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Objective To compare the clinical diagnoses with autopsy findings and evaluate the frequency of misdiagnosis.Methods The findings of 356 cases who were autopsied in our department due to medical treatment dispute during the period of 1988 to 2007 were retrospectively analyzed.The clinical diagnosis and autopsy findings,sex and age of the death,length of hospitalization,the hospital department,distribution of death disease and the rank of hospital were analyzed.The concordance between diagnosis before death and at autopsy was calculated.Results In 162 cases(45.5%),the autopsy findings confirmed the clinical diagnosis.In 101 cases(28.4%),the clinical diagnosis suggested by clinicians were discordant with the autopsy findings.In 63 cases(17.7%),some diagnoses made by clinicians were proved by autopsy,and in 30 cases(8.4%),the clinical and postmortem diagnosis were beyond comparison.The most frequently misdiagnosed diseases were from cardiovascular and respiratory diseases,and among them,cardiomyopathy,aortic atherosclerosis and pneumonia were most common.Conclusion Autopsy is not only helpful for the management of medical dispute,but also beneficial to reduce the misdiagnosis in clinical practice.
RESUMO
Objective:To compare and analyze the relevant factors on perinatal women and infants mortality which caused medical malpractice,impact on the cause of death were reviewed.Methods:A retrospective analysis on the cause of death about women and infants died in perinatal for medical malpractice.Material came from department of Forensic Medicine,Chongqing Medical University,2000～2009;a total of 120 cases,of which 72 cases of women,48 cases of infants.Statistics include:number of autopsy,cause of death,time of death,hospital situation,mode of delivery,prenatal diseases,clinical diagnosis and autopsy diagnosis in line and so on.Results:①Women and infantsdied in perinatalwhich caused medicalmalpracticemosthappened in firstdegreeand second degreehospitals;② All levels of hospitals'average rate of misdiagnosis about perinatal child was 77.1%,far higher than the women's team:40.3%;③Women died in perinatal which caused medical malpractice have a high average age:30.5 years old,and 65.3% of them were more than 28 years old;④Women died in perinatal which caused medical malpractice most were farmers and unemployed people,accounting for 62% and 17%;⑤75% of the women died in perinatal were in high-risk pregnancy,and the first three risk factors were pregnancy complications,pregnancy and childbirth abnormalities;⑥The first five factors leading women died in perinatal which caused medical malpractice were:postpartum hemorrhage,amniotic fluid embolism,severe infections,pulmonary artery and vein thrombosis,acute necrotizing pancreatitis;⑦The first four factors leading infant died in perinatal which caused medical malpractice were:lung factors,umbilical cord factors,placental factors and labor factors.The time from the birth process begin to 48 hours after birth is the peak of infant mortality,accounting for 77.1% of infant died in perinatal.Conclusion:Medical conditions,high-risk pregnancy and rescue are important factors for perinatal women and infant mortality.To improve medical conditions of first degree and second degree hospitals,and to enhance its ability of handling high-risk factors,postpartum hemorrhage,amniotic fluid embolism,and lung factors and umbilical cord factors of infant in perinatal is the key of reducing perinatal women and infants mortality;and also can reduce the incidence of medical malpractice in Chongqing area.