[The medico-legal risk in obstetrics. What has been learned from studying 340 files on accidents (author's transl)]. / Le risque médico-légal en obstétrique. Les enseignements de l'étude de 340 dossiers d'accidents.

The authors, from perusal of 340 files where accidents in obstetrics were reported, have classified the medico-legal risks in pregnancy, wether the accidents gave rise or did not give rise to claims for responsibility. These accidents occurred between 1950 and 1978 and they happened during and after delivery. The classification shows up the most dangerous situations for the specialist and points out the factors that increase this risk so that systematically a preventive attitude can be taken to avoid claims, whether they are made under criminal or civil procedures. Particularly detailed have been statistical risks which are increasing continuously in association with instrumental deliveries and with the large indicence of Caesarean operation. After they have listed all the clinical forms of medico-legal risk picked out by counsel so that they can be avoided or their effects reduced, the authors have attempted to define the responsibility that the gynaecologist-obstetrician takes at present in the midst of his team that is always increasing in number. Among these are paediatricians, anaesthetists and resuscitators, midwives, nurses who give anaesthetics and all the para-medical team who have specialised responsibility which depends more or less on the needs of the gynaecologist-obstetrician. The medico-legal risks which are linked with a deficiency in premises, numbers of personnel and quality and quantity of equipment have been singled out with a relatively small balance of the characteristics of those who carried out the procedures recorded in a large series of files which are already old and which for the most part have been docketed so that they could be used without revealing any professional secrets nor legal secrets.

[Spontaneous rupture of the liver in pregnancy. Case study and review of the literature]. / La rupture "spontanée" du foie au cours de la grossesse. Etude d'un cas et revue de la littérature.

The authors report a case of "spontaneous" rupture of the liver in a woman of 35 years of age. This occurred immediately after post-partum eclampsia. It was not possible to obtain complete haemostasis using absorbable haemostatic compresses along the convexity of the liver. Complete cessation of bleeding only occurred after the operation when posterior pituitary abstracts had been transfused. The patient died 53 days after the initial procedure from a high gastro-intestinal haemorrhage. A study of the literature shows that this rare condition is most probably a complication of toxaemia of pregnancy but the physio-pathology of these liver lesions is ill-understood. The clinical picture is in two phases--the first corresponds to the formation of a sub-capsular haematoma and the second to the intra-peritoneal rupture of this haematoma. The prognosis for this condition is poor, the maternal mortality ranging from 56%-75%. The prognosis is linked to the speed with which the diagnosis is made and surgical intervention is carried out. This should be done before the capsule of the liver ruptures. Haemostasis is nearly always best obtained by using haemostatic compression with packs but haemostasis is not always adequate, particularly if there are several lesions in both lobes of the liver. This case history shows that using posterior pituitary abstracts in transfusion can be helpful.