A rare case of maternal foetal death caused by uterine rupture in the placenta accreta.

Background: Fetal death has various causes, among the most common are problems relating to the placenta, such as placental abruption or placental malformations such as placenta accreta. From the literature, it emerges that placental analysis at autopsy can allow for greater resolution of cases compared to clinical history and external examination of the fetus alone. Case Report: We report the case of a woman at the eleventh week of pregnancy who died in hospital. The medical history revealed two further previous pregnancies, both with births by cesarean section. The autopsy identified the cause of maternal death as acute cardiorespiratory arrest secondary to hemorrhagic shock from spontaneous uterine rupture. Hemorrhagic infiltrate was found in the intervillous placental spaces with rupture of the uterus due to placenta previa and accreta. Discussion: Placenta accreta is a condition in which a pathological adherence and/or invasion of the myometrium by the placenta is observed. This condition poses a problem during recovery with potential for severe bleeding. Therefore, we emphasize the macroscopic and histological analysis of the placenta, uterus and the ovaries in all cases of maternal-fetal death, suggesting however that the organs be analyzed both by gross analysis and after permanence in formaldehyde. Furthermore, in these cases, it is important to evaluate the clinical history and data, especially ultrasound scans performed in life, or insertion anomalies during instrumental investigations. For this reason, we recommend to collaborate with a multidisciplinary team in these cases, including the gynecologist and the forensic pathologist.

The role of operative protocols for the prevention of occupational infectious risk on the crime scene.

Background: Crime scenes are possible scenario of accidents for operators, despite those risks the are no operative protocols in literature. However, COVID-19 pandemic has affected in a positive manner the management of infectious risk, encouraging use of Personal protective equipment (PPE). The aim of the study is to deepen and examine the occupational risk of all health professionals involved in the analysis of the crime scene and biological material collection to develop an operational protocol that explains in detail all the strategies applicable to reduce it. Materials and Methods: We conducted a review of the literature researching among the main databases, such as: PUBMED, EMBASE, COCHRANE introducing as keywords: crime scene, medico-legal investigations, occupational risk, infections. Subsequently, we developed an operational protocol that is currently applied during the activity of the Institute of Forensic Medicine "Magna Graecia" of Catanzaro. Conclusion: The crime scene can show numerous dangers for operators, due to the presence of syringes, contaminated biological material or sharps or access to areas with poor hygienic and sanitary conditions. This paper shows various strategies that may be implemented to reduce the risk. The aim of this work is to focus on the occupational risk for operators by proposing an operative protocol showing in detail how to manage a crime scene by reducing the infectious risk for operators until the transfer of the body and the collected evidence to the morgue and to the laboratory.