孕产妇死亡医疗纠纷案例的法医病理学分析

【】　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。【Abstract】　Objective　Toanalyzethecausesofmaternaldeathwithmedicaldisputes,thecausesofmedicaldisputes,andtorecommendtherelatedpreventionsthroughaforensicpathologicalangle.　Methods　Weretrospectivelyanalyzed46casesofmaternaldeathwithmedicaldisputeswhichwerecollectedbyWestChinaCenterofForensicMedicineServiceinSichuanbetweenJanuary1999andDecember2008.　Results　Mostmaternaldeathsoccurredover30yearsold.Theymostfrequentlyhappenedduringtheperi-natalperiod(87.0%).Thecausesofdeathincludedobstetrichemorrhagicshockin21cases(45.7%),embolism-likediseasesin8cases(17.4%),infectiousdiseasesin5cases(10.8%)andotherreasonsin12cases(26.1%).Amongallthe46casesofmedicaldisputes,8(17.4%)werenotduetomedicalmalpractices,whiletheother38cases(82.6%)hadsomethingtodowithsuchmedicalmalpracticesasdelayedorinappropriatetreatment,misdiagnosisandsoon.Mostofthemalpracticesinthesecasesinvolvedmedicalinstitutionsatacountylevel(54.3%).　Conclusion　Forensicjudicatoryappraisalisimportanttoresolvemedicaldisputesofmaternaldeathbyfindingoutthecauseofdeath,clarifyingthemedicalresponsibilityandclearingthecauseofmedicaldisputes.