Utility of fetal autopsy findings to estimate time of intrauterine fetal demise in maternal trauma

Abstract

Forensic pathologists determine cause and manner of death in sudden and unexpected deaths. Fetal autopsies can be challenging because they are rare, fetal death can occur in the context of maternal injuries, and examination findings are usually affected by postmortem changes. We present a case involving a 26 week gestational age fetus with intrauterine demise in the context of maternal assault. In the assault, the assailant compressed the abdomen of the mother while striking her. The fetus was determined to be dead by ultrasound after the mother arrived at a hospital. The fetus was delivered by induction the following day. Examination of the fetus showed mild maceration, and microscopic examination of various organs showed findings compatible with a fetal death of no more than 48 h prior to delivery. Taking the circumstances, gross findings, and microscopic findings into account, the cause of death was determined to be the result of compression of the mother’s abdomen during the assault. This case highlights the importance of accurate timing of intrauterine fetal demise particularly as it relates to maternal trauma.

Keywords

• Intrauterine fetal demise
• Fetal death
• Timing of fetal demise
• Intrauterine retention time
• Maternal assault