Lethal intrauterine fetal trauma

Eight cases of lethal intrauterine fetal trauma secondary to motor vehicle accidents are retrospectively studied. In each instance the mother survived, usually sustaining only minor injuries. Some degree of placental abruption or infarction occurred in each case, but fetal abnormalities were more varied. Significant fetal injuries were limited to the head and included two instances of skull fracture associated with cortical lacerations and contusions. Six of the eight fetuses were stillborn, and the other two died during the first postnatal day. At least five of the mothers were unrestrained at the time of the accident, three of whom experienced abdominal impact against the steering wheel but no external abdominal injuries. Although two mothers were wearing seat belts, in only one instance could the seat belt be implicated in contributing to the fetal injury. This study shows that lethal placental or direct fetal injury can occur even though maternal injuries are minor or insignificant. The findings also support current recommendations for use of three-point restraints.