Domestic violence causing abruptio placenta and feto-maternal death: case report on autopsy

ABSTRACT

A 22 year old primigravida with 28 weeks/7 months pregnancy was brought in police custody 10 hours after her death reported at a Tertiary Care Center, Karachi. There was a history of soft tissues direct abdominal trauma 10 hours back. On complete physical examination there were no external marks of violence except a contusion on her back of 5 cm diameter. The internal examination after opening the uterus, placenta was separated and baby was delivered after opening the amniotic sac. A fresh still birth of male baby with 1.5 kg was delivered. The chemical and histopathology report evidenced that uterus, fallopian tubes and ovaries had decidua with necrotic tissues, edema and congestion. The final opinion after receiving the chemical/histopathology reports on this post mortem was that the death occurred due to fetal hypoxemia developing secondary to maternal shock as a result of direct uterine trauma and disseminated intravascular coagulation [DIC]. DIC develops due to circulating placental products responsible for fetal losses. This case reports fetal hypoxemia developing secondary to maternal shock, maternal hypotension, abruptio placentae, direct uterine trauma and disseminated intravascular coagulation [DIC]