24
International scientific and practical conference "Current issues of fundamental medicine: today and in the future."
11/28/2024. TashPMI 100140 Uzbekistan Tashkent st. Bogishamol 223
FORENSIC MEDICAL ASSESSMENT OF MEDICAL CARE IN OBSTETRIC
PRACTICE
D.B.Radjabova, M.F.Elieva
Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
Relevance:
In forensic medical practice, solving the problem of defining the concept of medical error
is necessary to distinguish offenses from the so-called "permissible professional errors in medical
activity." It is quite understandable that most manufacturers of medical services attribute medical errors
to purely medical concepts, and therefore they say that it is impossible to bring medical workers to
criminal responsibility for professional mistakes. At the same time, for many years in the works of
forensic doctors and lawyers, the concept of "medical error" has been so contradictory that it did not
contribute to an objective study of this phenomenon.
Based on the generally accepted characteristics of medical error in the production of medical services,
objective and subjective reasons for their formation should be distinguished. Specialists should
understand that the objective causes of medical errors are due to a significant group of external factors.
As for the subjective causes of the latter, they depend on a great many internal factors. From the point of
view of the analysis of external factors that are the causes of medical error, this is, first of all, the activity
of a medical worker committed under the influence of various circumstances. This activity is expressed
in deviation from the rules of work provided for by special acts and instructions (organizational and
technological standards - procedures and protocols), which may entail or cause adverse consequences for
the patient. The possibility of making a mistake lies in wait for the doctor at all stages of medical care.
The purpose of the study:
To conduct a retrospective analysis of defects in the provision of medical
care in the practice of an obstetrician-gynecologist based on the materials of commission forensic medical
examinations, to study and evaluate the morphological parameters of internal organs at maternal death.
Research materials and methods:
Analysis of forensic medical examination conclusions of 19
stillborn infants dead in different periods at the Navoi regional branch of the scientific and practical center
of forensic medical examination of the Republic.
As a research method, an analysis of the pathomorphological indicators of their corpses was carried
out.
Research results:
The observations of the main group were represented by fetuses and newborns both
in physiologically occurring pregnancy and in various perinatal pathologies (congenital anomalies,
intrauterine infections, fetal developmental delay syndrome, chronic intrauterine hypoxia, fetuses from
multiple births).
The leading criterion for inclusion in this group was the absence of putrefactive changes and
pronounced maceration in the cadaverous material.
In order to study the degree of resistance of the histostructure of fetal organs to autolysis, organ
fragments from 23 stillborn fetuses with maceration of 2-3 degrees were additionally examined.
In each case, the submitted medical documentation was examined, including data from multiple
prenatal echophetometry. In each case, the afterbirth was examined. Studies of the afterbirth, fetal corpses
and newborns were conducted in accordance with generally accepted standards. The obstetric gestation
period (post menstrualis) was considered as the gestational age. In one newborn whose life expectancy
exceeded the perinatal period, postconceptual age was taken into account as an indicator of gestational
age.
Liver morphogenesis in the middle and late fetal periods was characterized by an increase in the
absolute volume of liver lobules against the background of progressive ingrowth of connective tissue
along the branches of the portal vein. The growth of the country was accompanied by the growth and
differentiation of the branches of the portal vein and hepatic artery, as well as the biliary system. The
most important feature of the development of the fetal liver was a progressive decrease in the activity of
its functioning as a pharmacological organ of hematopoiesis. Morphogenesis of the spleen in the same
period the period was determined by the fonnation and further differentiation of white and red pulp, an
increase in the volume of all stroma components. The noted qualitative nature of the development of fetal
organs allowed only an approximate assessment of gestational age and did not provide the necessary level
of objectivity and accuracy of its establishment, while the use of quantitative analysis made it possible to
25
International scientific and practical conference "Current issues of fundamental medicine: today and in the future."
11/28/2024. TashPMI 100140 Uzbekistan Tashkent st. Bogishamol 223
develop a rational methodology for determining gestational age.
Conclusion:
The liver and spleen are quite informative objects for determining the gestational age of
fetuses and newborns in forensic medical expertise and pathoanatomical practice. Morphometric
indicators of these organs, such as the hematopoietic activity of the parenchyma and the thickness of the
connective tissue capsule of the liver, have varying degrees of pronounced gestational dynamics, the
density and diameter of lymphoid nodules, the thickness of the walls of the central arteries and the capsule
of the spleen.
References:
1.
Хакимова, Гулноза Ахадиллаевна, and Лола Абдуллаевна Каратаева. "ПРОГНОЗИРОВАНИЯ
КИСТ ЯИЧНИКА В АСПЕКТЕ МОРФОЛОГИИ." Science and innovation 3.Special Issue 44
(2024): 204-208.
2.
Абидова, Н. А., Бегманов, С. А., Махкамова, Н. Х., & Базарова, Ш. Ю. (2019). К ВОПРОСУ
ПАТОГЕНЕЗА СОЧЕТАННОГО АТЕРОСКЛЕРОЗА. ББК 72я43 A 19, 131.
