In the Sverdlovsk region, the court put an end to the high-profile case of the tragic death of a 22-year-old woman who died shortly after giving birth in a hospital in the city of Nizhny Sergi. Anna Malikova, who at that time was the acting head of the obstetric and gynecological department of the city hospital, was accused of the fact that her patient died as a result of a medical error. But the court found that there was no corpus delicti in the doctor's actions and the woman died through no fault of her. However, some episodes of this case leave questions that were not answered during the trial. The incident raised doubts about the reliability of the regional health care system, and a court ruling hardly helped remedy the situation. Lenta.ru correspondent Igor Nadezhdin understood the details of the high-profile case.
22-year-old Alisa Tepikina, a resident of the city of Nizhnie Sergi, did not tolerate pregnancy very well: in November 2018, she had stitches in her uterus to avoid premature birth. Alice suffered from toxicosis, during pregnancy she gained a lot of weight, but she followed all the doctors' instructions.
According to the district gynecologist, she was supposed to give birth on March 3-5, 2019. On February 25, at 09:00, Alisa arrived at the Nizhneserginsk hospital in a planned manner.
At 09:30 Alice was placed an intravenous catheter, and at around 12:40 the stitches were removed and her water drained. Then she said that she was given an IV, after which she was forced to walk, despite the pain. At 03:52 Alice wrote to her husband that the disclosure was almost complete - and now they are waiting for the child's head to go down. This was the last message from her.
According to the birth history, at 05:00 Alice began to struggle, and at 05:50 she gave birth to a healthy baby girl weighing 3 kilograms 260 grams and 49 centimeters tall. As the doctors wrote, “the girl was born alive, full-term, with an umbilical cord entwined around the leg, torso and neck. She screamed at once. But it is from the moment of birth that strange things begin in this matter.
As the representative of the victims, a lawyer and an anesthesiologist-resuscitator Vadim Karataev, explains in an interview with "Lenta.ru", after the birth of the child, the placenta must separate. Previously, in domestic obstetrics, it was believed that the afterbirth should come out on its own, and no later than 30 minutes later - this, they say, is less traumatic.
Anna Malikova, acting head of the obstetric and gynecological department of the Nizhneserginsk hospital, at the very first interrogation - still as a witness - told the investigators that the latter separated on its own at 06:00, but not completely - one half of it remained in the uterine cavity.
Both during the investigation and at the trial, Malikova argued that she did not try to extract the afterbirth in the case of Alisa Tepikina. However, according to the representative of the victims, lawyer Boris Chentsov, the only witness, a nurse, told investigators that Malikova pulled the last one with her hands.
According to Malikova herself, having found the afterbirth partially released, she immediately called the duty anesthesiologist Tashtanbaev. It was Tashtanbaev who was the first to suspect massive blood loss in the patient and began to insist on her transfer from the hospital to intensive care. But Malikova (namely, the obstetrician-gynecologist is considered the main one in the delivery room) categorically refused to follow this recommendation.
At 6:11 am (according to medical records), Dr. Malikova called the surgeon on duty Igor Torop. He immediately came to the delivery room and soon strongly advised his colleague to contact the obstetricians of the territorial Center for Disaster Medicine (TCMK) for consultation.
Malikova called the Center only at 06:33. The dispatcher immediately sent a team to Nizhny Sergi and gave the phone number of an obstetrician-gynecologist - Dr. Oleg Patsuk. While he was on the road, Malikova phoned him at least seven times.
From the moment of the first conversation with Dr. Patsuk, as almost all the witnesses explain, Malikova forbade anyone to approach the patient: “The doctors of the TCMK are going, they were forbidden to touch the patient,” she told everyone.
Meanwhile, at 07:35 on February 26, 2019, the head of the intensive care unit, Doctor Galina Medvedeva, a doctor with 30 years of clinical experience, came to work at the Nizhneserginsk CRH. She saw how Alisa Tepikina was being taken from the delivery room to the intensive care unit, and decided to examine her herself.
Medvedeva threw back the sheet - and immediately saw an inverted uterus between her legs. According to the representative of the victims Boris Chentsov, all the witnesses describe further events in the same way.
But Medvedeva did not listen: she, who herself worked as a gynecologist in the past, understood that inversion of the uterus is always accompanied by massive blood loss. And she demanded to immediately start Tepikina's blood transfusion.
Transfusion into two veins started at 08:00, 2 hours 10 minutes after delivery. And at 08:10 Alice's heart stopped. There were several doctors around the functional bed on which Alice lay - and they immediately began cardiopulmonary resuscitation. Three minutes later, the patient was able to withdraw from the state of clinical death.
At 08:30, a team from the territorial center of disaster medicine arrived from Yekaterinburg to Nizhneserginskaya CRH. When examining the patient, they found a complete inversion of the uterus and blood-soaked swaddling under it. To the clarifying question of doctors "what is this?" Malikova replied: "I have not seen that."
Which, however, contradicts the testimony of both the head of the intensive care unit Medvedeva and other witnesses. According to Oleg Patsuk, an obstetrician-gynecologist (more than 25 years of work experience), Alisa Tepikina's blood loss at that moment was about four liters.
Later, he will tell colleagues that he was a little mistaken: the true blood loss was slightly less. First, Patsuk separated the placenta - it came off in one piece and with little effort. After that, it was not possible to correct the uterus: in the end it had to be removed.
