围产儿死亡54例临床分析

为提高产科质量，加强围产期保健，现将我院15年中，54例围产儿死亡原因分析如下。临床资料妊娠28周至出生后周内，体重＞1000g，每1000个生产数中的死服、死产及新生儿死亡数为围产期死亡率。1979年2月～1993年12月，新生儿总数6169人，围产期死亡54例，围产期死亡率为8．8％。，其中死胎18人．占2．9灿，死产14人占2．3％。，新生儿死亡22人，占％O3．6渐。围产儿死亡情况见表1。麦1国产儿死亡情况表中示新生儿死亡率近5年已由《．9％o降为3·7％。。原因在于加强了产期的宣教，应用了B超、胎心监护仪等手段，密切注视孕期各项指标变化，…     

臀产围产儿死因分析

随着围产医学的兴起与发展,臀产围产儿死亡率已有大幅度下降,但臀位发生率仍较高,臀产仍为造成围产儿死亡的主要原因之一.充分了解及重视臀产的特殊性,合理选择分娩方式是降低臀产围产儿死亡率的重要途径.本文回顾分析我院臀产围产儿死亡病例,对围产儿死因及其有关问题进行探讨.临床资料我院自1954～1985年分娩总数为15030例,臀产403例,发生率为2.68%,低于国内文献报道,与驻北京地区六个部队医院联合报导的发生率2.92%接近.其中双胎16例,7例两儿均为臀位,一例3胎两儿为臀位,故婴儿总数为411,其中死胎4,死产11,新生儿死亡     

臀位的处理(附216例分析)

臀位为仅次于头位之常见胎位,国内邢淑洁报告南京鼓楼医院妇产科臀位收治率为2.4％,潘美兰报告贵州医学院妇产科臀位收治率为4.84％ 我院1972年至1981年住院分娩总数6,915例,臀位216例(双胎不计在内),发生率为3.12％。 文献报道臀位围产儿死亡高于头位4～10倍。我院同时期6,699例头位分娩,新生儿死亡32例,死亡率4.78％;216例臀位分娩围产几死亡12例,死亡率55.56％(包括死胎4例,2例严重先天畸形)。调正臀位围产儿死亡率27.78％,高于头位5.8倍。     

围产儿死亡88例死因调查分析

目的：探讨围产儿死亡原因，降低围产儿死亡率。方法：对我院1984－1999十六间围产儿死因进行回顾调查。结果；分娩总数6828人，围产儿死亡88例，死亡率12.88%。按其危险程度分析死亡原因，排在前三位的是畸开有、死胎、早产低体重。其他依次为：死产、窒息、颅内出血、吸入性肺炎、先心病及其他。结论：加强围产期保健，开展好围产儿死因调查工作，对降低围产儿死亡率，促进国产医学的发展 有很大的指导作用。     

围产儿54例死亡原因分析

目的 通过分析围产儿死亡原因,以进行防范,降低围产儿死亡率。方法 对１９９０年１月￣１９９９年１２月在我院分娩死亡的围产儿５４例进行回顾性分析。结果 十年来我院围产儿死亡率为８．０３％（３．１５％￣１２．５２％）,引起围产儿死亡的前５位因素为脐带因素、胎儿畸形、新生儿重度窒息、胎盘因素、早产。前后５年比较,本片及外片围产儿死亡数明显减少,外地围产儿死亡数有显增加。结论 提高孕妇自我保健意识,加强孕     

常住人口与流动人口围产儿死亡率分析

目的：了解和探讨常住人口与流动人口的围产保健现状。方法：对200l-2002年发生的围产儿死亡进行回顾性分析。结果：两年共分娩围产儿2116例，死亡52例；常住人口的围产儿死亡率8．2‰，流动人口围产儿死亡率28‰，两者有显著差异。流动人口围产儿死亡中，85．7l％未行系统产前检查。如果做好围产期保健，流动人口中不可避免的围产儿死亡率为8．57‰，与常住人口的平均水平相近似。结论：流动人口的围产儿死亡率明显高于常住人口的平均水平，主要原因是缺乏围产期保健和临产后未到医院分娩；加强对流动人口的管理，提高她们的围产保健意识，可以降低围产儿死亡率。     

