Muniraman Hemananda, Cascione Miranda, Ramanathan Rangasamy, Nguyen Jimmy
a Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC + USC Medical Center, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA.
b Center for Fetal and Neonatal Medicine, Division of Neonatal-Perinatal Medicine , Children's Hospital Los Angeles, University of Southern California , Los Angeles , CA , USA.
J Matern Fetal Neonatal Med. 2018 Aug;31(15):2043-2049. doi: 10.1080/14767058.2017.1335704. Epub 2017 Jun 8.
The management of expectant mothers and infants born at the threshold of viability is challenging. We describe medicolegal cases from a major United States legal database involving periviable births in an effort to identify areas for improvement.
We conducted a retrospective review of all United States state and federal cases in the Westlaw database from 1980 through 2016 involving peripartum and immediate post-delivery management of infants born between 22 0/7 and 25 6/7 weeks' gestation.
Our search criteria returned 736 results, and 15 cases met full inclusion criteria. Eight cases involved conflicts on resuscitation contrary to parental directives. Eleven cases comprised alleged miscommunication between families and providers. Of these, seven cases alleged inadequate prenatal counseling of infant's chances of survival and neurological outcome, whilst four cases alleged miscommunication of infant's condition post-delivery.
Miscommunication between providers and families during prenatal counseling and after birth was a major component of malpractice cases regarding infants born at the threshold of viability. The infant's immediate post-delivery condition and long term prognosis were of primary interest to parents, and improving effective communication may aid toward more genuinely informed resuscitation directives.
对处于可存活临界状态的孕妇及出生婴儿进行管理颇具挑战性。我们描述了来自美国一个主要法律数据库的涉及接近可存活孕周出生婴儿的法医学案例，以确定有待改进的领域。
我们对Westlaw数据库中1980年至2016年期间所有涉及孕周在22 0/7至25 6/7周之间出生婴儿围产期及分娩后即刻管理的美国州和联邦案例进行了回顾性研究。
我们的搜索标准返回了736个结果，15个案例符合完全纳入标准。8个案例涉及违背父母指令进行复苏的冲突。11个案例包括家庭与医疗服务提供者之间所谓的沟通失误。其中，7个案例称产前关于婴儿存活几率和神经学预后的咨询不足，而4个案例称分娩后婴儿状况的沟通有误。
产前咨询期间及产后医疗服务提供者与家庭之间的沟通失误是涉及接近可存活孕周出生婴儿医疗事故案例的一个主要因素。婴儿出生后的即刻状况和长期预后是父母主要关心的问题，改善有效沟通可能有助于做出更真正明智的复苏指令。
