Traumatic Fetal Decapitation After Spontaneous Abortion: An Extremely Rare Occurrence.

Pregnancy loss before 20 weeks’ gestation without outside intervention is termed spontaneous abortion and may be encountered in as many as 20% of clinically diagnosed pregnancies.1 It is said to be complete when all products of conception are expelled, the uterus is in a contracted state, and the cervix is closed. On the other hand, retention of part of products of conception inside the uterus, cervix, or vagina results in incomplete abortion. Although incomplete spontaneous miscarriages are commonly encountered in early pregnancy,2 traumatic fetal decapitation has not been mentioned in the medical literature as a known complication of spontaneous abortion. We report an extremely rare and unusual case of traumatic fetal decapitation due to self-delivery during spontaneous abortion in a 26-year-old woman who presented at 15 weeks’ gestation with gradually worsening vaginal bleeding and lower abdominal pain and with the fetal head still lying in the uterine cavity. During our search for similar cases, we came across just 1 other case report describing traumatic fetal decapitation after spontaneous abortion,3 although there are reports of fetal decapitation from amniotic band syndrome, vacuum-assisted deliveries, and destructive operations.4–8 A 26-year-old woman, gravida 2, para 0, presented to the emergency department with vaginal bleeding and cramping pain in her lower abdomen, both of which had gradually increased in severity over the previous 2 days. Her pulse and blood pressure were 86 beats per minute and 100/66 mm Hg, respectively, and her respiratory rate was 26 breaths per minute. She had a high-grade fever; her temperature was 103°F (39.4°C), recorded orally. There was suprapubic tenderness on palpation. About 8 or 9 days before presentation, she had severe pain in the lower abdomen, followed by vaginal bleeding. She gave a history of passing brown to black clots, one of which was particularly large, and she had to pull it out herself as if it was stuck. It resembled “an incomplete very small baby” in her own words. Although not sure, she could not make out the head of the “baby,” although she could appreciate the limbs and trunk. Thereafter, the bleeding gradually decreased over the next 2 days, but her lower abdominal pain persisted. However, after 1 day, she again started bleeding, and her pain increased in intensity. Meanwhile she also developed fever. She gave a history of recent cocaine use and alcohol drinking occasionally. No history of smoking was present. According to her last menstrual period, the gestational age was at 15 weeks, and during this pregnancy, she never had a sonographic examination. She reported taking a urine test for pregnancy at home 4 weeks before, which showed positive results. She gave a history of being pregnant 11⁄2 years before. At that time, also, she aborted spontaneously at 9 weeks’ gestation. No complications were seen at that time. She resumed her menses normally after about 2 months and was regular until 3 months back. The patient was referred for emergency sonography, which revealed that the fetal head was lying in the uterine cavity (Figure 1, A and B) along with the presence of fluid/ hemorrhage in the cervix and upper vagina (Figure 1C). No other definite fetal part could be identified. The placenta was also seen in the uterine cavity, and it was upper anterior and fundic (Figure 1D). No free fluid in abdomen was seen. Subsequently after stabilization, the patient underwent dilation and evacuation and had an uneventful postoperative course. As mentioned earlier, traumatic fetal decapitation accompanying spontaneous abortion is a very rare occurrence; we came across only 1 other case3 describing similar findings. Patients presenting to the emergency department with features suggestive of abortion, whether threatened, incomplete, or complete, should be thoroughly evaluated by both pelvic and sonographic examinations to check for any retained products of conception with frequent followups in case of threatened or incomplete abortions.