Fetal death caused by intentional poisoning with Warfarin: a case report

We present a case of intrauterine fetal death resulting from deliberate warfarin administration to a pregnant woman. During the 18th week of gestation, the pregnant woman developed sudden, unexplained ecchymoses on both lower limbs. One week later, obstetric ultrasound confirmed the absence of fetal cardiac activity and movement, and clinical evaluation revealed significantly abnormal coagulation parameters with severely reduced activities of vitamin K-dependent factors FII (96% decrease), FVII (96% decrease), FIX (93% decrease), and FX (93% decrease). Then, labor was induced, leading to delivery of a stillborn fetus. Autopsy of the fetus demonstrated cerebral parenchymal hemorrhage, along with placental and fetal membrane tearing and hemorrhage. Toxicological analysis identified warfarin in maternal blood, urine, and fetal tissue samples, establishing it as the primary cause of fetal death. This report highlights the critical role of comprehensive toxicological and autopsy investigations in determining the etiology of unexpected fetal losses, particularly when maternal coagulopathy of unexplained origin is present.