Summary Maternity Tang Moumou into the defendant's obstetrics and gynecology department to be born, the newborn after the birth of the mother appeared amniotic fluid embolism, the treatment was ineffective and died.April 9, 2019 the court after the hearing that the medical side of the progress of the maternal labor process lacks a comprehensive, meticulous observation and monitoring, does not exclude the possibility of contraction overly induced amniotic fluid embolism, the maternal morbidity and disease of the medical side of the amniotic fluid embolism After the onset of labor, the doctor's treatment of amniotic fluid embolism was not standardized, which exacerbated the condition of the mother, thus to a certain extent depriving the mother of her chances of survival. The court ruled that the defendant should be liable for 50% of the plaintiff's damages, which amounted to 627,926 yuan.
Keywords medical dispute, liability, amniotic fluid embolism, Class I-A, medical malpractice
I. Basic case
The plaintiff's relative, the mother Tang Moumou, was admitted to the defendant's Department of Obstetrics and Gynecology at about 22:30 on January 5, 2015 because of "menopause of 38+5 weeks, redness with lower abdominal pain for 2 hours." At about 2:00 a.m. on January 6, the mother's pain worsened, and the nurses arranged for the mother to go into the waiting room. At about 4:00 a.m., due to intrauterine oxygen deprivation, the doctor on duty asked the family to sign and operated immediately. The newborn was born, around 2 hours. The doctor asked the family to transfer the newborn to the neonatology department of Hospital X. At 10:00 a.m. on January 6, the doctor informed the family that the mother had suffered a DIC amniotic fluid embolism and her life was in danger, and she died on January 14 after treatment.
II. Medical point of view
January 6, 2015 at about 04:00 hours, the maternal sudden sudden drop in fetal heartbeat, medical timely and clear diagnosis of "intrauterine distress", emergency in the maternity ward cesarean section has indications, to save the fetus. After cesarean section, the mother had poor uterine contraction and bleeding, so she was given continuous uterine massage, the use of oxytocin and xinmuepe, gauze uterine cavity tamponade and other treatments; the mother was apathetic, and in order to prevent atypical amniotic fluid embolism, she was given anti-allergic treatment; the mother's blood pressure dropped and her heart rate increased, so she was given anti-shock and other symptomatic resuscitation; and in the event of uncontrollable bleeding, hysterectomy was carried out. The woman died after the failure of rescue.
According to the clinical manifestations combined with the forensic autopsy report, amniotic fluid embolism caused death. The specific cause of amniotic fluid embolism in this case is unknown, and there are no medical factors that could have led to amniotic fluid embolism, so the occurrence of amniotic fluid embolism is not considered to be causally related to the medical treatment. The probability of amniotic fluid embolism is extremely low, and it is difficult to anticipate and prevent the occurrence of amniotic fluid embolism, and once it occurs, it is difficult to rescue and the mortality rate is extremely high. In this case, amniotic fluid embolism occurred when the fetal heart rate dropped after the rupture of the membranes, but it was an atypical amniotic fluid embolism, which was difficult to diagnose clinically.
III. Judicial appraisal opinion, the medical side of the Tang Moumou diagnosis and treatment process there is fault, the fault is the same cause of his death, the proposed participation of 45% -55%.
IV. Medical fault analysis
After admission to the hospital, the medical side of the progress of maternal labor lack of comprehensive, meticulous observation and monitoring. The woman was admitted to the hospital to closely observe the labor process, the results of the examination recorded in a timely manner, the contraction, fetal heart and mouth dilatation and fetal head descent, etc., need to be comprehensive, meticulous observation and monitoring, found abnormalities as soon as possible to deal with. In this case, the doctor lacked comprehensive and careful observation and monitoring of the labor process, incomplete monitoring of contractions and fetal heart rate, incomplete monitoring of maternal heart rate and blood pressure, so it is difficult to diagnose and deal with the possible presence of excessive contractions in the labor process.
