死产案件中开展多专家委员会法医鉴定时组织形态学研究的作用

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论证：俄罗斯联邦侦查机关在开展与产科医疗救治质量不佳相关的核查措施和刑事案件侦查时，其程序方法中包括委托实施由多名专家共同进行的委员会法医鉴定。对归档尸体解剖材料和胎盘实施法医组织学检查，是根据案件材料在胎儿宫内死亡案件中开展多专家委员会法医鉴定的重要环节。

目的：分析死产案件中的多专家委员会法医鉴定，并根据现代科学观点明确对归档尸检材料和胎盘进行法医组织学检查的必要性。

方法：在俄罗斯Stavropol Krai “Territorial Bureau of Forensic Medical Examination”复杂鉴定科的档案库中，开展了一项单中心、横断面、抽样的观察性研究。纳入标准为：在产前期和产时胎儿宫内死亡案件中开展的多专家委员会法医鉴定。

结果：纳入研究的胎儿宫内死亡案件多专家委员会法医鉴定共有68例（n=68），时间范围为2015年1月1日至2022年12月31日。其中，79.4%（n=54）由俄罗斯联邦侦查委员会侦查员委托，16.2%（n=11）由俄罗斯联邦内务部所属部门的侦查员/调查员/刑警委托，4.4%（n=3）由法官委托。在86.7%的案件中，此类鉴定是在核查材料框架内开展的。死产原因中，57.4%（n=39）为产前期胎儿死亡，39.73%（n=27）为产时胎儿死亡，2.9%（n=2）为先天性发育异常。在胎儿宫内死亡案件的多专家委员会法医鉴定中，97.1%（n=66）的病例中，法医组织学专家对尸检材料和胎盘进行了法医组织学检查。

结论：分析表明，39.1%的产科—妇科方向多专家委员会法医鉴定与死产相关。为提高此类鉴定的质量，有必要对尸检材料和胎盘进行法医组织学检查。完善死产案件中多专家委员会法医鉴定的方法学，是法医专家、病理解剖学家、产科医生及新生儿科医生跨学科合作的一项重要任务。

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作者简介

Margarita V. Berlay

The Russian National Research Medical University named after N.I. Pirogov

编辑信件的主要联系方式.
Email: berlay_mv@mail.ru
ORCID iD: 0000-0002-5809-8480
SPIN 代码: 3676-6025

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Moscow

Evgeny M. Kildyushov

Stavropol State Medical University

Email: kem1967@bk.ru
ORCID iD: 0000-0001-7571-0312
SPIN 代码: 6412-0687

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Stavropol

Ilya I. Fedko

Stavropol State Medical University

Email: fedkoi@mail.ru
ORCID iD: 0000-0002-7314-1221
SPIN 代码: 8015-3062

MD, Cand. Sci. (Medicine), Assistant Professor

俄罗斯联邦, Stavropol

Horen A. Avanesyan

Stavropol State Medical University

Email: avanesyan-1983@inbox.ru
ORCID iD: 0000-0002-8039-7612

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Stavropol

Vera N. Borschevskaya

Stavropol State Medical University

Email: vera.borshhevskaya@bk.ru
ORCID iD: 0000-0002-9798-2607
SPIN 代码: 7767-5112

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Stavropol

Elena A. Zolotukhina

Stavropol State Medical University

Email: zolotykhina.alena2015@yandex.ru
ORCID iD: 0009-0005-4969-9232
俄罗斯联邦, Stavropol

Sergey M. Karpov

Stavropol State Medical University

Email: karpov25@rambler.ru
ORCID iD: 0000-0003-1472-6024
SPIN 代码: 3890-9809

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Stavropol

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2. Fig. 1. Antenatal death of the fetus at 30 weeks of gestation. The duration of intrauterine death is 7–10 days: a — histological preparation of the kidney (stained with hematoxylin and eosin, magnification ×40): pronounced tissue autolysis, the nuclei of the cells of the proximal and distal tubules are not outlined, the capillary loops of the glomeruli are collapsed; b — histological preparation of the liver (stained with hematoxylin and eosin, magnification ×40): pronounced autolysis of the parenchyma, the beam structure of the lobules is not visible, hepatocytes are in a granular-lumpy mass, their nuclei are not outlined.

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3. Fig. 2. Antenatal death of the fetus at 37–38 weeks of gestation. Histological preparation of the placenta (stained with hematoxylin and eosin): a — magnification ×100, basal deciduitis (black arrow), retroplacental hematoma due to placental abruption (white arrow); b — magnification ×400, segmented leukocytes are visible among the cellular infiltrate (white arrows).

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