Atypical gunshot wounds resulting in fetal death: two rare case reports

Gunshot wounds (GSW) pose serious risks to both mother and fetus. Determining the trajectory and cause of death in the fetus in GSW is of forensic importance. This study aims to contribute to the literature with two rare GSW cases leading to fetal death through different mechanisms.

Two cases of pregnant women exposed to firearm violence were analyzed. In the first case, the fetus sustained 3 GSWs. Autopsy findings revealed fatal organ injuries and fractures. The trajectory was reconstructed using characteristic bone fragments on the ribs, confirming the path from front to back and top to bottom. The cause of fetal death was direct GSW. In the second case, the bullet entered the mother's back, causing fatal vascular and visceral injuries. Although the fetus sustained a non-lethal GSW to the posterior chest wall, fetal death was secondary to maternal death and impaired uteroplacental blood flow.

Fetal outcomes in firearm injuries are dictated by gestational age, fetal presentation, and the bullet's trajectory. These cases demonstrate that while the hypertrophic uterus can act as a protective barrier for the mother by dissipating kinetic energy, it often fails to protect the fetus as gestational age increases. Furthermore, our findings underscore the diagnostic importance of fetal bone defects in reconstructing ballistic trajectories. These rare instances highlight that fetal death can occur either through direct trauma or secondary to maternal hemodynamic collapse, necessitating a meticulous multidisciplinary forensic approach.