西宁地区72例围产儿死亡病因分析

目的：通过分析西宁地区72例围产儿死亡原因,从而提高国产保健工作质量,进一步降低围产儿死亡率。方法：收集2000年4月-2008年12月72例死亡围产儿临床资料,分析围产儿死亡的原因,了解围产儿死亡的影响因素。结果：导致围产儿死亡的主要并发症及死因为早产、胎儿畸形、妊娠并发症。死胎中以畸形、脐带因素为主,新生儿以RDS（肺透明膜病）、肺出血及窒息综合症为主。结论：加强孕期监护、预防早产、窒息和感染、加强产科和新生儿科的合作、防止并发症发生,是降低围产儿死亡率的主要措施。     

如何减少和预防死胎

围产死亡率是由死胎,死产,新生儿死亡率三类所组成。其中新生儿死亡率已随着新生儿特别护理单位的建立以及医疗护理质量的改进和提高而下降;在产程图理论的指导下,通过积极正确的处理产程、及早发现和治疗胎儿宫内窒息,及时采取最佳方案终止妊娠而使死产率减少。唯有死胎这一类围产儿死亡,绝大多数是在入院前的不同阶段出现胎动消失后才入院的,未能得到医务人员的监护和治疗的结果。本文通过对死胎原因的分析,以达到进一步降低围产死亡的目的。     

青海省出生缺陷监测的研究

本组自１９８６年１０月～１９９２年９月在青海省２２所医院内进行６年出生缺陷动态监测、共监测围产儿６８９３２例，检出畸形儿６８４例，出生缺陷发生率９．９２‰，城市发生率１１．０１％，农村发生率９．４１‰，牧区发生率７．４８‰。自１９８６年开始动态监测、出生缺陷发生率逐年下降，由２２．６６‰下降至５．２９‰（１９９２年）。出生缺陷发生顺位：第一，领面部、畸形１９５例占２８，６％，其中唇裂、腭裂１１０例居多数；第二，中枢神经系统畸形１７６例占２５．８％；第三，肌肉骨骼系统畸形１６９例占２４．８％；第四，泌尿生殖系统畸形４２例占６．２％；第五，消化系统畸形３４例占４．９％，末组有６种畸形发生率最高，依次为①唇裂、腭裂；②多指（趾）；③脑积水；④马蹄内、外翻；⑤无脑儿；⑥开放性脊柱裂。本组围产儿死亡１５８例，死亡率２３０．９９‰。     

围生儿死亡52例原因分析

目的:研究围生儿死亡原因,降低新生儿的死亡率和伤残率。方法:对52例围生儿进行尸解做评定分析,按常规系统地进行大体肉眼检查及脏器组织病理切片检查。结果:新生儿主要死因是肺透明膜病和出身缺陷。死胎、死产主要是胎盘因素和出身缺陷。结论:围生儿病理检查是诊断围生儿死亡最佳手段,针对死亡原因,结合临床表现,促进临床早期诊断,为临床提供有价值的信息。     

Analysis of cases of forensic veterinary opinions produced in a research and teaching unit

The aim of the study was to present the results of necropsies carried out in the years 2000–2014 in the Department of Pathological Anatomy, Faculty of Veterinary Medicine, University of Life Sciences in Lublin.The material used for the analysis consisted of expert opinions prepared on the basis of a decision by a judicial body to admit an expert opinion as evidence.An increase was observed in the demand for the services of veterinary forensic experts, beginning in 2006 and persisting through 2014. The response to the growing popularity of veterinary forensic examinations should be systematization of knowledge and exchange of experience, which would enable the further development of this interdisciplinary science.     

Accuracy in certification of cause of death in a tertiary care hospital – A retrospective analysis

Every physician is duty bound to issue a “Cause of Death” certificate in the unfortunate event death of his/her patient. Incomplete and inaccurate entry in these certificates poses difficulty in obtaining reliable information pertaining to causes of mortality, leads to faulty public health surveillance, and causes hindrance in research. This study intends to evaluate the completeness and accuracy of Medical Certification of Cause of Death in our Institute and to formulate strategy to improve the quality of reporting of cause of death. During the period from January 2012 to December 2012, a total of 151 certificates of cause of death were issued by the faculty members of various departments. Maximum number of death certificates were issued for patients in the extremes of the age <10 years (n = 42, 27.82%) and in >60 years (n = 46, 30.46%). The various inadequacies observed by us are as follows: 40 (26.49%) cases had inaccurate cause of death, interval between onset and terminal event was missing in 94 (62.25%) cases, in 68 (45.03%)cases the seal with registration number of the physician was not available on the certificate, incomplete antecedent & underlying cause of death was found in 35 (23.18%) & 84 (55.63%) cases, in 66 (43.71%) cases there was use of abbreviations and the handwriting was illegible in 79(52.32%) cases.     

