Medicolegal aspects of Maternal Deaths due to Pulmonary Thromboembolism

Abstract

A state of hypercoagulability protects pregnant women from bleeding tendency which leads to pulmonary thromboembolism and results in medicolegal issues. Case 01 32 year old pregnant female who developed weakness of legs, and was suspected to have Spinal Tuberculosis. Lower Segment Caesarian Section was performed and Heparin was started as she was immobile. Vertebral surgery was performed and anticoagulants were stopped. She died due to sudden onset difficulty of breathing. Allegations of medical negligence were raised by the relatives at the autopsy. The autopsy revealed bilateral Deep Vein Thrombosis (DVT) and pulmonary embolism. Case 02 A mother who presented with a first trimester abortion and pain in right leg died following sudden onset shortness of breath. She also had a history of a previous first trimester abortion. Autopsy revealed an embolus in the pulmonary artery with swollen and congested right leg without DVT. CONCLUSIONS Case 01 Regarding the allegations of medical negligence, the legal authorities will consider whether the discontinuation of prophylactic anticoagulants before the 2nd surgery was a necessity and whether it was for the best interest of the patient. Case 02 Immunological syndromes and inherited thrombophilia could be considered as underlying causes for multiple first trimester abortions and Deep Vein Thrombosis. The Importance of performing the risk assessment of DVT when indicated is highlighted. Sri Lanka Journal of Forensic Medicine, Science & Law-December 2014-Vol.5 No.2; 20-22