A case of intrauterine lethal fetal injury after attempted suicide of the mother

Traumatic injuries in pregnancy such as abdominal trauma, pelvic fractures and penetrating trauma are major causes of maternal and neonatal morbidity and mortality. The most common causes of trauma during pregnancy are motor vehicle accidents, falls, assaults, gunshots, and burns. Pregnancy itself has been identified as a risk factor for trauma, together with a younger age, drug use, alcohol use, and domestic violence. We report the case of a 46-year-old woman, 34 weeks pregnant, who attempted suicide by jumping from a flyover, immediately after a probably deliberate traffic collision with the guardrail. She had fractures of five lumbar vertebrae and three ribs with pulmonary contusions, but was without other injuries. Following the mother's stabilization, the fetal heart tones were detected as abnormal and the patient had an emergency caesarean section delivering a still-born male infant. Neither alcohol nor drugs were found in the mother who had been diagnosed with an unspecified episodic mood disorder. She recovered completely from her injuries. At autopsy of the newborn, a massive subarachnoid hemorrhage with deformity of the skull was found, caused by maternal blunt abdominal trauma following car accident and fall. This case is an outstanding example of fetal head trauma which occurred with no life-threatening maternal injury due to attempted suicide. It is important for clinicians and forensic pathologists to have adequate knowledge and practical experience of these cases, because pregnancy is a special risk factor for self-inflicted injuries among females, with significant adverse effects on the fetus even with minor injuries to the mother.