At 11:10, Alisa Tepikina's heart stopped again - but it was restarted. At about 16:00 an ambulance helicopter flew in from Yekaterinburg, but Tepikina's condition deteriorated sharply, and the doctors refused to transport because of the threat to the life of the young woman.
Alice's relatives were told about the problems with her only at about seven o'clock in the morning on February 27, and they immediately rushed to the hospital. After a long wait, the head of the intensive care unit Medvedev came out to them, who said that the condition of the young mother was very difficult. She noted that for 30 years of work, she had not seen anything like it. Tepikina's parents became ill, they both received help. And Alice's husband managed to get into intensive care.
Alisa Tepikina's heart finally stopped on February 27 at about 11:20. During the autopsy, pathologists named the cause of the woman's death to shock of mixed genesis against the background of complete exsanguination. A concomitant diagnosis is complete inversion of the uterus. The girl born to Alice turned out to be completely healthy and, according to the doctors, completely full-term.
Nizhnye Sergi is a small town. Everyone quickly became aware of serious problems in childbirth, and they started talking about the quality of medicine on social networks. And in the center of attention of the townspeople was the doctor Anna Malikova.
She was born in 1991. From 2008 to 2016 she studied at the Ural Medical Academy, in 2017 she graduated from residency in the specialty "obstetrics and gynecology". Since September 2017, Malikova was assigned to the Nizhneserginsk hospital for distribution, that is, at the time of the tragedy, her medical experience was less than two years.
However, despite this, since the summer of 2018, Malikova has been acting as the head of the obstetric and gynecological department. Since March 2018, she also got a job at the Pervouralsk Perinatal Center.
A criminal case was initiated on March 19, 2019 based on the statements of Alisa Tepikina's relatives. The autopsy, which was carried out by the pathologist of the Nizhneserginsk hospital, raises many questions for any more or less competent specialist.
The very first and most important - why was there originally a pathological and anatomical, and not a forensic autopsy? According to the law, a forensic expert must open any suspicions of illegal actions.
The guiding diagnosis is: "Spontaneous inversion of the uterus." The pathologist, having examined the materials, removes the word "spontaneous" and fixes the anemia of all organs, that is, hemorrhagic shock.
It should be especially noted that in the first studies there are no signs of dysplasia (pathology) of connective tissue, which will appear much later as the main cause of the tragedy. True, where they come from is not clear.
In addition, later a certain genetic predisposition of the woman in labor to eversion of the uterus will emerge - allegedly her grandmother had a similar situation during childbirth. During the investigation and trial, this is completely refuted, but at the time of the analysis of the case at the regional level, the main emphasis will be placed on this false information.
Many doctors of the Sverdlovsk region speak about serious pressure from the regional minister of health and concurrently the head of the regional medical chamber Andrey Karlov.
Many experts say that if there is a suspicion of a medical error, the Ministry of Health begins to receive instructions. Some admit that they sign the protocols of medical commissions, although they themselves did not take part in the meetings.
It is interesting that in the materials on the case of Dr. Malikova there is a court order on the seizure of medical records in the Nizhneserginsk hospital. As a rule, the chief doctor himself gives out all the materials at the request of the investigation, but in this case they had to go to court. This in itself is weird. For this reason, a forensic medical examination was assigned to another region - to Khanty-Mansiysk.
The conclusion of the experts from Khanty-Mansiysk is unambiguous: Alisa Tepikina did not have spontaneous eversion of the uterus. But in her case, traction (stretching) took place, committed by the doctor in the third stage of labor, and with a gross violation of the order of manipulation - the doctor did not hold the uterus through the anterior abdominal wall.
But in Khanty-Mansiysk, one negligence was made: the anesthesiologist-resuscitator was not included in the expert commission. Malikova's defense was hooked on this and demanded to appoint a new examination - in the Sverdlovsk region.
The new examination came to exactly the opposite conclusions: according to its data, the cause of Alisa Tepikina's death was a short umbilical cord, connective tissue dysplasia (without emphasis on histology data) and "partially present signs of placental separation."
Experts from Khanty-Mansiysk, who studied all the materials of the criminal case, say: the signs of the separation of the afterbirth of Schroeder, Alfred and Klein described in the history of childbirth at 05:55 could not really be. The reason is that at 08:30 the placenta was found outside the vulvar ring, fully attached to the inverted uterus.
There is both documentary evidence and testimony of several witnesses. To which the experts from Sverdlovsk answer: we studied only the documents presented and come to the conclusion that Tepikina's signs of Alfred and Klein could be observed when examined at 05:55, and the definition of Schroeder's sign in its classical form is doubtful.
At the same time, the Sverdlovsk experts do not explain how signs of separation of the placenta could appear if it did not separate.
However, it was their conclusions that were adopted by the defense of Anna Malikova: all versions of the lawyers justifying their client revolved around the pathology of the pregnant woman. Meanwhile, according to the investigation, Malikova is not to blame for the fact that Alisa Tepikina had an eversion of the uterus, but for the fact that she really did nothing to reposition it.
No corpus delicti was revealed in the actions of Anna Malikova, and, as the court found, no one was to blame for the death of Alisa Telikina, except her - she just had to go to another hospital. The parents of the deceased woman have already announced that they will appeal this sentence as unfair. The regional Ministry of Health declined to comment.
