An intrauterine fetal death alleged as medical negligence: an autopsy-based case report

Abstract

Adverse events during the pregnancy deter the mother’s health and raise questions regarding the country’sexistent healthcare. India is among the few nations responsible for two-thirds of all intrauterine fatalitiesworldwide. Intrauterine deaths risk medical negligence lawsuits by the aggrieved family members againstthe treating doctors and the hospital authorities. Fetal autopsy forms a valuable audit of clinical care, enableslearning about such adverse pregnancy outcomes, and assists in administering justice in medical lawsuits. Wediscuss a case of a 30-year-old pregnant female at 38 weeks +1 day of gestation. She was reported to a hospitalwith lower abdominal pain. Per abdomen examination, fetal heart sound was reported to be present, and shewas sent home. She presented with complaints of lower abdominal pain, rupture of membrane, and loss offetal movements the next day and was diagnosed as intrauterine fetal death. The family members alleged it asmedical negligence, and the fetus was sent for a medicolegal autopsy. During the autopsy, skin desquamation ofabout 75% of the total body surface area was present. The umbilical cord stump was dark reddish brown colored.Overriding of the cranial bones was noted. The diaphragm was present at the level of the 4th rib. The lungs werenon-crepitant and had liver-like consistency. Hydrostatic and stomach-bowel tests were negative. Cut sectionsof the lower end of the femur, the upper end of the tibia, and the body of the sternum, calcaneum, and talusshowed the appearance of the ossification centers. Medicolegal autopsy helped answer the investigating officer’squestions and establish fetal age, time since intrauterine death, and whether the fetus was live or dead born.