Fetal Extrusion Research Articles

Early Evidence of Post-Mortem Fetal Extrusion in Equids: A Case from the Western Zhou Period (1045-771 BC) Site of Yaoheyuan in Northwestern China.

Post-mortem fetal extrusion, also known as "coffin birth", refers to the phenomenon where a fetus is pushed out of a deceased female due to pressure from decomposing gas in the abdominal cavity. While post-mortem fetal extrusion has been documented in humans at several archaeological sites, there are few reports of it occurring in non-human animals. In this study, we present a case of post-mortem fetal extrusion in equids observed in a chariot-horse pit (CMK2) at the Western Zhou period site of Yaoheyuan in northwestern China, dating to the early first millennium BC. This specific pit, one of four excavated at the site, contained at least 29 horses and 3 wooden chariots. Most of these horses were young adults aged between 4 and 12 years. Out of the 22 horses with sex estimates, 21 were males. Among these individuals, one adult female horse (Horse 6) and one infantile horse (Horse 10) were of particular importance. Based on the age-at-death, sex, and head orientation of the two individuals, alongside their spatial relationships, it is highly likely that Horse 6 was the fetus of Horse 10 and was extruded in the pit. According to the parturition stage of Horse 10, Horse 6 was likely interred in CMK2 in late spring or early summer of the year, during which the relatively high temperature may have generated gas that led to the extrusion of the fetus. Although the specific reason for the inclusion of a pregnant mare in a chariot-horse pit at Yaoheyuan remains a topic for future research, this case marks the first report of post-mortem fetal extrusion in archaeological horses. The findings offer insights into the timing of horse interment as part of ritual practices among the settled elites during the Bronze Age in China and provide valuable reference data for contemporary equine veterinary science.

Possible case of partial postmortem fetal extrusion: Preliminary observations on the mummified remains of a turn‐of‐the‐19th‐century noblewoman in Finland

AbstractWe report a plausible case of partial postmortem fetal extrusion dating to the turn of the 19th century. A fetal skull protruded from the obstetric canal of the partially mummified remains of an adult woman buried in a private burial chapel in Vihti, South Finland. The fetal size implies the mother having died during the early third trimester of her pregnancy. The cause of death was not obvious from the limited external examination of her remains, but the underdeveloped state of the fetal remains renders it unlikely that this case represents a maternal death resulting from dystocia. Rather, the finding should be interpreted as a case of partial postmortem fetal extrusion, a process probably interrupted by decelerated decomposition of the maternal remains before full expulsion of the fetus.

Ten years of uterine rupture in an Australian tertiary hospital

Complete uterine rupture is a rare and serious complication of pregnancy. Although most commonly associated with attempted vaginal birth after caesarean (VBAC), rupture also occurs in atypical/non-VBAC cases. This retrospective, single-tertiary-institution observational study aimed to assess the prevalence and morbidity of complete uterine rupture during 2010-2020. Hospital discharge codes and local maternity databases identified uterine rupture cases, with medical record reviews confirming the diagnosis, distinguishing complete rupture from dehiscence, and extracting additional data. VBAC attempt was defined as planned labour trial after one prior caesarean. Over the decade, 27 complete ruptures occurred among 58614 women, a rate of 4.6 per 10000 births. One woman with three successive fundal ruptures had only the first included in further analysis, leaving 25 discrete women; 19 ruptures occurred in term planned VBAC attempts and six in preterm atypical/non-VBAC cases (two nulliparas and four women with multiple prior caesareans). The VBAC-attempt rupture rate was 0.74%, similar to published reports. All five perinatal deaths occurred in preterm atypical/non-VBAC cases. In the term VBAC-attempt group, rupture-related perinatal morbidity included four cases (21%) of hypoxic-ischaemic encephalopathy, with two cases (11%) of cerebral palsy at follow-up. Overall, perinatal morbidity was highest with total fetal extrusion. Maternal blood loss ≥1500mL or transfusion was almost threefold higher, and postnatal length-of-stay was three days longer, after vaginal than caesarean birth, with delay in rupture recognition being a factor. A high suspicion index for uterine rupture is imperative during any labour, particularly in the scarred uterus, with vigilance continuing after successful vaginal birth.