The condition of amniotic fluid embolism develops rapidly, and once amniotic fluid embolism is suspected in clinical practice, it is necessary to give immediate treatment of anti-shock, anti-allergy, prevention and treatment of DIC, and alleviation of pulmonary arterial hypertension. The drugs of choice for resuscitation are glucocorticosteroids and opioid hydrochloride. In this case, with fetal heart deceleration and persistent non-recovery, the physician had considered the possibility of atypical amniotic fluid embolism, but the physician did not give reasonable medication according to the treatment plan and principles of amniotic fluid embolism. For example, they did not use hormonal drugs according to the norms, and they did not use drugs to relieve pulmonary hypertension, such as popivarine hydrochloride.
The contraction of hysteronin and xinmupe will promote the contraction of the uterus, and when the uterus contracts, it will send amniotic fluid into the blood circulation of the mother again, and the medical party will consider the possibility of amniotic fluid embolism in the preoperative and intraoperative cesarean section surgery. However, the medical party has used the contraction of hysteronin and xinmupe, and has continuously massaged the uterus, and when the uterine contraction is still poor, the use of xinmupe again will make the uterine blood sinus and the venous amniotic fluid enter into the blood circulation of the mother again and aggravate the amniotic fluid embolism, so that it can be used again. This will cause the amniotic fluid in the uterine sinuses and veins to re-enter the mother's blood circulation and aggravate amniotic fluid embolism.
When amniotic fluid embolism occurs, when the mother is hemorrhaging, it is necessary to check the coagulation function in time and give active supplementation of blood volume and coagulation factors, and if the bleeding cannot be stopped after active treatment, hysterectomy should be performed. In this case, when considering amniotic fluid embolism several times, the doctor did not check the coagulation function of the mother in time, and did not replenish the blood volume and coagulation factors in time, and the doctor did not carry out hysterectomy in time when the mother suffered hemorrhage during and after cesarean section and there was no significant improvement after treatment.
Heparin can be used to prevent and treat DIC in women with amniotic fluid embolism, but it is still controversial. It is generally recommended to use it during the hypercoagulable phase, but when it is found to be in the phase of ablative hypocoagulability or even later, it is not recommended to use heparin. In this case, the woman was already hemorrhagic and heparin should not be used, but should be supplemented with blood and coagulation factors.
V. Court decision
With reference to the appraisal opinion, taking into account the urgency of the maternal condition, individual differences and medical fault, the court decided that the defendant should bear 50% of the compensation responsibility for the plaintiff's losses. on April 9, 2019 the court ruled that the defendant, the first hospital of city x, compensated the plaintiff for the various damages *** totaling 627,926.69 yuan within ten days from the date of entry into force of the present judgment. .
VI. Summary
The lack of comprehensive and meticulous observation and monitoring of the progress of labor, do not rule out the possibility of contraction induced amniotic fluid embolism, maternal illness after the diagnosis and treatment of amniotic fluid embolism is not standardized, which aggravates the condition of the mother, so that to a certain extent, the mother lost the chances of survival. Amniotic fluid embolism is a rare but dangerous obstetric complication, with rapid clinical progression, extremely rapid development, difficult rescue and high mortality. In this case, amniotic fluid embolism may have occurred in the first stage of labor at the time of rupture of membranes, with atypical symptoms at the time of occurrence, and it cannot be ruled out that the mother had a hypersensitive body, and the condition progressed rapidly and severely, which made it more difficult for the doctor to diagnose and treat her.
References 1. Medical dispute: complete placenta praevia induced labor, not standardized treatment of placental remnants resulting in hysterectomy. 2. Medical dispute: maternal cesarean section of pulmonary embolism after death, medical behavior there is fault hospitals need to assume responsibility. 3. Medical dispute: appendicitis in pregnancy was misdiagnosed as placenta previa, the cesarean section of the preterm baby died. 4.