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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2018; 78(02): 153-159
DOI: 10.1055/s-0043-120446
GebFra Science
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Pregnancy-associated Death – Clarifying the Cause of Death and Medico-legal Assessments in Accusations of Malpractice

Article in several languages: English | deutsch
Reinhard Dettmeyer
1   Institut für Rechtsmedizin, Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Gießen, Germany
,
Juliane Lang
1   Institut für Rechtsmedizin, Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Gießen, Germany
,
Rainer Amberg
2   Facharztpraxis für Rechtsmedizin Freiburg, Freiburg, Germany
,
Barbara Zedler
1   Institut für Rechtsmedizin, Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Gießen, Germany
,
Ronald Schulz
3   Institut für Rechtsmedizin, Westfälische Wilhelms-Universität Münster, Münster, Germany
,
Christoph Birngruber
1   Institut für Rechtsmedizin, Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Gießen, Germany
› Author Affiliations
Further Information

Publication History

received 19 July 2017
revised 26 August 2017

accepted 26 September 2017

Publication Date:
19 February 2018 (online)

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Abstract

Background Pregnancy-associated deaths are extremely rare in Germany. Most deaths are from natural causes, and a range of causes are possible.

Method The deaths of 22 women who died of pregnancy-associated causes and who were autopsied in the Institute of Forensic Medicine of Justus-Liebig University Gießen between 1992 and 2016 were analyzed.

Results The autopsy results and histological examinations for the majority of women who died of pregnancy-associated causes between 1992 and 2016 showed that they had died of natural causes, although complications of pregnancy were a leading cause of death.

Conclusion The death of a pregnant woman should not automatically raise the suspicion of malpractice, although the question does arise in cases of bleeding complications only detected at very late stages. Experts must prove that a real mistake was made during treatment and provide evidence of the causality between malpractice and patient death. Particularly when well-known complications of pregnancy were present, this is only the case if poor monitoring resulted in the complication being detected too late or if treatment was not in accordance with accepted standards of care. The majority of pregnancy-associated deaths are from natural causes and the death of a pregnant woman does not mean that medical malpractice was involved, although this accusation is often levelled in cases where rupture was not immediately diagnosed or in cases of fatal postpartum hemorrhage.

Key words

miscarriage - ectopic pregnancy - HELLP syndrome - pregnancy
 

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