Maternal–fetal death in medieval Pieve di Pava (central Italy, 10th–12th century AD)

AbstractDespite the assumed elevated rates of young female mortality in ancient times, likely associated with pregnancy and childbirth risks, evidence of maternal–fetal deaths is surprisingly scarce in the osteoarchaeological record. Archaeological excavations conducted in the medieval rural cemetery of Pieve di Pava (Tuscany, central Italy) brought to light the burials of four young females deceased with fetuses. This research aims to reconstruct the osteobiographies of these mothers and the unborn children in order to investigate potential complications that may have played a role in their death. In this context, a paleopathological analysis of the female individuals was performed along with the examination of fetal position and the assessment of gestational age (GA) to explore potential links to obstetrical deaths. The spatial association of the mother and the fetus suggests a death during the later stages of pregnancy or childbirth for the two individuals T. 71 and US 8432; moreover, the position of her preterm 8‐month fetus, found between her legs of the latter, might be consistent with a case of postmortem fetal extrusion, a phenomenon that is rarely observed in osteoarchaeology. According to the same analytical criteria, two other females (T. 99 and US 8941), with an eight/nine‐month and a six‐month fetus respectively, reasonably died during pregnancy.The study of these cases from medieval Italy contributes to current interpretations of maternal–fetal death in the past, providing insights into the health status of young females and the risks they may have faced during pregnancy and childbirth.

Post mortem fetal extrusion: Analysis of a coffin birth case from an Early Medieval cemetery along the Via Francigena in Tuscany (Italy)

Death was a common factor during pregnancy and childbirth in both past and recent societies. Nevertheless, the recording of women from archaeological contexts still featuring a fetus in the pelvic cavity or dystocia is very rare. Even less frequent are cases of post mortem fetal extrusion.At the archaeological site of San Genesio (San Miniato, Pisa), a stoppage point along the Via Francigena, the cemetery phases dating from the 6th to the 13th century were investigated. In one of the phases dating to the Early Medieval period, the skeleton of a female individual of about thirty years of age, deceased during the 32nd week of pregnancy, was documented. The fetus was positioned between the femurs, in the opposite orientation to that of the mother. Taphonomic analysis, comparative review of other forensic and archaeological cases and the anthropological study of the recorded skeletons suggest that, due to the accumulation of gas during the emphysematous phase of decomposition, the fetus would have been expelled from the mother’s pelvic cavity before the bodies were completely covered by soil. We can define this finding as one of those rare cases of “coffin birth” in an archaeological context.

Infant outcome after complete uterine rupture

Complete uterine rupture is a rare peripartum complication often associated with a catastrophic outcome for both mother and child. However, little has been written based on large data sets about maternal and infant outcome after complete ruptures. This is partly due to the rarity of the event and the serious maternal and infant outcome; it is also partly due to the use of international diagnostic codes that do not differentiate between the less catastrophic partial rupture and more catastrophic complete uterine rupture. As uterine rupture is expected to increase due to increased cesarean delivery rates worldwide, it is important to know more completely about the outcome following complete uterine rupture. We sought to explore risk factors associated with poor infant outcome in cases of complete uterine rupture. This population-based study used data from the Medical Birth Registry of Norway, the Patient Administration System, and medical records. We included births with complete uterine rupture after start of labor in all maternity units in Norway during the period 1967 through 2008 (n= 244 births), identified among 2,455,797 births. Uterine ruptures were identified and further studied through a review of medical records. We estimated the associations between infant outcomes and demographic and labor risk factors using logistic regression analyses. Odds ratios with 95% confidence intervals for each risk factor were determined after adjustment for demographic factors and period of birth. The main outcome measure was infant outcome: healthy infant, intrapartum/infant deaths, hypoxic ischemic encephalopathy, and admission to the neonatal intensive care unit. We identified 109 (44.7%) healthy infants, 56 (23.0%) infants needing neonatal intensive care unit admission, 64 (26.2%) intrapartum/infant deaths, and 15 (6.1%) infants with hypoxic ischemic encephalopathy. The highest number of intrapartum/infant deaths occurred in 1967 through 1977 (51.6%) and the fewest in 2000 through 2008 (15.0%). Unscarred uterine ruptures did not significantly increase intrapartum/infant deaths compared to scarred uterine ruptures. Placental separation and/or fetal extrusion had the highest odds ratio for intrapartum/infant deaths (odds ratio, 17.9; 95% confidence interval, 7.5-42.4). Time-to-delivery interval <20 minutes resulted in fewest intrapartum/infant deaths (9.9%), although there were 2 deaths at 10-minute interval. Time to delivery >30 minutes vs <20 minutes increased risk of death (odds ratio, 16.7; 95% confidence interval, 6.4-43.5). Intrapartum/infant death after complete uterine rupture decreased significantly over the decades. Time to delivery >30 minutes and placental separation and/or fetal extrusion had the highest association with intrapartum/infant deaths after complete uterine rupture. Time to delivery <20 minutes limited the incidence of intrapartum/infant deaths.

Neurosurgery on a Pregnant Woman with Post Mortem Fetal Extrusion: An Unusual Case from Medieval Italy.

