Schulz Friedrich, Püschel Klaus, Tsokos Michael
Institute of Legal Medicine, University of Hamburg, Butenfeld 34, 22529, Hamburg, Germany.
Forensic Sci Med Pathol. 2005 Dec;1(4):273-6. doi: 10.1385/FSMP:1:4:273.
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.
一名34岁的海洛因成瘾孕妇在怀孕八个月时被发现死于其公寓内。一个胎儿的头部部分从该女子衬裙下方伸出。尸检时，尸体处于高度腐败状态，几乎整个体表呈绿色变色，有明显的大理石花纹，此外，此时不仅胎儿头部，还有死胎胸部的上半部分都以头先露的姿势从产道中挤出。尸检显示生前无外部暴力迹象，特别是未发现产道和子宫区域有先前操作的迹象。子宫腔内有明显的腐败改变，羊膜部分隆起并呈气球样膨胀。毒理学分析显示母婴均有急性海洛因中毒。未成熟的新生儿无活产迹象。从发病机制来看，尸检时发现胎儿不仅头部而且胸部上半部分从产道中挤出（与死亡现场观察到的只有胎儿部分头部突出的情况相反），这与早期德国法医病理学文献中报道的腐败气体对妊娠子宫的压力导致的死后胎儿挤出一致。
