Investigation of severe maternal outcomes based on forensic medical examination

Abstract

Investigation of severe maternal outcomes based on forensic medical examination V.F. Bezhenar1, I.A. Dobrovolskaya1, Т.А. Levina2 1 Pavlov First Saint Petersburg State Medical University 2 Bureau of Forensics and Medical Expertise, St. Petersburg, Russian Federation Severe maternal outcomes are often the subject of forensic examinations. Death or a critical condition due to a serious pathological process is considered in terms of the consequences of defects in the provision of medical care. The study of medical records in adverse outcomes contributes to a better understanding of the mechanisms of the development of pregnancy-related terminal states, an assessment of the causes of the defects, and the search for ways to optimize the completion of pregnancy. The aim of the work was to study the causes of severe maternal outcomes on the data of forensic examinations and to identify the relationship between poor quality medical care and adverse pregnancy outcome. Patients and Methods: the results of 50 commission forensic examinations were analyzed: 19 — on the death of patients and 31 — on the medical assistance. Results: all patients were in the group of high perinatal risk, but most of them completed pregnancy in the second-level hospitals. Among the causes of maternal mortality were the complications of preeclampsia, sepsis and hemorrhagic shock; the majority of patients died in the first day after the completion of pregnancy from bleeding and fulminant sepsis. Critical states of «near miss» patients are hemorrhagic shock, sepsis and complications of preeclampsia, which developed in half of the patients during childbirth and in the first day of the postpartum period. Conclusion: the majority of patients from both groups received medical care of inadequate quality, with most of the defects admitted in hospitals and associated with the stage of treatment. Despite the low number of defects in the diagnosis and succession, they often predetermined the development of a chain of dramatic events. Between the unfavorable outcomes of pregnancy and medical care defects, in most cases, an indirect cause-and-effect relationship has been established, since the development of critical conditions was based on serious complications, and not actually on the defects of medical care, which does not exclude their significance in the aggregate of causes of severe maternal outcomes. Key words: severe maternal outcomes, maternal mortality, «near miss» patients, defects in medical care, cause-and-effect relationship. For citation: Bezhenar V.F., Dobrovolskaya I.A., Levina Т.А. Investigation of severe maternal outcomes based on forensic medical examination. Russian journal of Woman and Child Health. 2018;1(1):18–25.