregnancies, postpartum hemorrhage, amniotic fluid embolism, perinatal pulmonary factors and umbilical cord factors is to reduce perinatal women and infants in Chongqing Mortality and the key to the incidence of medical disputes.