CAJ | 학술논문

目的：探讨孕产妇死亡案例的特点、死亡原因及其医疗纠纷产生的原因并提出相应预防措施．方法对昆明医科大学司法鉴定中心2002年1月至2012年12月鉴定的35例孕产妇死亡案例进行回顾性分析．结果35例孕产妇死亡案例中：（1）30岁以上多见（14例，40%），17～19岁也较常见（6例，17.1%）；农村人口为主（25例，71.4%）；（2）围产期的孕产妇死亡24例（68.5%）；（3）县级、乡镇医院及非正规医疗机构死亡26例（74.3%），家中分娩和途中分娩死亡5例（14.3%）；（4）因产科出血引起的失血性休克死亡17例（48.6%），羊水栓塞死亡11例（31.4%），羊水栓塞合并产科出血死亡2例（5.7%）；（5）30例孕产妇死亡引发的医疗纠纷中临床诊断与病理诊断不相符20例（误诊漏诊率为66.7%）；（6）医疗纠纷产生的原因：临床诊断不明11例（36.7%），怀疑抢救不及时、处理不当11例（36.7%），怀疑误诊漏诊8例（26.6%）．结论产科出血、肺羊水栓塞是导致孕产妇死亡的主要原因；提高基层产科人员对产科出血、肺羊水栓塞的诊断和救治能力，可减少孕产妇死亡和医疗纠纷的发生．同时，还应提高妇女的自我保健意识，减少早婚早孕，提高住院分娩率．
목적：탐토잉산부사망안례적특점、사망원인급기의료규분산생적원인병제출상응예방조시．방법대곤명의과대학사법감정중심2002년1월지2012년12월감정적35례잉산부사망안례진행회고성분석．결과35례잉산부사망안례중：（1）30세이상다견（14례，40%），17～19세야교상견（6례，17.1%）；농촌인구위주（25례，71.4%）；（2）위산기적잉산부사망24례（68.5%）；（3）현급、향진의원급비정규의료궤구사망26례（74.3%），가중분면화도중분면사망5례（14.3%）；（4）인산과출혈인기적실혈성휴극사망17례（48.6%），양수전새사망11례（31.4%），양수전새합병산과출혈사망2례（5.7%）；（5）30례잉산부사망인발적의료규분중림상진단여병리진단불상부20례（오진루진솔위66.7%）；（6）의료규분산생적원인：림상진단불명11례（36.7%），부의창구불급시、처리불당11례（36.7%），부의오진루진8례（26.6%）．결론산과출혈、폐양수전새시도치잉산부사망적주요원인；제고기층산과인원대산과출혈、폐양수전새적진단화구치능력，가감소잉산부사망화의료규분적발생．동시，환응제고부녀적자아보건의식，감소조혼조잉，제고주원분면솔．
Objective This study aimed to investigate the characteristics of maternal death cases, the cause of maternal death and the cause of medical dispute,and recommended the relative prevention measures. Methods We retrospectively analyzed 35 cases of maternal death identified in the College of Forensic Medicine in Kunming Medical University from January 2002 to December 2012. Results In 35 maternal death cases: (1) Most maternal deaths are over 30 years old (14 cases, 40%), followed by 17 to 19 years old (6 cases, 17.1%) . And most maternal deaths came from countryside (25 cases,71.4%) . (2) 26 cases maternal deaths happened during the perinatal period (68.5%) . (3) 26 cases happened in county hospitals, township hospitals and informal medical organizations (74.3%) . 5 maternal deaths happened on the way to the hospital or at home (14.3%) . (4) 17 cases died of obstetric hemorrhagic shock (48.6%), 11 cases died of amniotic fluid embolism (31.4%), 2 cases died of amniotic fluid embolism and obstetric hemorrhagic shock (5.7%) . (5) 30 cases of medical disputes were caused by maternal death. Among them, the clinical diagnosis was not consistent with the pathological diagnosis in 20 cases (The misdiagnosis rate was 66.7%) . (6) The causes of medical dispute:clinical diagnosis was unknown in 11 cases (36.7%),11 cases were suspected that rescue was not timely or improper (36.7%),and 8 cases were suspected of misdiagnosis (26.6%) . Conclusion Obstetric hemorrhage and pulmonary amniotic fluid embolism were the main reasons of the maternal death. The incidence of maternal death and medical disputes could be reduced by improving the ability of obstetric staff,and strengthening the diagnosis and treatment about obstetric hemorrhage and pulmonary amniotic fluid embolism. At the same time, women should improve their self-care awareness, reduce early marriage and early pregnancy,and enhance the consciousness of hospital treat and cure.