Trepanation is one of the most ancient and applied surgical treatments; several archaeologically documented cases are known, dated back from prehistory to the Middle Ages. This case study reports the anthropologic analysis of the skeletal remains of a young medieval woman and a fetus (Imola, Italy). The fetal remains were laid between her pelvis and lower limbs. A perforating injury was observed to her frontal bone. After assessing biologic profiles, we attempted to interpret the injury and to reconstruct possible circumstances of death. The lesion seems commensurate with a surgical intervention; signs of an osteogenic reaction were detected at its edges. It can be hypothesized that the survival of the woman undergoing the surgery was approximately 1 week and the fetus extruded after the burial. Thus, this case represents a unicum, spreading more light on the history of neurosurgery during the Early Middle Ages in Europe.

Comparison of the Outcomes of Traditional and Mis-gav-Ladach Techniques in Caesarean Section

Caesarean section is the most common surgical procedure in obstetrics, and its application is rising in the entire world. The aim of the present study was to compare the outcomes of traditional and Misgav-Ladach techniques in caesarean section. This randomized clinical trial study was conducted on 186 cases of primary elective and emergency C-Section over 37 weeks of gestation in Imam Reza Hospital in 2010. The pregnant women were randomized into two groups: 1.traditional 2. Misgav-Ladach. Both groups were similar in terms of age and BMI. The major outcomes were studied duration of surgery, such as fetal extrusion time, blood loss during surgery, need for blood transfusion and analgesics, duration of bowel function restoration, persistent fever after surgery, use of antibiotics, endometritis and wound complications. Kolmogorov-Smirnov (KS) test was used to evaluation of the normality of quantitative data. Variables with normal distribution were analyzed by using parametric test (independent t-test) and Variables with non-normal distribution were analyzed by using non-parametric (Man withny - U test). Chi-square and Fisher's test were used to determine the relationship between qualitative variables. The Misgav-Ladach group had significantly smaller duration of surgery, fetal extrusion time, antibiotics use, and length of hos- pital stay after surgery compared to the traditional group. This study showed that Misgav-Ladach technique can be used as a substitute for traditional methods in cases of elective or emergency C-Section.

Diagnosis of Uterine Rupture with Ultrasound: An Unusual Presentation with Extrusion of Fetus into the Broad Ligament at Second Trimester

We describe an unusual case of uterine rupture caused by intra-amniotic ethacridine used for second trimester pregnancy termination. Ultrasound revealed no amniotic sac or fetal parts in the uterine cavity; instead, major parts of the dead fetus enclosed by membranous demarcation were found expulsed to the left side of the uterus. This membranous structure enclosing products of conception on one side of the uterus was detected by ultrasound and turned out to be the broad ligament. Uterine rupture was confirmed at surgery, and the fetus was expelled into the broad ligament through the lateral wall. The ultrasound findings may help to confirm this rare type of uterine rupture.

Prelabor uterine rupture and extrusion of fetus with intact amniotic membranes: a case report

Abstract Introduction: The increasing rate of cesarean sections is an important issue globally, especially in developed countries. During the last decade, despite decreasing rates of vaginal delivery attempts after a previous cesarean section, the risk of uterine rupture has remained. Uterine rupture is a significant and catastrophic obstetric complication associated with maternal and fetal morbidity and mortality. We report here a very rare case of prelabor uterine rupture with intact membranes. Case report: A 28-year-old, gravida 3, para 2 Turkish woman was referred to our emergency unit at 34 weeks’ gestation because of the absence of fetal movements and abdominal pain. She had had a vaginal birth in 2007 and a cesarean section in 2009. In the delivery room, the fetal extremities were palpated at the abdominal wall, and an ultrasonography revealed ruptured uterus and fetal death. A midline laparotomy was carried out to open the peritoneal cavity. An intact amniotic sac with fetus was observed in the abdominal cavity, and the uterus was also observed to be ruptured. The male fetus, weighing 2500 g, was dead. The rupture was extending from the left lateral side of cervix to the fundus. The tear was repaired by primarily suturing the uterus in two layers after ligation of the left uterine artery to control hemorrhage. The total estimated blood loss was about 1300 mL. The patient received two units of blood transfusion during the operation. In the 4th postoperative day, the patient was discharged. Conclusion: Complete uterine rupture is a rare but catastrophic event, and if diagnosed late, can result in mortality. Uterine rupture is rare during a trial of vaginal labor in a patient with a history of cesarean section; it is much rarer to occur before any trial of vaginal labor in such a patient. If a patient with a history of cesarean section, especially with an unknown type of incision, presents with complaints of abdominal tenderness or vaginal bleeding in the 3rd trimester, the possibility of complete uterine rupture must be considered.

Postmortem fetal extrusion in a case of maternal heroin intoxication.

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.

