Unusual diastatic separation of the sagittal suture: Avoiding confusion with inflicted head trauma

Certain artifacts presenting on a fetus due to maceration or birth trauma, mimic inflicted head trauma (IHT) occurring post partum. In such cases, absent a thorough history and examination of the circumstances, the distinction may be impossible. This case report presents an unusual artifact occurring in a stillbirth delivered after the mother had complained of not feeling fetal movements for at least 24 hours. At autopsy, the macerated fetus presented with unusual widening of the sagittal suture and galeal/subgaleal hematomas. There were no other injuries. Review of the mothers antenatal, personal and social history combined with the absence of other injuries to the mother and fetus, helped distinguish the unusual birth-related diastatic separation from IHT. Consequently, in a case where the pathologist is presented with limited information for instance an abandoned fetus, a cautious approach to the determination of the cause and manner of death is strongly recommended.