產婦早期破水違反注意義務判賠事例【寰宇醫事裁判】 試閱
Case of Compensation Awarded for Breach of Duty of Care in Premature Rupture of Membranes
本件為日本浜松市某綜合醫院於早期破水產婦分娩過程的醫療過失，導致新生兒A周產期窒息，留下重度腦性麻痺等後遺症。A及其父母基於診療契約的債務不履行及不法行為，向被告醫院求償。根據被告醫院提出的嚴重不良事件報告書， A母因早期破水引起絨毛膜羊膜炎及子宮內感染，乙型鏈球菌感染又使病程惡化、併發敗血症，催產素的持續投與使宮縮過於頻繁或過強，進一步加重病情。但由於胎心監測數據不明，無法確定A心跳減慢的起始及持續時間。最終，法院認為當胎心監測顯示胎兒處於長期缺氧狀態，子宮收縮頻率已增至可被評估為頻繁收縮的程度，若分娩進展與速度無法支持早期自然分娩，並伴有早期破水及發燒等臨床表現，即便不完全符合絨毛膜羊膜炎等診斷基準，也應認識到感染可能性，謹慎管理，於緊急情況立即施行剖腹產，否則將構成醫療過失。
The issued case pertains to an instance of medical malpractice that occurred during the delivery of a patient with premature rupture of membranes at a general hospital in Hamamatsu City, Japan. This incident resulted in neonatal asphyxia and subsequent severe cerebral palsy. A and parents initiated legal proceedings against the defendant hospital, seeking compensation for breach of contract and tort. As indicated in the hospital’s report on serious adverse events, the mother exhibited symptoms of chorioamnionitis and intrauterine infection as a consequence of premature rupture of the membranes. The patient’s condition was further exacerbated by a Group B Streptococcus (GBS) infection, leading to sepsis. The continuous administration of oxytocin resulted in excessive or overly strong uterine contractions, thereby exacerbating the patient’s condition. However, the presence of unclear cardiotocography (CTG) data hindered the confirmation of the onset and duration of A’s decelerated heart rate. The court ultimately determined that in instances where CTG indicated an increase in fetal hypoxia and uterine contraction frequency to a level that could be assessed as frequent contractions, and if labor progression and speed could not support early spontaneous delivery, and in the presence of clinical manifestations such as premature rupture of membranes and fever, even if the diagnostic criteria for chorioamnionitis were not fully met, there was a strong indication for the recognition of infection. Caution should be exercised in management, with immediate emergency caesarean section being performed. Failure to do so constitutes medical negligence.
064-078
