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.

Analysis of toxicological findings related to immunofluorescence investigations.

Background: The subject of this article is the role of forensic toxicology in post-mortem examinations using immunofluorescence methods, its implications and its role in providing conclusive evidence for both criminal and civil proceedings. The aim of the study is to verify the correlation between the mode of death and the ingestion of exogenous substances and, if positive, to identify the category of substances ingested and assess their role in the cause of death. Materials and methods: A laboratory study was carried out, consisting of several phases: pre-analytical phase; analytical phase; post-analytical phase. The variables analyzed were sex, cause of death, age. Abused substances tested: amphetamines, methamphetamines, barbiturates, benzodiazepines, cocaine, methadone, opiates, tricyclic antidepressants, delta-9-tetrahydrocannabinol (cannabis), alcohol. Conclusions: Retrospective analysis was performed on a total sample of 55 cases. The most relevant data emerged: cocaine with an incidence of 7.3% (4 cases out of 55), amphetamines with 5.4% (3 cases in total). The results of the screening tests were then subjected to confirmatory tests. There is an association between the use of certain exogenous substances and an increased risk of certain causes of death, such as overdose, traffic accidents, cardiovascular deaths, etc. This paper has highlighted the possibility of using first level immunological tests, such as immunofluorescence, to provide preliminary answers to the judicial authority immediately after autopsy, and a quantitative deepening with further second level tests, such as gas chromatography, as a gold standard to determine the cause of death.

The artificial intelligence in autopsy and crime scene analysis.

Background: In the evolving field of forensic medicine, artificial intelligence (AI) technologies may revolutionize traditional autopsy practices by enhancing the precision and efficiency of postmortem examinations. Methods: A review of the literature was carried out on the Pub-med and Scopus search engines by inserting the keywords "artificial intelligence" AND "forensic" AND ("autopsy" OR "crime scene management" OR "forensic odontology" OR "post mortem interval" OR "forensic anthropology" OR "forensic sciences"). The works that analyzed the applications of artificial intelligence in the forensic and autopsy field were analyzed. Conclusion: The results showed the application of different forms of artificial intelligence such as machine learning, deep learning, robotics, artificial neural networks. Various applications are therefore possible in the autopsy field including forensic identification, analysis of radiological data through Virtopsy, estimation of the weapon used through analysis of firearm damage with ballistics, estimation of the Post-Mortem Interval (PMI), forensic toxicology. AI's potential to aid in the precise identification of causes of death, estimation of postmortem intervals. With forensic pathologists facing the constant challenge of making accurate diagnoses under pressure, AI applications can offer much-needed support by reducing subjective judgment and the inherent human error due to fatigue. Therefore, the integration of AI into autopsies, while promising in terms of efficiency and accuracy, demands a careful balance between technological advancement and ethical responsibility to ensure trust and integrity in forensic practices.