Exchanged identities in a complex multiple homicide case. Identification and cause of death

We report a multiple homicide in Angola involving six Portuguese citizens. Immediately after the crime, four bodies were retrieved from the homicide site. Forensic autopsies were allegedly performed by local doctors and three bodies were transferred to Portugal, where they were buried with no extra expertise, presumably identified only by the examinations carried out in Angola. The two remaining bodies, presumably from sub-adults, were only discovered 1 year later. At that time, some bone samples of these two corpses were sent to Portugal. A multidisciplinary team of the National Institute of Legal Medicine (NILM) in Portugal, including forensic anthropologist and pathologists, and forensic geneticist, found out that the bodies were previously misidentified. In fact, the anthropological and genetic examinations on the remains of the two persons showed that they did not belong to a child and an adolescent but instead to two adult victims, at least one of them was supposed to be buried in Portugal since 1 year. The verification of this misunderstanding led to a series of exhumations, of the three victims previously buried in Portugal. In all, the identities were reconstructed and the cause of death could be established in four of them. A multiplicity of severe traumatic cranial injuries were detected, which were, undoubtedly due to a violent death.     

道路交通伤院内死亡分析

目的 探讨道路交通伤院内死亡原因和流行病学特点。方法 统计分析１９８１年１月￣１９９６年１２月我院收治路交通伤院内死亡病例的致伤方式,部位和创伤严重等特点,对死亡时间与原因的关系行Ｒｉｄｉｔ分析,结果 交通伤院内死亡伤员年龄较大,农民所占比例明显上升;致伤方式多为机动车肇事;颈椎和腹部致伤比较常见;死亡原因依伤后时间不同而有明显区别,据此可将其病程分为脑损伤休克期（急性期）、过渡期,感染期和多脏器     

Medical death certification by forensic physicians in the Netherlands: Validity and interdoctorvariation

The aim of the study was to assess interdoctorvariation and validity in death certification by forensic physicians using 19 written scenarios. The scenarios described typical cases from forensic-medical practice. Physicians were asked to determine the manner of death (natural/unnatural) and to provide an ICD-10 code for the cause of death. In contrast to most studies on this topic, the measure of agreement among physicians was chance-corrected and a standard was used to assess the correctness of the assigned cause and manner of death. Forty-seven physicians participated in the survey. The study demonstrated that forensic physicians varied widely in their conclusions. With respect to manner of death, adequate agreement (defined as kappa>0.70) was achieved in six scenarios (32% of all scenarios). Concerning the underlying cause of death, adequate agreement was reached in three cases (16% of all scenarios). Furthermore, predictors for the correctness of manner and cause of death were studied using logistic regression. Years of experience as a forensic physician significantly predicted the correctness of cause of death (p < 0.05). Other predictors remained insignificant. With regard to manner of death, none of the studied predictors proved to be significant. To conclude, there appears to be a lack of consistency among forensic physicians regarding death certification. The ICD-10 coding of causes of death applied by forensic physicians is questionable. Less experienced physicians need supervision by more experienced colleagues when making judgments concerning the cause of death. Altogether, there is an urgent need to work out consensus-based guidelines for forensic physicians on how to certify deaths.     

The incidence of iatrogenic deaths in the Finnish cause-of-death statistics; a retrospective study

PurposeAn adverse event in health care leading to death is a significant event when assessing patient safety. This study was designed in order to assess, how many iatrogenic deaths are registered in Finland annually, and what type of treatment they are mostly related to.MethodsMaterial was collected using cause of death-statistics that includes “manner of death”-classification in Finland in 2014–2015.ResultsThere were 350 cases that met the criteria of the study. In a majority of the cases (264, 75%), a medico-legal autopsy was performed. This represents only 1.4% of all medicolegal autopsies during the study period in Finland. The cases were most often related to medication (30%) or known high-risk procedures such as gastrointestinal surgery (23%) and cardiothoracic surgery (11%). Only 12% of the cases had no prior significant medical history. Patient characteristics were somewhat different among the surgical disciplines, probably reflecting treatment practices.ConclusionDeaths that are classified as iatrogenic are mostly related to known high-risk surgery or medication. Further studies are needed to assess the true incidence of malpractice among this material.     

