Postmortem fetal extrusion in a case of maternal heroin intoxication

Friedrich Schulz, Klaus Püschel, Michael Tsokos

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.