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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。
Objective To explore the characteristics, main causes of death and medical countermeasures of medical dispute cases of maternal death. Methods A retrospective study was conducted on the data of forensic autopsy cases from 1985 to December 2003 in our hospital and the maternal death cases in which there was medical dispute were analyzed. Results 31 cases of medical malpractice death of pregnant women autopsy cases: (1) 26 cases of perinatal death (83.9%), 5 cases (16.1%) died of induced abortion in early pregnancy; (2) bleeding caused by obstetric hemorrhage 22 cases (71.0%) died of sexual shock, 5 cases (16.1%) died of amniotic fluid embolism and 4 cases (12.9%) died of other causes; (3) 17 township medical institutions (54.8% (23.6%), municipal hospitals in 4 (12.9%) and other cases in 3 (9.7%); (4) the cause of the disputes was suspected to be misdiagnosis in 14 (45.2%), misdiagnosed (29.0 %), Salvage not timely in 7 cases (22.6%), the other one case (3.2%). Conclusion Maternal death medical disputes occurred mainly in the perinatal period, followed by early pregnancy; obstetric hemorrhage is one of the most important factors leading to maternal mortality; township and county-level medical institutions are apt to cause disputes; the main cause of disputes is misdiagnosis , Mistreatment and rescue not timely.