Medicolegal study of Egyptian suspicious childhood deaths during 2020–2021

BackgroundPediatric autopsy is an effective tool for identifying the cause and the manner of death in suspicious childhood deaths.Aim of the studyTo explore the pattern of suspicious childhood deaths during the recent years (2020–2021) in the Egyptian community and to identify the risk factors to avoid them during the childhood period.Subjects and methodsOne hundred and fifty Egyptian suspicious child death cadavers (less than 18 years old) were autopsied in Zeinhom Morgue during one-year period (2020–2021). Demographic data, circumstances of death, causes and manner of death were defined and statistically analyzed.ResultsIdentity was known in 77.3% of the studied cases, and male to female ratio was 2.2:1. Most of cases were recruited from Cairo and Giza governorates. Adolescents contributed to about one third of the cases. Deaths at home or in hospital were more than outdoor deaths. Seasonal variation was observed as more cases were autopsied during spring and summer. Homicidal deaths (32%) were more in toddlers and adolescents mostly by blunt trauma (58.3%) with signs of violence and resistance or child abuse, mainly in males. The perpetrator was known to be a family member in more than half of the studied cases (56.25%). Accidental deaths (17.3%) were mainly by firearm injuries or poisoning. Suicidal deaths (13.3%) were represented more in adolescents by hanging or by aluminum phosphide poisoning. Natural deaths (13.3%) by bronchopneumonia or leukemia were found in neonates and adolescents. Sudden infant death syndrome (SIDS) (6.7%) was diagnosed by exclusion among neonates and infants only during spring, with equal gender distribution (1:1). Malpractice (6%) leads to death by sepsis or hemorrhage.ConclusionsAll manners of death contribute to suspicious death during childhood period, especially during summer and spring. Family members are the perpetrator for most of accidental, homicidal or suicidal deaths.RecommendationsTraining courses are recommended to parents for proper care and protection of their children to avoid violence, abuse and accidents at home or outdoor.     

Fatal poisonings in Jutland (Denmark) during the 1980s

Summary During the period 1980 through 1989 a total of 1029 cases of fatal poisoning (638 men and 391 women) were examined at the Department of Forensic Medicine, Aarhus University, Denmark. In 68% of the cases death had been caused by drugs, whereas acute alcohol poisoning and carbon monoxide accounted for 15% and 14% of the cases, respectively. Alcohol was detected in more than half of the 1029 fatal poisoning cases, and in 42% of all cases the blood alcohol concentration was above 0.8 g/kg. In 57% of the cases death was categorized as accidental, only in 31% of the cases as suicide. Accidental deaths were especially predominant amongst drug and/or alcohol abusers. Propoxyphene was the drug found to have caused most fatal poisonings during the decade (30% of the drug-related deaths). Most of the propoxyphene-related deaths occurred during the early and mid-eighties. Barbiturate poisonings were quite frequent during the first half of the eighties. However, the number of deaths caused by barbiturates decreased significantly after 1986, when most barbiturates were withdrawn from the market. The number of deaths caused by narcotics and analgesics increased during the survey period, while no specific tendency was observed concerning antidepressants.     

Cytokinetics of epidermic cells in skin from human cadavers

Summary Punch biopsies taken from the extensor side of the thigh of 35 human cadavers were incubated in vitro with radioactively labeled thymidine (³H-thymidine=³H-TdR, ¹⁴C-thymidine=¹⁴C-TdR) to determine whether a relationship exists between changes in the proliferative activity of the skin and the postmortal interval after irreversible cardiac arrest. The cadavers were stored at 4°C. Cadavers with indeterminable time of death or presence of intoxication, drug therapy with cytostaic agents, or a skin disease were excluded from the study. Single, double, or multiple biopsies were performed on the same cadaver; single labeling with ³H-TdR was done in all cases; double labeling with ³H-TdR and ¹⁴C-TdR in selected cases.No relevant changes in the labeling index (mean, 2.39±1.03%) were demonstrable within the examined postmortal interval of 77.75h. The DNA synthesis time (t _s) was, on the average, 4.75±1.44h; a certain relationship to the postmortal interval existed since t _s declined with increasing storage time. The potential doubling time (t _pot) decreased accordingly, beginning with 181.7h (mean storage time, 29.9h) and ending with 137.7h (mean storage time, 41.7h). No statistically relevant differences, however, were established at the 1% level. Whereas both labeling index and t _pot during the early postmortal interval are comparable with observations in live humans, t _s was relatively short as compared to that for the epidermis of live humans.Dedicated of Professor Dr. G. Dotzauer on the occasion of his 75th birthday