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’s
existent healthcare. India is among the few nations responsible for two-thirds of all intrauterine fatalities
worldwide. Intrauterine deaths risk medical negligence lawsuits by the aggrieved family members against
the treating doctors and the hospital authorities. Fetal autopsy forms a valuable audit of clinical care, enables
learning about such adverse pregnancy outcomes, and assists in administering justice in medical lawsuits. We
discuss a case of a 30-year-old pregnant female at 38 weeks +1 day of gestation. She was reported to a hospital
with lower abdominal pain. Per abdomen examination, fetal heart sound was reported to be present, and she
was sent home. She presented with complaints of lower abdominal pain, rupture of membrane, and loss of
fetal movements the next day and was diagnosed as intrauterine fetal death. The family members alleged it as
medical negligence, and the fetus was sent for a medicolegal autopsy. During the autopsy, skin desquamation of
about 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 were
non-crepitant and had liver-like consistency. Hydrostatic and stomach-bowel tests were negative. Cut sections
of the lower end of the femur, the upper end of the tibia, and the body of the sternum, calcaneum, and talus
showed the appearance of the ossification centers. Medicolegal autopsy helped answer the investigating officer’s
questions and establish fetal age, time since intrauterine death, and whether the fetus was live or dead born.