Extrusion of fetus into the abdominal cavity following complete rupture of uterus: a case report

A gravida 10 para 9, after one Cesarean section (CS) followed by four vaginal deliveries was admitted at term without uterine contractions complaining of abdominal pain. The type of uterine scar was unknown. Severe bradycardia was observed at admission and an emergency Cesarean section was performed. A complete uterine rupture was revealed, the fetus in intact membranes and placenta were found in the abdominal cavity.

Neonatal morbidity associated with uterine rupture: What are the risk factors?

Objective: The purpose of this study was to evaluate factors associated with severe metabolic acidosis or death in a situation of uterine rupture. Study Design: A retrospective study was performed with review of charts and electronic monitoring strips. Results: Between November 1988 and November 2000, a total of 23 cases of complete uterine rupture were identified from among 2233 trials of labor after a previous low transverse cesarean delivery. Nine neonates (39.1%) had severe metabolic acidosis (pH < 7.0); among these, hypoxic-ischemic encephalopathy was diagnosed in 3 neonates and another neonate died. Placental or fetal extrusion or both were associated with severe metabolic acidosis (P <.001) but not with the other factors (birth weight, induction of labor, use of oxytocin, use of epidural, and cervix dilatation). Two newborns with severe acidosis had impaired motor development even with an intervention time less than 18 minutes from the onset of prolonged deceleration to delivery. Conclusion: When uterine rupture occurs, placental or fetal extrusion was the most important factor associated with severe metabolic acidosis. Prompt intervention did not always prevent severe metabolic acidosis and neonatal morbidity. (Am J Obstet Gynecol 2002;186:311-4.)

Trial of labor after cesarean delivery with a lower-segment, vertical uterine incision: Is it safe?

Objective: Our purpose was to assess maternal and perinatal outcomes associated with a trial of labor and attempted vaginal birth after prior low-segment vertical cesarian delivery. Study design: During a 10-year period in a single tertiary hospital, all patients with a prior low-segment uterine incision (whether vertical or transverse) were considered candidates for a trial of labor in the absence of other contraindications or patient refusal. Among the 1137 women who underwent low-segment vertial cesarean delivery, 262 were subsequently delivered of 322 live-born infants, and 174 (54%) of them were identified retrospectively as having attempted vaginal birth. The maternal and perinatal outcomes of patients who did or did not undergo a trial of labor were analyzed and compared. Results: No significant differences between the two patient groups were observed regarding demographic characteristics, antepartum complications, gestational age at delivery (mean 37.4 weeks), birth weight, and cord pH at delivery. Vaginal delivery was accomplished successfully in 144 of 174 (83%) patients who underwent a trial of labor. Abdominal delivery was necessary for 17 mothers with labor disorders and 13 with suspected fetal distress. Postpartum hemorrhage occurred more often in the trial of labor group ( 7 174 [4.0%] vs 2 148 [1.4%], p not significant), but endometritis developed significantly more often in patients with elective repeat cesarean delivery (16.9% vs 6.3%, p - 0.006)/ Rupture of the low-segment vertical cesarean group scar occurred in 2 patients during a trial of labor (1.1%) versus none in the elective repeat cesarean group. Neither mother experienced fetal extrusion or adverse maternal or fetal sequelae. Frequency of serious neonatal complications (8.1% vs 10%) and neonatal mortality (1.7% vs 2.0%) were similar between groups. All neonatal deaths were a result of extreme prematurity or congenital anomalies. Conclusions: Our experience indicates that a mother with a prior low-segment vertical cesarean delivery can undertake a trial of labor with relative maternal-perinata safety. The likelihood of successful outcome and the incidence of complications are comparable to those of published experience with a trial of labor after a previous low-segment transverse incision.

Uterine rupture after previous cesarean delivery: Maternal and fetal consequences

The purpose of this study was to identify the risk factors associated with overt, catastrophic uterine rupture and to report maternal and neonatal outcomes. The associated elapsed time window for delivery of an uncompromised neonate was also investigated. A retrospective study with review of charts and monitor strips was performed. Between Jan. 1, 1983, and June 30, 1992, there were 106 cases of uterine rupture at our institution. Of these, seven charts were incomplete and excluded; of the remainder, 28 patients had complete, 13 patients had partial, and 58 patients had no fetal extrusion into the maternal abdomen. Maternal characteristics or intrapartum events were not predictive of the catastrophic extent of uterine rupture. There was one maternal death. Complete fetal extrusion was associated with a higher incidence of perinatal mortality and morbidity. Significant neonatal morbidity occurred when > or = 18 minutes elapsed between the onset of prolonged deceleration and delivery. Neonatal and maternal complications in uterine rupture with complete fetal extrusion were low with prompt intervention.