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目的对30例孕产妇死亡案例的尸体检验情况进行分析,探讨孕产妇死亡原因及医疗纠纷产生的原因。方法收集赤峰学院医学院司法鉴定中心1999—2007年受公安机关和卫生行政机关委托检验已经鉴定的孕产妇死亡纠纷案例30例,综合系统病理尸体解剖、法医病理组织学检查和临床专家会诊意见等资料,分析死亡原因及其与医疗行为的关系。结果30例案例中,个体门诊15例(50%),其中非法行医10例(33%)。10例非法行医案例中,大出血后未抢救4例,缩宫素使用不当导致产道严重损伤并大出血2例,使用缩宫素并发肺羊水栓塞死亡2例,输液意外死亡1例,人工流产术后未做认真检查、术后3d异位妊娠破裂出血1例。20例合法行医案例中,胎盘植入致大出血3例,臀位生产接生不当致产妇死亡3例(其中母子双亡2例),宫口撕裂大出血休克死亡3例,药物引产中并发呼吸循环衰竭1例,剖宫产术后并发肺羊水栓塞死亡7例,剖宫产术后过早出院、对肺动脉栓塞警惕性不高3例。结论产科出血、肺羊水栓塞、剖宫产术后感染并肺动脉栓塞等均是严重威胁产妇生命且易导致医疗纠纷的产科并发症。应提高基层产科从业人员的业务素质,提高其对产科急重症的识别诊断和救治能力;同时还应加大孕期保健知识的宣传力度,提高孕产妇及家庭成员的自我保健意识,以避免孕产妇死亡及医疗纠纷的发生。
Objective To analyze the postmortem examination of 30 cases of maternal death and discuss the causes of maternal death and the causes of medical disputes. Methods Thirty cases of maternal death disputes which were appraised by public security organs and health administrative authorities from 1999 to 2007 were collected from the Center of Forensic Medicine of Chifeng Academy of Medical Sciences. The autopsy, pathological examination of forensic pathology and consultation of clinical experts Data, analyze the cause of death and its relationship with medical behavior. Results Of the 30 cases, 15 were outpatients (50%), of whom 10 were illegally practiced (33%). 10 cases of illegal medical practice cases, 4 cases were not rescued after massive bleeding, inappropriate use of oxytocin lead to serious injury and bleeding in 2 cases, the use of oxytocin combined with pulmonary amniotic fluid embolism in 2 cases, 1 case of accidental infusion death, induced abortion Did not do a careful examination, postoperative 3d ectopic pregnancy rupture and bleeding in 1 case. In 20 cases of legal practice, placenta accreta occurred in 3 cases of bleeding, improper delivery of breech was caused by maternal death in 3 cases (2 cases of both mother and child), bleeding in the cervix died of haemorrhage in 3 cases, drug induced abortion in the respiratory cycle 1 case of failure, cesarean section after pulmonary embolism death in 7 cases, cesarean section premature discharge, vigilance of pulmonary embolism is not high in 3 cases. Conclusion Obstetrical complications such as obstetric bleeding, pulmonary amniotic fluid embolism, post-cesarean section infection and pulmonary embolism are the serious complications of maternal life-threatening medical disputes. Should improve the professional quality of obstetrics and gynecology practitioners at the grassroots level to improve their ability to diagnose and treat obstetric emergencies; at the same time, publicity should be intensified during pregnancy to raise awareness of maternal and family members’ self-care so as to avoid maternal Death and medical malpractice.