Intrauterine Fetal Death in Gunshot Injury to the Gravid Uterus: Forensic Perspective

Abstract

A 38-week-pregnant woman was brought to the emergency of PGIMER, Chandigarh with history of gunshot injury to abdomen with Intra-uterine fetal death. She underwent surgical intervention within two hours of the incident.

Maternal and Neonatal Outcomes of Gunshot Wounds in Pregnancy: A Systematic Review of Case Reports

“…56 Table 1 demonstrates the results of the appraisal, finding all 41 studies to be detailed enough to be replicated, relevant to contemporary practice, and demonstrate adequately ascertained exposure (GSW) and coprimary outcomes (maternal and/or neonatal death). While 82% (34/41) of studies had adequate follow-up of surviving patient(s) until or beyond discharge, [4][5][6][7][8][12][13][14][15][16][17][18][19][20][23][24][25][27][28][29][30][31][32][33][34][35][36][38][39][40][41][42][43][44] few studies (6/41) with a clear selection method were limited to the case series and small registries in this review. 5,6,11,16,41,43 In the GRADE 57 assessment of our review based on observational studies, our certainty of evidence was downgraded due to risk of selection bias and upgraded as possible confounders not discussed in the studies (comorbidities, obstetric history, socioeconomic status, degree of education, global variation in standards of care, etc.)…”

“…56 Table 1 demonstrates the results of the appraisal, finding all 41 studies to be detailed enough to be replicated, relevant to contemporary practice, and demonstrate adequately ascertained exposure (GSW) and coprimary outcomes (maternal and/or neonatal death). While 82% (34/41) of studies had adequate follow-up of surviving patient(s) until or beyond discharge, 4-8,12-20,23-25,27-36,38-44 few studies (6/41) with a clear selection method were limited to the case series and small registries in this review. 5,6,11,16,41,43…”

“…Labor indications include failed induction of labor, first and second stage arrest of labor. d Five articles 6,7,38,41,44 report the indication for cesarean delivery to be traumatic uterine rupture secondary to the gunshot wound(s). e Four articles report fetal injury, 6 surgical inaccessibility to maternal trauma site, 6 lack of a GSW exit site, 17,20 anticipated delay in the operating room, 23 artificial rupture of membranes, 28 and "cornical presentation" 32 as indications for cesarean delivery.…”

“…GSW, Gunshot Wound(s); NR, Not Reported; NRFHT, Non-reassuring fetal heart tones; Tr Ut, Traumatic Uterine; CD, Cesarean Delivery. a Extremities, Thorax, Head/Neck, Back/Spine, Poly-site, Other/Unknown. b One article 29 reports a patient who delivered spontaneously prior to delivery. c Labor indications include failed induction of labor, first and second stage arrest of labor. d Five articles 6,7,38,41,44 report the indication for cesarean delivery to be traumatic uterine rupture secondary to the gunshot wound(s). e Four articles report fetal injury, 6 surgical inaccessibility to maternal trauma site, 6 lack of a GSW exit site, 17,20 anticipated delay in the operating room, 23 artificial rupture of membranes, 28 and “cornical presentation” 32 as indications for cesarean delivery.…”

“…2,3 The primary literature on maternal and neonatal outcomes of GSW in pregnancy is limited, with most publications consisting of case reports or small case series. 4-44 Several reports 45-49 predate the classification of perimortem cesarean delivery as the primary method of maternal resuscitation. 50…”