Medicolegal aspect of maternal deaths in Assiut Governorate

Abstract

Background In obstetric practice, most allegations against obstetrician–gynecologists relate in some manner to the management of labor and delivery; few solely involve perceived flaws in prenatal or postpartum care.Objective To evaluate the incidence and causes of maternal deaths and to evaluate the role of medical malpractice leading to maternal deaths in Assiut Governorate.Patients and methods Women delivered at Al-Azhar University Hospital during a 6-month period in 2013 and women delivered in the period extending from 2005 to 2010 in Assiut Governorate as documented by the local Medicolegal Department of the Ministry of Justice were the subjects of this study.Results Among 2556 women delivered in a 6-month period, two women died, representing a maternal mortality rate of 0.078% (a maternal mortality ratio of 78/100 000 live birth). Antepartum hemorrhage and postpartum hemorrhage were the reported causes in a case each. We also studied 50 maternal deaths referred to local Medicolegal Department of the Ministry of Justice owing to medicolegal claims. We found that the chronic hypertension was the most commonly reported morbidity (20.0%) followed by severe anemia (18.0%), diabetes mellitus (8.0%), epilepsy (2.0%), and deep vein thrombosis (2.0%). More than two-thirds (68.0%) of them had antenatal care, whereas the remainder (32.0%) did not receive it. Regarding the neonatal outcome in the studied women, we found that in 34 (68.0%) cases, women delivered a live mature baby, whereas in 15 (30.0%) cases, fetal death occurred, and in one (2.0%) case, the delivered newborn was macrosomic. In all cases, there was a civil liability. Negligence was the commonest cause (42.0%) followed by misdiagnosis (30.0%) and delayed treatment (28.0%). Regarding the qualification of the service provider, we noted that those with master qualification came on the top (52.0%) followed by general practitioners (18.0%) and diploma holders (12.0%). In 44.0% of cases, delivery took place in governmental hospital, whereas in 32.0% of cases was in health unit and in 24.0% of cases was in private clinic. In our study, surgical specialties accounted for 31.0% of claims followed by obstetrics (25.0%), anesthesia (17.5%), internal medicine (14.5%), and pediatrics (12.0%).Conclusions In the present study, we reported a maternal mortality rate of 0.078% (maternal mortality ratio of 78/100 000 live birth). With respect to the type of liability in the studied women, we found that in all cases, there was civil liability.