Postmortem Fetal Extrusion in a Case of Maternal Heroin Intoxication

Abstract

A 34-year-old heroin addict in the eighth month of pregnancy was found dead in her apartment. The head of a fetus was partly protruding from underneath the woman's slip. At the time of autopsy, the body was in a state of advanced putrefaction with greenish discoloration of almost the complete body surface showing pronounced marbling and, in addition, now not only the head but also the upper part of the chest of a dead fetus were extruding from the birth canal with head presentation. Autopsy showed no signs of external violence prior to death and, in particular, no indication of preceding manipulations in the region of the obstetrical canal and the uterus could be detected. The uterine cavity showed pronounced putrefactive alterations with the amniotic membranes being partially raised and bloated in a balloon-like fashion. Toxicological analyses revealed acute heroin intoxication of mother and child. The immature neonate showed no signs of live birth. Pathogenetically, the finding of not only the head but also the upper part of the chest of the fetus extruding from the birth canal at the time of autopsy (contrary to the observation made at the death scene that only part of the head of the fetus was protruding) is consistent with post-mortem fetal extrusion caused by putrefactive gas pressure against the pregnant uterus as reported in the earlier German forensic pathological literature.

Reconsidering obstetric death and female fertility in Anglo-Saxon England

“…Coffin births have been described in modern forensic cases but not as the result of decomposition (Schulz, Püschel and Tsokos 2005). For example, in one fire-related death a foetus was found outside the mother's body, reportedly caused by the initial heating and subsequent shrinking of the uterine wall (Vennemann et al 2008).…”

“…For example, in one fire-related death a foetus was found outside the mother's body, reportedly caused by the initial heating and subsequent shrinking of the uterine wall (Vennemann et al 2008). Another case of coffin birth involved foetal expulsion after heroin overdose; labour had onset so the foetus was head down (Schulz, Püschel and Tsokos 2005;Vennemann et al 2008). In this case the heroin may have induced the early stages of labour.…”

Expulsión fetal postmortem

“…El hallazgo ocasional de los cuerpos de la madre y del feto por separado llevó a la creencia de que tal fenómeno se producía en mujeres embarazadas aparentemente muertas que habían sido enterradas vivas o bien habían sido víctimas de una mala actuación médica u obsté-trica o, incluso, que habían fallecido mientras le practicaban un aborto voluntario [1].…”

“…En la actualidad, cuando la cesárea postmortem está erradicada, podemos encontrar en la literatura algunos casos de "expulsión fetal postmortem" como el que presentamos en este artícu-lo, aunque son anecdóticos [1,5]. El "parto postmortem" se define como la expulsión de un feto muerto tras el fallecimiento de una mujer embarazada o parturienta, cuando el útero materno muestra claros signos de putrefacción [1].…”

“…El "parto postmortem" se define como la expulsión de un feto muerto tras el fallecimiento de una mujer embarazada o parturienta, cuando el útero materno muestra claros signos de putrefacción [1]. Se considera que los gases generados en la fase enfisematosa de la putrefacción cadavérica dentro de la cavidad abdominal, que actúan en estos casos sobre un útero disminuido de consistencia y un feto reducido de tamaño por los efectos propios de la descomposición, pueden prolapsar el útero y causar la expulsión total o parcial del feto detenido en el canal vaginal, o bien, desgarrar la cara anterior del abdomen a nivel de alguna cicatriz quirúrgica antigua que debilite la pared.…”